Parkinson Disease

Parkinson Disease is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Gradual progressive neurologic disorder of middle or late life
  • Degeneration of dopaminergic neurons in the substantia nigra
  • Development of Lewy bodies in the residual dopaminergic neurons
  • Accelerated cortical atrophy
  • Can begin unilaterally, but generalizes to symmetric
  • Affects 1% of people >60 yr; 4% >80 yr
  • May have symptoms 20 yr prior to diagnosis
    • Nonspecific:
      • Fatigue
      • Constipation
      • Hyposomia

Etiology

  • Sporadic or idiopathic
  • Disorders presenting with parkinsonism:
    • Drug induced:
      • Parkinsonism-hyperpyrexia syndrome (dopaminergic drug withdrawal)
      • Amphotericin B
      • Chemotherapeutic drugs
      • Neuroleptic treatment induced
    • Toxins:
      • Carbon monoxide
      • Methanol
      • Cyanide
      • Organophosphate poisoning
      • 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine
    • Brain lesions:
      • Basal ganglia stroke
      • Midbrain lesions
      • Hydrocephalus
    • Infections:
      • Mycoplasma
      • Viral encephalitis
    • Other:
      • Central pontine myelinosis
      • Encephalitis lethargica (autoantibodies against basal ganglia antigens)

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