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Parkinson's Exam
 
 

Parkinsonism

 
 
 
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Overview

  • Clinical Features

  • Resting tremor
  • Rigidity - leadpipe, cogwheel
  • Akinesia - hypokinesia (small movements), bradykinesia (slow movements)
  • Postural instability - reduced postural reflexes
  • Causes of Parkinsonism

  • Parkinson’s disease - Parkinsonism, anosmia, REM sleep behavioural disturbance, frontal executive dysfunction, depression
  • Parkinson’s Plus Syndromes

  • Progressive supranuclear palsy (PSP) - Parkinsonism with supranuclear downward gaze palsy (inability to look down)
  • Multiple systems atrophy (MSA) - Parkinsonism, autonomic dysfunction, cerebellar involvement and pyramidal signs
  • Dementia with Lewy Bodies (DLB) - Parkinsonism, visual hallucinations, fluctuating cognition
  • Corticobasal degeneration (CBD) - rigidity, dystonia, focal myoclonus, ideomotor apraxia, alien limb syndrome
  • Others

  • Drugs - antipsychotics, metoclopramide, lithium
  • Normal pressure hydrocephalus
  • Hypoxic brain injury
  • Wilson’s disease
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