Investigations

Cards (14)

  • What are the key diagnostic features of PD?
    MUST have bradykinesia, and 1 of the following;
    • rigidity
    • tremor (4 -6 Hz)
    • postural instability
  • What would be shown in a PD examination?
    Bradykinesia
    Resting tremor
    Freezing -> seen during rapid alternating movements & gait examination (esp when turning or in doorways)
    Reduced facial expression
    Parkinsonian gait
    Pull test -> postural instability
    Motor symptoms often present unilaterally, then progress to bilaterally
  • What is a Parkinsonian gait?
    Stooped posture
    Shuffling gait
    Reduced arm swing
  • What would a DaTSCAN look like in someone with PD?
    Period shaped striatum
    Not definitive for PD
  • What is a DaTSCAN?
    Dopamine active transporter scan
    Form of CT -> assesses function of dopamine transporters in brain
    Uses radioactive tracer (iodine 123) -> binds to pre-synaptic dopamine transported in striatum
  • Why would blood tests be done in PD?
    Rule out other conditions
  • What are the differential diagnoses of PD?
    Essential tremor
    Dementia with Lewy bodies
    Vascular Parkinsonism
    Parkinson's plus syndromes
  • How can essential tremor be differentiated from PD?
    Will have postural tremor (tremor when holding a posture)
    No bradykinesia
    No increased tone
    Gait is usually unaffected
  • How can dementia with Lewy bodies be differentiated from PD?
    Will have early severe dementia with disturbances of memory, language or praxis (planning)
    Onset of cognitive symptoms less than 1 year from Parkinsonism (or before)
  • What is dementia with Lewy bodies?
    Dementia caused by Lewy bodies (clumps of protein in brain)
  • What is vascular Parkinsonism?
    Caused by poor blood supply to the brain
  • How can vascular parkinsonism be differentiated from PD?
    Unilateral features after 3 years
    Repeated strokes with stepwise progression
    Will have lower limb predominance
    Respond less well to levodopa
  • What are Parkinson's plus syndromes?
    Group of neurodegenerative diseases similar to PD
  • How can Parkinson's plus syndromes be differentiated from PD?
    Will have cerebellar signs
    Will have early severe dysautonomia (ANS does not work)