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Parkinsonism
A group of neurodegenerative diseases
involving the substantia nigra (an area in the basal ganglia).
Etiology and classification
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1. 1ry idiopathic Parkinsonism
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Parkinson?s disease
Juvenile Parkinsonism |
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2. Secondary (aquired, symptomatic)
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Parkinsonism:
Infectious: post-encephalitic
Drugs: neuroleptics, reserpine, tetrabenazine, lithium, flunarizine,
cinnarizine.
Toxins: ethanol, methanol, CO, Hg.
Vascular: multi-infarct, hypotensive shock.
Trauma: pugilistic encephalopathy.
Other: parathyroid abnormalities, hypothyroidism, hepatocerebral degeneration,
brain tumour, normal pressure hydrocephalus, syringomesenchephalia.
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3. Heredodegenerative Parkinsonism
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Autosomal dominant Lewy body disease.
Huntington?s disease.
Wilson?s disease.
Hallervorden-Spatz disease.
Olivopontocerebellar and spinocerebellar degenerations.
Familial basal ganglia calcification.
Familial Parkinsonism with peripheral neuropathy.
Neuroacanthocytosis. |
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4. Multiple system degeneration
(Parkinsonism plus)
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Progressive supranuclear palsy
Shy-Drager syndrome
Striatonigral degeneration
Parkinsonism ? dementia- ALS complex.
Corticobasal ganglionic degeneration.
Alzheimer?s disease.
Hemi-atrophy Parkinsonism. |
Primary idiopathic Parkinsonism
Parkinson's disease (paralysis agitans):
Affects patient 40-60 years old, of gradual onset, progressive course.
Tremors are more pronounced than rigidity. For more info
click here.
There are other idiopathic (of unknown cause) conditions as
Parkinson's disease that may cause Parkinsonism. In these conditions
the problem is not the deficient production of dopamine but the
inefficient binding of dopamine to its receptors located on globus
pallidus.
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Parkinson-Plus diseases
There are other disorders that are called Parkinson-Plus diseases.
These include Shy-Drager Syndrome (SDS), Progressive Supranuclear Palsy
(PSP) and Olivopontocerebellar Atrophy (OPCA which is also called
Multiple System Atrophy). Patients often begin with typical Parkinson's
disease symptoms and these Parkinson-Plus diseases can only be diagnosed
when other symptoms become apparent after some years. These
Parkinson-Plus diseases usually progress more quickly than the typical
main illness, and the usual anti-Parkinson's medications do not work as
well at controlling symptoms.
Secondary Parkinsonism
Secondary Parkinsonism (or briefly Parkinsonism) is a term used for a
symptom constellation that is similar to that of Parkinson's disease but
is caused by other disorders or medications. Major reasons for secondary
Parkinsonism are stroke, encephalitis, narcotics, toxins and carbon
monoxide poisoning.
Post-encephalitic Parkinsonism
Affects any age, of acute onset ? regressive or stationary course.
The patients presents with both rigidity and tremors equally.
Associated symptoms occulogyric (sudden spasm of conjugate movement mainly
upwards), greasy, sialorrhoea, obesity, impotence / amenorrhea, diabetes
insipidus and pyramidal signs if the cause involves extensive
involvement of the brain tissues.
Atherosclerosis
Affects those over 60 years of gradual onset with remissions and exacerbations.
In atherosclerotic Parkinsonism rigidity is more pronounced than tremors.
This is usually associated with hypertension, diabetes, CHD, pyramidal signs.
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