[10.07c] Common Adult Neurological Diseases and Emergencies (Part 3).pdf

Movement disorder

What is the primary clinical classification of Parkinson’s Disease?

45-70 years

What is the typical range for the age of onset in Parkinson’s Disease?

6th decade

In which decade of life does the incidence of Parkinson’s Disease typically peak?

Males

Which gender is somewhat more commonly affected by Parkinson’s Disease?

Rural areas

In which geographic setting is there an increased incidence of Parkinson’s Disease?

Bradykinesia, Resting tremor, Rigidity, and Postural instability

What are the four cardinal features of Parkinson’s Disease?

Asymmetric

Are the initial symptoms of Parkinson’s Disease typically symmetric or asymmetric?

Hypomimia

What is the term for reduced facial expression in Parkinson’s Disease?

Festination or shuffling gait

What terms describe the characteristic walking pattern of a Parkinson’s patient?

Freezing

What is the term for the sudden inability to move while walking in Parkinson’s Disease?

Froment sign

Which sign is characterized by rigidity that is elicited or enhanced by having the patient engage the opposite limb in a motor task?

Myerson sign

What is the term for the inability to inhibit blinking in response to tapping the bridge of the nose or glabella?

Reduced blinking

What is the general status of blinking in patients with Parkinson’s Disease?

REM sleep disorder

Which non-motor symptom is typically seen in conditions involving the abnormal accumulation of alpha-synuclein?

Lewy bodies

What is the histological hallmark of alpha-synuclein accumulation?

Hyposmia

What is the medical term for a decreased ability to smell in Parkinson’s Disease?

Constipation

What common gastrointestinal symptom is a non-motor feature of Parkinson’s Disease?

10 to 15 percent

What percentage of Parkinson’s patients eventually develop dementia?

Substantia nigra

In which brain structure is the loss of pigmented cells the most constant finding in Parkinson’s Disease?

Dopamine

The loss of pigmented cells in the substantia nigra results in a decrease of which neurotransmitter?

Basal ganglia

In which functional part of the brain is dopamine a crucial neurotransmitter for movement control?

Lewy bodies

The essential histological feature of Parkinson’s is the accumulation of alpha-synuclein in the form of what?

Symptom relief

Since no treatment can halt or reverse neuronal degeneration, what is the primary goal of Parkinson’s medications?

Give dopamine precursors, stimulate receptors directly, or prevent breakdown

What are the three pharmacological rationales for treating Parkinson’s symptoms?

Motor fluctuations or dyskinesia

Device-assisted therapies are indicated for patients with what two complications despite optimal levodopa?

Deep brain stimulation, continuous levodopa-carbidopa gel, apomorphine infusion, and subcutaneous levodopa-carbidopa infusion

What are the four device-assisted therapies mentioned for Parkinson’s?

Unilateral MRI-guided focused ultrasound pallidotomy

Which lesioning therapy is used for refractory motor fluctuations or dyskinesias?

Unilateral MRI-guided focused ultrasound thalamotomy

Which lesioning therapy is used for refractory tremors?

Fluctuations in cognition and early vivid visual hallucinations

What are the specific "Parkinson’s Plus" features of Dementia with Lewy Bodies?

Symmetric

Is the presentation of Dementia with Lewy Bodies typically symmetric or asymmetric?

Alpha-synuclein

What proteinopathy is associated with Dementia with Lewy Bodies?

Poor

How do patients with Dementia with Lewy Bodies typically respond to Levodopa?

Vertical gaze palsy and frequent falls

What are the specific "Parkinson’s Plus" features of Progressive Supranuclear Palsy?

Symmetric

Is the presentation of Progressive Supranuclear Palsy typically symmetric or asymmetric?

Tau

What is the proteinopathy associated with Progressive Supranuclear Palsy?

Hummingbird sign and Mouse ear configuration

What are the two characteristic neuroimaging findings for Progressive Supranuclear Palsy?

Poor

How do patients with Progressive Supranuclear Palsy respond to Levodopa?

Prominent dysautonomia and cerebellar symptoms

What are the specific "Parkinson’s Plus" features of Multiple System Atrophy?

Symmetric

Is the presentation of Multiple System Atrophy typically symmetric or asymmetric?

Alpha-synuclein

What is the proteinopathy associated with Multiple System Atrophy?

Hot-cross bun sign and Putaminal ring sign

What are the two characteristic neuroimaging findings for Multiple System Atrophy?

Poor

How do patients with Multiple System Atrophy respond to Levodopa?

Apraxia, cortical sensory deficits, and alien-limb

What are the three specific "Parkinson’s Plus" features of Corticobasal Degeneration?

Asymmetric

Is the presentation of Corticobasal Degeneration typically symmetric or asymmetric?

Tau

What is the proteinopathy associated with Corticobasal Degeneration?

Severe asymmetric perirolandic cortical atrophy

What is the characteristic neuroimaging finding for Corticobasal Degeneration?

Poor

How do patients with Corticobasal Degeneration respond to Levodopa?

Remarkable

What is the characteristic response to Levodopa in Parkinson’s Disease compared to the "Plus" syndromes?

Cervicomedullary Junction

Where does the Corticospinal Tract decussate?

Medulla

Where does the Dorsal Column Tract decussate?

1 to 2 spinal segments above entry

Where does the Spinothalamic Tract decussate?

Motor

What is the primary purpose of the Corticospinal Tract?

Vibration and position sense

What is the primary purpose of the Dorsal Column Tract?

Pain and temperature

What is the primary purpose of the Spinothalamic Tract?

Cervical (C1-C8), Thoracic (T1-T12), Lumbar (L1-L5), and Sacral (S1-S5)

What are the four segments of the spinal cord?

C1

Which vertebral spine corresponds to the C1 cord segment?

C6

Which vertebral spine corresponds to the C7 cord segment?

T4

Which vertebral spine corresponds to the T6 cord segment?

T10

Which vertebral spine corresponds to the L1 cord segment?

T12 to L1

Which vertebral spines correspond to the S1 cord segment?

Longer than the cord

In adults, how does the length of the vertebral spine compare to the spinal cord?

L1

At which vertebral caudal border does the spinal cord typically end in adults?

L2/L3

At which vertebral rostral portion does the spinal cord end in neonates?

Gray matter and motor neurons

What makes up the center butterfly shape of the spinal cord?

White matter tracts

What surrounds the butterfly-shaped gray matter in the spinal cord?

Cervical

In lateral tracts, which fibers are located closest to the midline?

Sacral

In lateral tracts, which fibers are located on the outermost part?

Sacral

In dorsal tracts, which fibers are located closest to the midline?

Cervical

In dorsal tracts, which fibers are located on the outermost part?

ASIA Impairment Scale

What scale is used to make reporting of sensory symptoms more uniform?

A and B

Which grades on the ASIA scale carry a poorer prognosis?

C, D, and E

Which grades on the ASIA scale show better functional recovery?

No motor and no sensory

What defines Grade A on the ASIA scale?

Sensory preserved but no motor

What defines Grade B on the ASIA scale?

Motor function reduced in more than 50 percent of key muscles

What defines Grade C on the ASIA scale?

Motor function reduced in less than 50 percent of key muscles

What defines Grade D on the ASIA scale?

Normal motor and sensory

What defines Grade E on the ASIA scale?

C5

What is the cord level for elbow flexors?

C6

What is the cord level for wrist extensors?

C7

What is the cord level for elbow extensors?

C8

What is the cord level for finger flexors?

T1

What is the cord level for finger abductors?

L2

What is the cord level for hip flexors?

L3

What is the cord level for knee extensors?

L4

What is the cord level for ankle dorsiflexors?

L5

What is the cord level for long toe extensors?

S1

What is the cord level for ankle plantar flexors?

Fracture, dislocation, or disc protrusion

A disruption of the vertebral column through what three mechanisms causes most traumatic SCI?

Cervical spine

Which part of the spine is most vulnerable because it is highly mobile and lacks ribcage protection?

Primary mechanism

Which mechanism of injury refers to the immediate effects of trauma like transection or compression?

Secondary mechanism

Which mechanism refers to the physiologic response like ischemia, hypoxia, or inflammation occurring minutes to hours after injury?

Bilateral loss of all sensory and motor functions

What is the hallmark of Complete Spinal Cord Transection?

Anhidrosis, vasomotor instability, and sexual dysfunction

What are three autonomic symptoms of a complete cord lesion?

T6

Cardiac arrhythmias and bradycardia occur in lesions above which level?

C3

Cessation of respiration occurs in lesions above which level?

Diaphragmatic paralysis

Why is respiration compromised in lesions from C3 to C5?

Brown-Sequard Syndrome

What is another name for hemisection of the cord?

Contralateral

In Brown-Sequard Syndrome, is loss of pain and temperature sensation ipsilateral or contralateral?

Ipsilateral

In Brown-Sequard Syndrome, is loss of vibration and position sense ipsilateral or contralateral?

Ipsilateral

In Brown-Sequard Syndrome, is spastic weakness and hyperreflexia ipsilateral or contralateral?