CLINICAL EXAMINATION OF PARKINSON’S DISEASE PATIENTS€¦ · CLINICAL EXAMINATION OF...
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CLINICAL EXAMINATION OF PARKINSON’S DISEASE PATIENTS Amaal AlDakheel, MD Consultant, Movement Disorders Director, Movement Disorders Program King Faisal Specialist Hospital & Research Centre Riyadh, Saudi Arabia [email protected]
Transcript of CLINICAL EXAMINATION OF PARKINSON’S DISEASE PATIENTS€¦ · CLINICAL EXAMINATION OF...
CLINICALEXAMINATIONOFPARKINSON’SDISEASE
PATIENTSAmaalAlDakheel,MDConsultant,MovementDisordersDirector,MovementDisordersProgramKingFaisalSpecialistHospital&ResearchCentreRiyadh,[email protected]
Disclosures
§ None
LearningObjectives
§ Identifythephenotypicspectrumofparkinsonism
§ IllustratetheclinicalphenotypeofParkinson'sdisease
§ Demonstrateclinicaltechniquesforexaminingpatients
withParkinson’sdisease
§ DescribetheclinicalcluesusefulinthediagnosisofAtypicalParkinsonism
TheEtiologyofParkinsonism
Parkinsonism
Degenerative Symptomatic
Parkinson'sDisease AtypicalParkinsonism
Alpha-synucleinopathy Tauopathy
MultipleSystemAtrophy(MSA)DementiaofLewy-bodies(DLB)
ProgressivesupranuclearPalsy(PSP)CorticobasalDegeneration(CBD)
Secondary
Parkinsonism
§ Parkinsonismremainsdefinedasbradykinesiaplusrigidityandresttremorsorboth
§ Bradykinesia-decrementinspeedoramplitudeisrequired
Parkinsonismisaclinicaldiagnosis
Bradykinesia
LookforaDecrementof(speedandamplitude)
RestTremor
Tremor
ActionTremor
ParkinsonianTremor
RestmeansREST!1-Nomuscularactivity2-NoGravity
Re-Emerging-Phenomenon
Video
PosturalTremor
KineticTremor
IntentionTremor
Maintainingapositionagainstgravity
Duringvoluntaryactions
Increasedamplitudewhenapproachinggoal
Essential/DystonicTremor Cerebellar
Tremor
Rigidity
§ Velocity-independenthypertoniaoftenwithcogwheelphenomenon• Involving2joints
§ Differentialdiagnosis:• Spasticity:velocity-dependent,flexorsmoreinvolvedthanextensors
• Paratonia:inconsistent,distractible‘’Gegenhalten”
ClinicalPresentationofParkinsonism
Video
Video Video
Bradykinesia
RestingTremor Rigidity
and/or
GeneralExaminationThefacecangiveyoua
clue
“Procerussign”AstonishedlookofthePSPpatients
InPD-Facelacksexpressivemobility(hypomimia)Reducedblinking,2-10perminHypophoniaandmonotonousspeech
Video
GaitExamination
Video Video Video
Inclinicalexamination,trytoavoidcueing
Festinationofgait FreezingofgaitReducedArmswing
AxialSymptoms-AxialDystonia
Retrocollis Anterocollis Camptocormia Pisa-Syndrome
PSP MSA MSAPD
AxialSymptoms-Posturalinstability
Video Video Video Video
PosturalstabilityinPull-test PosturalinstabilityinPull-test
SpontaneousPosturalinstabilityinPull-test
ToCompleteyourexamination
§ Don’tforgettolookfor:
• CerebellarSigns
• PosturalbloodPressure
• Cognitiveexamination(MoCA)
KeyMessage
§ Bradykinesia,restingtremor,rigidityandpostural
instabilitydetectionarethemainclinicalsignsof
Parkinson’sDisease
§ Clinicalsignscanvaryduringtheclinicalexamination
§ RecognizingtheredflagsforatypicalParkinsonismis
crucial
§ References:1. Papapetropoulosetal,Anterocollis:clinicalfeaturesandtreatment
options,MedSciMonit.2008
2. Dohertyetal,PosturaldeformitiesinParkinson’sdisease,Thelancet2011
3. PrinciplesandPracticeofMovementDisorders,StanleyFahn,2007
4. CaseStudiesinMovementDisorders:CommonandUncommon
PresentationsRobertoErro,KailashBhatia,MariaStamelou,2017
5. MovementDisorders,RayL.Watts,DavidG.Standaert,2011
