Parkinson's Disease

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍tremor

Specific difficulties: ‍ ‍writingbuttoning clothesusing utensilswalkingstanding up from a seated position

Onset was ‍gradualsudden

Impact on daily activities is ‍minimal

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍tremors

‍rigidity

‍bradykinesia

‍postural instability

‍loss of automatic movements

‍speech changes

‍writing changes

‍difficulty swallowing

‍depression

‍anxiety

‍cognitive changes

‍sleep problems

‍bladder problems

‍constipation



Contributing factors:

‍exposure to toxins

‍head injury

‍smoking

‍high caffeine intake

no history of: ‍Parkinson's disease

no use of: ‍antipsychotic medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk





ASSESSMENT:

‍Parkinson's disease ‍likelysuspectedpossible

DDx: idiopathic Parkinson's disease, drug-induced parkinsonism, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), vascular parkinsonism, normal pressure hydrocephalus (NPH), Wilson's disease, Huntington's disease, Alzheimer's disease, essential tremor, dystonic tremor, Lewy body dementia, frontotemporal dementia, brain tumor, traumatic brain injury, toxin exposure, metabolic disorders, infectious causes





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍B12, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs

- CT scan of the head

- MRI of the brain

- DaT scan if diagnosis uncertain

Treatments:

- Education about Parkinson's disease

- Regular physical exercise

- Balanced diet

- Regular sleep schedule

- ‍Dopaminergic agents

- ‍MAO-B inhibitors

- ‍Anticholinergics

- ‍Amantadine

- Physiotherapy

- Occupational therapy

- Speech therapy

Further care:

- Referral to neurologist

- Referral to geriatrician

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as confusion or hallucinations