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What is not?

 Impossible is not a fact, its an opinion 

Parkinsons Disease

May 20, 2010 by drsalman

Case Sheet

A 60 year old male is brought into the office by his wife who describes him getting slower while walking and unable to keep his pace with her.This has bee progressively worsening since past 6 months.She also dscribes him having very small steps while walking.His wife also  complains that his limbs has become more stiff and his more forward bent.His speech also changes and he speaks slowly in a monitonous way.

On examination pateint has expressionless face,greasy skin,monotonous speech,festinanat ait,4-6 Hz resting tremor in both upper limbs.Cogwhhel rigidity in Upperlimbs and Leadpipe rigidity in lower limbs is well apprecialted.Glabellar sign is positive.

 

Case Discussion: 

Al  parkinsons disease are parkinsonism but not all parkinsonisms area parkinsons disease

Rules: 

Symptoms

Hypokinesia:70

Rigidity:60

    Leadpipe:70

    Cogwheel:70

Tremor:50

4-6 Hz:60

>6Hz:5

<4Hz:5

Expressionless face:20

Festinent gait:50

Monotonous speech:20

Glabellar sign:40

If age<65 and disease severe:give Anticholinergics

If age>65 and disease severe: give Amantidine

If disease ver severe give Levodopa and carbidopa

 

Questions: 

What is the diagnosis?

What is the best next step in managing this patient?

When do you start treatment?

Which drug really changes pathogenensis of parkinsons disease?

What are secondary causes of parkinsonism???

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