Clinical features of Secondary Parkinsonism - Dr. Guruprasad Hosurkar скачать в хорошем качестве

Clinical features of Secondary Parkinsonism - Dr. Guruprasad Hosurkar

Parkinson’s disease is usually classified as primary Parkinson’s disease or secondary Parkinson’s disease. Primary Parkinson’s disease or idiopathic Parkinson’s disease, there is a neurogenetic basis and then they follow a certain onset of symptoms and progression, whereas secondary Parkinson’s disease , there are so many other causes for that. One is the atypical Parkinsonism, where you have multiple system atrophy, progressive proonucleopalsy, CBGD, all this come under atypical Parkinsonism. So there the clinical presentation is quite different, the progress is quite rapid, there can be symmetrical onset Parkinsonism, they can have early falls, they can have memory loss. So all these clinical features need to be assessed and than quantified and diagnosis made. We also take help of imaging or nuclear scan to differentiate between these two typical or atypical Parkinsonism and then make a diagnosis. Talking about secondary Parkinsonism, where you have drug induced Parkinsonism or metabolic reasons for Parkinsonism like hyponatremia or other ineffective causes for Parkinsonism. You need to get the history of infective agents or investigations to back up your diagnosis. The clinical presentation will be different in the onset the progression is more faster, there is symmetric involvement, there is also associated non motor symptoms such as change in behaviour change in conscious levels, early falls, more axially involvement than limb involvement. So these are some of the clinical features that we look into for secondary Parkinsonism. Specifically speaking about vascular Parkinsonism, means there are ischemic changes in the brain leading to Parkinsonism. So you have small infarction sin the brain, either it is related to chronic hypertension, diabetes or multiple infarcts in the last causing Parkinsonism features but here the salient features are that the lower limbs are more involved than the upper limbs, the gait is more affected. They are more slow in terms of walking, they can’t initiate gait, they can’t walk faster as compared to typical Parkinsonism. So more lower limb is classical of atherosclerotic or vascular Parkinsonism and they also have urinary incontinence associated with this type of Parkinsonism. Upper limbs are not so involved early or in the later day they become slower in the upper limbs as well. The masking of face, the speech is not much affected early on in vascular Parkinsonism.