Parkinsonism

Overview

Parkinsonism is a combination of resting tremor, rigidity, bradykinesia, and loss of postural reflexes. Parkinson disease (PD) is the most common form, but must be distinguished from its imitators.

Causes

  • Idiopathic Parkinson disease (77%)
  • Parkinson-plus syndromes (12%)
    — Multiple system atrophy(MSA): autonomic instability
    — Corticobasal ganglionic degeneration (CBGD): alien hand syndrome
    — Progressive supranuclear palsy(PSP):slow and restricted vertical saccades
    — Diffuse Lewy body disease (DLB): prominent visual hallucinations
  • Drug-induced Parkinsonism (5%)
    — Dopamine receptor blockers, e.g. antipsychotics, antiemetics
    — Dopamine depletors, e.g. reserpine
    — Calcium channel blockers
  • Other neurodegenerative conditions
    — Alzheimer disease
    — Pick disease
    — Motor neuron disease-Parkinsonism
  • Toxins
    — e.g. carbon monoxide, manganese, methanol, cyanide, disulfiram
  • Metabolic
    — hepatolenticular degeneration, Wilson disease, hypocalcemic Parkinsonism, post-anoxic Parkinsonism
  • Infectious causes:
    — fungal, toxoplasmosis, HIV, post-encephalitic Parkinsonism
  • Structural lesions (rare but must be excluded)
    — Normal pressure hydrocephalus
    — Communicating hydrocephalus
    — Subdural hematoma
  • Others
    — Vascular Parkinsonism
    — Other neurodegenerative conditions, such as PKAN, Huntington disease, Neuroacanthocytosis
    — Familial conditions such as SCA1, 2, 3, 12, FTD with Parkinsonism

CCC Differential Diagnosis Series

NEURO

Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision

RESP

Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement

CVS

Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction

GIT

Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage

GUT

Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency, 

MSK

Arthritis, Shoulder pain, Wasting of the small muscles of the hand

DERM

Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans

ENDO

Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss

HAEM

Splenomegaly

PAEDS

Floppy infant 

MISC

Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest

IMAGING

CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR,
ABDO: Gas on abdominal X-ray, Kidney mass,
BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly,
OTHER: Pseudofracture on X-Ray, 

LABS

LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia, 

HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia, 

ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis,

Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

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CCC 700 6

Critical Care

Compendium

…more CCC

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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