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 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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