. EXTRAPVRM1IDAL SYNDROMES PARKINSON ISM Definition - parklnsonem is a syndrome characterized by hypokinesia. tremor and rigldty Pathogenesis

Variable - Ankle jerks lost, knee jerks may be absent. Both exaggerated il lateral column lesion predominates 5. Sphincter dslurbances - First dlllcult or precipitate micturition, later reienilon ol urine or Incontinence Impotence early 6. Menial changes - not uncommon. Mild dementia impaired memory. Confusiorial psychosis or irritability or depression. 7. Bilateral primary optic atrophy in 5% DIAGNOSIS • Low haemoglobin, macrocyiosis, high MCHC, megaloblastic bone marrow, gastric achlortiydria. serum vitamin B12 ess than 100 pg/ml. MANAGEMENT -1,000 mcg crt vitamin B12 IM dally far 7-10 days, then same dose twice a week for one month, men once a fortnight to be continued for the rest of the patient's life. 19. EXTRAPVRM1IDAL SYNDROMES PARKINSON ISM Definition - parklnsonem is a syndrome characterized by hypokinesia. tremor and rigldty Pathogenesis - The hallmark of Parkinson's disease is degeneration of melanin -containing dopaminergic neurones of the substantia nigra and typical neuronal inclusions known as Lewy bodies. The dopamine in the basal ganglia participates in a complex circuit of both excitatory and inhibitory pathways These pathways are part of a loop that connects the cortex 10 the thalamus via the basal ganglia and hack to the frontal cortex. This loop serves to modulate the motor system. Parkinson's disease is a common clinical presentation of dfferent kinds of injuries to the substantla nlgra Basic sliological taclors are 1 Heredty - An inherited susceptibility to an agent is likely. 2. Toxins-HPTP. an analogue of mepridine, produced a syndrome almost indistinguishable from Parkinson's dsease Only a few cases of Parkinsonism induced by other toxins have been documented.3. Infectlons - Parkinsonism has been know to occur following typical viral infections Causes; 1. IDIOPATHIC - Paralysis agitans. (Parkinson's dsease). 2. POST-EN CEPHALfTIC PARKINSONiSM. 3. SYMPTOMATIC PAHKINSONISM - (a) Trauma - Head Injury, (b) Carbon monoxide intoxication. (c) Manganese and other metallic poisoning, MPTP (d) Drug-Induced - Reserpirie phenothiazines haloperldol. (e) Cerebral arteriosclerosis. (f) Syphilitic mesencephalitis. (g) Tumours ol brain stem rarely (h) Tuberculosis (rare) Clinical Features Triad of - 1. Tremor- may be first symptom, usually starts in one upper limb; characteristically iremor at rest and described as 'pill rolling' Head may be Involved. Tremors disappear dunng sleep. 2. Rigidly - Plastic or lead pipe. I.e present to equal extent In opposing muscle groups and if a limb is passivety moved the rigidly gives way with a series of slight jerks, or "cog wheel type if combined with tremor. 3 Hypokinesia - (a) Mask-like facies - with staring eyes. (b) inrrequeni blinking. (c) Impaired ocular convergence, (d) Slow and monotonous speech. (e) Micrographia. (f) Reduced swinging of arms whiIe walking (g) Festinant gait OTHER CLINICAL FEATURES - (a) Menial disturbances - Depression (b) Oculo-gvric attacks - in post-encephalitic parkinsonism. The eyes are deviated upwards or upwards and outwards and associated with flushing, hypertension and tashycarda. The attacks are more common in patients with brain stem lesions, (c) Drooling of saliva, (d) Constipation. (e) Weight loss. (f) Excessive sweating and greasy skin. (g) Postural hypotension and syncope from autonomous nervous system involvement., (h) Glabella tap test -When the glabella or nasion is tapped quickly, normally there is blinking of both eyes for 2 to 3 taps, then there will be no response due to the subject's adaptation. In Parkinsonism tha patient may be unable to suppress the