Differential Diagnosis of Parkinson’s Disease帕金森病的鉴别诊断.pptVIP

Differential Diagnosis of Parkinson’s Disease Early Signs and Symptoms Cardinal Characteristics Resting tremor Bradykinesia Rigidity Postural instability Other Micrographia Masked face Slowing of ADLs Stooped, shuffling gait Decreased arm swing when walking Additional Signs and Symptoms Difficulty arising from a chair Difficulty turning in bed Hypophonic speech Sialorrhea Loss of the sense of smell Foot dystonia Criteria for Diagnosis At least two of three: rest tremor, bradykinesia, rigidity Absence of a secondary cause—drugs, metabolic, etc. Definitive diagnosis can only be made by autopsy Clues Suggesting Atypical Parkinsonism Early onset of, or rapidly progressing, dementia Rapidly progressive course Supranuclear gaze palsy Upper motor neuron signs Cerebellar signs—dysmetria, ataxia Urinary incontinence Early symptomatic postural hypotension Neurodegenerative disorders with Parkinsonism (I) Progressive supranuclear palsy Supranuclear downgaze palsy, square wave jerks Upright posture/frequent falls Pseudobulbar emotionality Furrowed brow/stare Corticobasal degeneration Unilateral, coarse tremor Limb apraxia/limb dystonia/alien limb Neurodegenerative disorders with Parkinsonism (II) Multiple system atrophy Shy-Drager syndrome Autonomic insufficiency—orthostasis, impotence Striatonigral degeneration Tremor less prominent Olivopontocerebellar atrophy Cerebellar signs Neurodegenerative Disorders with Parkinsonism (III) Diffuse Lewy body disease Early onset of dementia Delusions and hallucinations Agitation Alzheimer’s disease Dementia is the primary clinical syndrome Rest tremor is rare Hereditary disorders associated with parkinsonism Wilson’s disease Huntington’s disease Dentatorubro-pallidoluysian atrophy (DRPLA) Machado-Joseph disease (SCA-3) Differential Diagnosis of PD: Drug-induced Toxin-induced Metabolic Structural lesions (vascular parkinsonism, etc.) Hydrocephalus Infections Drug-Induced Parkinsonism Crucial to rule out, since most cases are reversible C