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MEDICAL CAUSES OF PARKINSON'S DISEASE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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PARKINSONISM

There are other medical disorders that can cause symptoms, some of which coincide with those of Parkinson's Disease. In most cases the medical disorder is called a Parkinsonism. Somebody that has one of these medical disorders can be wrongly diagnosed with Parkinson's Disease due to some of the symptoms resembling those of Parkinson's Disease. Muscular injury and muscular strain can also cause symptoms similar to those of Parkinson's Disease but only in the affected muscles and whilst the muscular injury or muscular strain lasts.

ACQUIRED HEPATOLENTICULAR DEGENERATION

Repeated episodes of liver failure or chronic liver cirrhosis may cause acquired hepatocerebral degeneration. Acquired hepatolenticular degeneration is also known as "Parkinsonism in cirrhosis". Liver transplantation is usually effective. Reports of post-transplant residual symptoms suggest an element of irreversibility in some cases. It is characterised by extrapyramidal symptoms including hypokinesia, dystonia and rigidity that are rapidly progressive and may be independent of the severity of cognitive dysfunction. Typical features included rapid progression over several months, symmetric akinetic-rigid syndrome, postural but not resting tremor, and early postural impairment and gait impairment.


CEREBELLAR THORACIC OUTLET SYNDROME

The Thoracic Outlet is a space between the rib cage (thorax) and the collar bone (clavicle) through which the main blood vessels and nerves pass from the neck and thorax into the arm. The nerves and blood vessels leave the neck between the two muscles (the scalene muscles). Thoracic outlet syndrome causes a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet. Cerebellar Thoracic Outlet Syndrome (CTOS) patients had associated neurological lesions as a result of hypo-perfusion and hypo-metabolism in certain areas of the brain and cerebellum.


CORTICOBASAL DEGENERATION

Corticobasal degeneration (CBD) is quite a rare neurological disease in which parts of the brain deteriorate or degenerate. The outer layer of the brain is severely affected, especially the fronto-parietal regions, which are located near the centre-top of the head. Other deeper brain regions are also affected including parts of the basal ganglia, hence the name "corticobasal" degeneration. The initial symptoms are often stiffness, shakiness, jerkiness, slowness, and clumsiness, in either the upper or lower extremities. Other initial symptoms may include dysphasia (difficulty with speech generation), dysarthria (difficulty with articulation), difficulty controlling the muscles of the face (hypomimia) and mouth, or walking and balance difficulties.
                                                                                                                                                            

CREUTZFELD-JAKOB DISEASE

Creutzfeldt-Jakob Disease is a rare, degenerative, and invariably fatal brain disorder. It is one of the diseases known as transmissible spongiform encephalopathies. Spongiform refers to the appearance of infected brains, which become filled with holes until they resemble sponges under a microscope. It is characterised by rapidly progressive dementia. Initially, patients experience problems with muscular co-ordination; personality changes, including impaired memory, judgement, and thinking; and impaired vision. They may experience insomnia, depression, or unusual sensations. Mental impairment eventually becomes severe. They often develop myoclonus, and may go blind. They eventually lose the ability to move and speak, and enter a coma.


ENCEPHALITIS LETHARGICA

People who have Encephalitis Lethargica have autoantibodies reactive against human basal ganglia antigens. Between 1917 and 1928 Encephalitis Lethargica affected thousands of people of all ages. Although an epidemic of Encephalitis Lethargica has not recurred since then, occasional cases of Encephalitis Lethargica are still seen. Encephalitis Lethargica could cause death in a short period or cause sleep that might last for days, weeks or months. Its symptoms were thought to encompass almost anything imaginable, which made its diagnosis very difficult. Some of the symptoms of Parkinson's Disease often occur in Encephalitis Lethargica.
                                                                                                                                                                                                              

FAHR'S SYNDROME

Fahr's Syndrome is a rare inherited neurological disorder. It is characterised by abnormal deposits of calcium in areas of the brain that control movement, including the basal ganglia and the cerebral cortex. Fahr's Syndrome can present with a wide spectrum of symptoms, including those of Parkinson's Disease. Symptoms that are similar to those of Parkinson's Disease include deterioration of motor function, dementia, dysarthria, tremors, muscle rigidity, a mask-like face, shuffling gait, and "pill-rolling" motion of the fingers. These symptoms usually occur later on. The more common symptoms include dystonia (disordered muscle tone) and chorea (involuntary, rapid, jerky movements).


FTDP-17

Frontotemporal dementia is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe. Frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) is a genetic disorder. It is caused by mutations in the tau gene, which encodes a microtubule-binding protein. FTDP-17 has three cardinal features : behavioural changes, cognitive impairment, and Parkinsonism. FTDP-17 can be further differentiated from Parkinson's Disease by there being a poor symptomatic response to L-dopa, progressive speech difficulties from the onset, and seizures that are poorly controlled with standard anticonvulsant therapy.


FRAGILE X-ASSOCIATED TREMOR / ATAXIA SYNDROME

Fragile X-associated tremor / Ataxia Syndrome (FXTAS) is a genetic disorder caused by mutation of the FMR1 gene on the X chromosome. The main features of FXTAS are cerebellar ataxia and/or intention tremor. Other documented symptoms are short-term memory loss, executive function deficits, parkinsonism, cognitive decline, peripheral neuropathy, lower limb proximal muscle weakness, and autonomic dysfunction. The clinical presentation of these patients, coupled with a specific lesion visible on magnetic resonance imaging and with neuropathological findings distinguishes it from other movement disorders. Peripheral neuropathy is common among people with FXTAS, and can be the first or the only symptom.


GAUCHER'S DISEASE

Gaucher's disease is a genetic disease in which lipid accumulates in some cells and organs. It is caused by a genetic deficiency of the enzyme glucocerebrosidase, which acts on glucocerebroside. Mutations in the Glucocerebrosidae gene are more frequent in Parkinson's Disease. Gaucher's Disease has been found to make Parkinson's Disease four to five times more likely. Gaucher's Disease is an inherited metabolic disorder in which harmful quantities of a substance called glucocerebroside can accumulate in the spleen, liver, lungs, bone marrow, and the brain. Glucocerebroside accumulates because glucocerebrosidase (the chemical that breaks it down) is deficient in Gaucher's Disease.

                                                                                                                                                               HALLERVORDEN-SPATZ DISEASE

Hallervorden-Spatz Disease is a rare, inherited, neurological disorder characterised by the progressive degeneration of the nervous system. Hallervorden-Spatz syndrome is characterised by dystonia, parkinsonism, and iron accumulation in the brain. There is progressive difficulty with movement, typically beginning in childhood, and can result in death in early adulthood. Movement abnormalities include involuntary muscle spasms, rigidity, and trouble with walking that worsens over time. Many people with Hallervorden-Spatz syndrome also develop problems with speech and some develop a loss of vision. Those people affected by Hallervorden-Spatz Disease may experience a loss of intellectual function, including dementia, and develop psychiatric symptoms such as behavioural problems, personality changes, and depression.



PHENYLKETONURIA
                                                                                                                                                                                     Phenylketonuria (PKU) is an autosomal recessive metabolic disorder due to mutations in the phenylalanine hydroxylase gene, which converts L-phenylalanine to L-tyrosine. Although it is principally a childhood disorder, in rare cases, the first signs of Phenylketonuria may develop in late adulthood resembling common neurological diseases. Phenylketonuria, if it is untreated, can lead to seizures, tremors, or trembling and shaking, stunted growth, hyperactivity, skin conditions, such as eczema, a musty odour of their breath, skin or urine. If treated it can lead to depression, anxiety and phobias. Signs of Parkinsonism can sometimes occur in Phenylketonuria, particularly with age.

                                                                                                                                                                                                       PROGRESSIVE SUPRANUCLEAR PALSY

Progressive supranuclear palsy (PSP) is a rare brain disorder that causes serious and permanent problems with the control of gait and balance. The most frequent first symptom of Progressive Supranuclear Palsy is a loss of balance while walking. Patients may have unexplained falls or a stiffness and awkwardness in gait. The most obvious sign of the disease is an inability to aim the eyes properly, which occurs because of lesions in the area of the brain that coordinates eye movements. Patients often show alterations of mood and behaviour, including depression and apathy as well as progressive mild dementia. The symptoms of Parkinson's Disease can occur in people with Progressive Supranuclear Palsy, and can initially even be the sole manifestation.


RETT SYNDROME

Rett Syndrome is a rare genetic disorder of the grey matter of the brain that almost exclusively affects females but has also been found in males. The clinical features of Rett Syndrome include small hands and feet and a deceleration of the rate of head growth. Repetitive stereotyped hand movements, such as wringing or repeatedly putting hands into the mouth also occur. People with Rett syndrome are prone to gastrointestinal disorders. Up to 80% of them have seizures. They typically have no verbal skills, and about 50% of affected individuals do not walk. Parkinsonian rigidity common occurs and increases in its extent with age. Several other Parkinsonian symptoms, including gait disturbance, can occur in Rett Syndrome.


VASCULAR PARKINSONISM

Vascular Parkinsonism is produced by strokes that affect the basal ganglia. A stroke is the loss of activity of a discreet brain area (lesion) because of blockage of the blood supply to that brain region. Vascular diseases are associated with a higher prevalence of Parkinson's Disease. Parkinson's Disease symptoms can occur in Vascular Parkinsonism. However, the resting tremor in Vascular Parkinsonism is either reduced or absent. Parkinson's Disease symptoms that occurred in Vascular Parkinsonism were bradykinesia (100%), rigidity (96%), falls (76%), pyramidal signs (54%), urinary incontinence (50%), and dementia (39%).  People with Vascular Parkinsonism had an older age of onset than those people who had Parkinson's Disease. Only a minority, but a large minority, of people with Vascular Parkinsonism respond to L-dopa.


WILSON'S DISEASE

Wilson's Disease is a genetic disorder in which there is an abnormal accumulation of copper. Copper begins to accumulate immediately after birth. Wilson's Disease first affects the liver and can then affect the brain. Wilson's Disease can result in hepatitis, psychiatric symptoms (including depression and aggression), neurological symptoms, jaundice, abdominal swelling, vomiting of blood, abdominal pain, tremors, difficulty in walking, talking and swallowing. Women may have menstrual irregularities, absent periods, infertility, or multiple miscarriages. Symptoms of Parkinson's Disease can often occur with Wilson's Disease.



X-LINKED DYSTONIA-PARKINSONISM

X-linked dystonia-parkinsonism syndrome is a rare movement disorder that is highly prevalent in Panay Island in the Philippines. X-linked dystonia-parkinsonism syndrome is associated with sequence changes within the TAF1/DYT3 multiple transcript system. The function is related to vesicular transport, dopamine metabolism, synapse function, Ca2+ metabolism and oxidative stress. X-linked dystonia-parkinsonism usually manifests itself primarly as torsion dystonia, later combined with or sometimes replaced with parkinsonism. It usually begins in adulthood, normally in the third or fourth decade. Imaging and autopsy studies have suggested involvement of the caudate and putamen in later stages.

 

 

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