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PARKINSONISM

 

 
 

A Parkinsonism is a medical disorder, some of whose symptoms can coincide with those of Parkinson's Disease. Consequently somebody  can be wrongly diagnosed with Parkinson's Disease due to having Parkinsonism - a medical disorder that to some extent merely resembles Parkinson's Disease.

 

ESSENTIAL TREMOR

Essential tremor is commonly described as an action tremor (getting worse when trying to use the affected muscle), but not resting tremor, and with rigidity often not even mentioned. For more information go to : Essential Tremor. Although that might describe Essential Tremor in its purest form, in practice there is far less difference between Essential Tremor and Parkinson's Disease than is often assumed. The prevalence of Parkinson's Disease in those people with Essential Tremor is more than 24 times greater than expected. Some people have both, or at least some of the other. The overlap of symptoms suggest that rather than being separate disorders, that they are actually different aspects of the same medical disorder. Parkinson's Disease and Parkinsonism can also occur simultaneously with Essential Tremor. In those cases the degree of tremor, rigidity, and functional disability did not differ from those people with idiopathic Parkinson's Disease. Hand tremor predominated (as it does in Parkinsonís Disease), and occurred in nearly all cases, followed by head tremor, voice tremor, neck, face, leg, tongue and trunk tremor. Most other tremors occurred in association with hand tremor. Walking difficulties in Essential Tremor are common. About half of patients have associated dystonia, including cervical dystonia, writer's cramp, spasmodic dysphonia, and cranial dystonia, and 20% of the patients had associated parkinsonism. Olfactory dysfunction (loss of sense of smell) is common in Parkinsonís Disease. However, it has also been reported to occur in patients with Essential Tremor.

 

HYDROCEPHALUS

Hydrocephalus is a medical disorder in which there is an abnormal accumulation of cerebrospinal fluid within the ventricles or subarachnoid space of the brain. In infancy, the most obvious indication of hydrocephalus is often the rapid increase in head circumstance or an unusually large head size. In older children and adults, symptoms may include headache followed by vomiting, nausea, papilledema (swelling of the optic disk, which is part of the optic nerve), downward deviation of the eyes (called "sunsetting"), problems with balance, poor coordination, gait disturbance, urinary incontinence, slowing or loss of development (in children), lethargy, drowsiness, irritability, or other changes in personality or cognition, including memory loss. For more information go to : Hydrocephalus. Symptoms of Parkinsonís Disease, most commonly gait disorders, can often occur simultaneously with Hydrocephalus, and can be due to the effects of Hydrocephalus. The Parkinsonís Disease symptoms may be caused by increased intracranial pressure reducing blood flow to the basal ganglia.

 

ENCEPHALITIS LETHARGICA

Encephalitis Lethargica is thought to be due to a massive immune reaction to an infection by the streptococcus-like bacterium, diplococcus. It is characterized by high fever, sore throat, headache, double vision, delayed physical and mental response, sleep inversion, catatonia and lethargy. In acute cases, patients may enter coma. Patients may also experience abnormal eye movements, parkinsonism, upper body weakness, muscular pains, tremors, neck rigidity, and behavioural changes including psychosis. Between 1917 and 1928, an epidemic of Encephalitis Lethargica spread throughout the world. During the outbreak, over a million died, and some were left frozen inside their bodies in institutions.  Isolated cases continue to occur. For more information go to : Encephalitis Lethargica. Some of the symptoms of Parkinson's Disease often occur in Encephalitis Lethargica. People with Encephalitis Lethargica have autoantibodies reactive against human basal ganglia antigens. Encephalitis Lethargica may be able to cause Parkinson's Disease symptoms by affecting the function of the dopaminergic neurons in the basal ganglia.

 

FXTAS (Fragile X-associated Tremor/Ataxia Syndrome)

Fragile X syndrome is a genetic disorder caused by mutation of the FMR1 gene on the X chromosome. Fragile X Syndrome is the most common form of hereditary mental retardation. Carriers of premutation (CGG) expansions of the fragile X gene are generally thought to be spared most of the problems associated with the full mutation. However, a recently discovered neurological disorder - FXTAS (Fragile X-associated Tremor/Ataxia Syndrome) - involving progressively severe tremor and difficulty with walking and balance, appears to specifically affect some older pre-mutation carriers. They are often oblivious to the fact that they are carriers and that they have symptoms of FXTAS rather than Parkinson's Disease, because the symptoms can coincide. For more information go to FXTAS. The disorder affects at least a third of male carriers over 50 years of age. Older men were much more likely to develop symptoms. Especially prone are those men who have grandchildren with Fragile X Syndrome, because that makes it more likely that they are a carrier of the mutation. Women are hardly affected. Tremor is usually the first symptom to appear, most typically at around 60 years of age, but often earlier. Tremor is usually followed by ataxia (incoordination), then proneness to falling. Males were more agitated, aggressive, depressed, apathetic, disinhibited, and irritable. There is also impairment of intellectual functioning, that is eventually on a scale similar to that seen in Alzheimer's Disease. In those female carriers without the core features (tremor, and difficulty with walking and balance), there were more complaints of chronic muscle pain, and history of tremor than is normal.

 

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 (scalene muscles). Thoracic outlet syndrome is 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. For more information go to : Thoracic Outlet Syndrome. Cerebellar Thoracic Outlet Syndrome (CTOS) patients had associated neurological lesions as a result of hypo-perfusion and hypo-metabolism in certain area of the brain and cerebellum. This chronic hypoxia produces different results, depending on the area of the brain and cerebellum affected. For more information go to : Cerebellar Thoracic Outlet Syndrome. When chronic hypoxia affects the basal ganglia in putamen, a decrease in the dopamine production takes place, causing symptoms of Parkinson's disease.

 


VASCULAR PARKINSONISM

Vascular parkinsonism is produced by one or more small 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. There are three different pathologic states that produce Vascular Parkinsonism (VP), including multiple lacunar infarctions in the basal ganglia area, subcortical arteriosclerotic changes (Binswanger's disease) and a single vascular lesion that present a clinical picture indistinguishable from Parkinson's disease. For more information go to : Vascular Parkinsonism. Parkinson's Disease symptoms can occur in Vascular Parkinsonism. However, resting tremor is either reduced, or absent, and only a minority, but a large minority, of people with Vascular Parkinsonism respond to L-dopa. Symptomscan be caused due to reduced blood supply to the part of the brain in which dopamine isproduced.

 

HALLERVORDEN-SPATZ DISEASE

Hallervorden-Spatz disease is a rare, inherited, neurological disorder characterized by progressive degeneration of the nervous system. It is also called Pantothenate kinase associated neurodegeneration. This condition is characterized by progressive difficulty with movement, typically beginning in childhood. Movement abnormalities include involuntary muscle spasms, rigidity, and trouble with walking that worsens over time. Many people with this condition also develop problems with speech and some develop vision loss. Additionally, affected individuals may experience a loss of intellectual function (dementia) and psychiatric symptoms such as behavioral problems, personality changes, and depression. For more information go to : Hallevorden-Spatz Disease. People with Hallervorden-Spatz Disease can cause people to develop the symptoms of Parkinson's Disease. This could occur as a result of degeneration of the part of the brain in which dopamine is produced.

 

PROGRESSIVE SUPRANUCLEAR PALSY

Progressive supranuclear palsy (PSP) is a rare brain disorder that causes serious and permanent problems with control of gait and balance. The most frequent first symptom of PSP 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. For more information go to : Progressive Supranuclear Palsy. The symptoms of Parkinson's Disease can occur in people with Progressive Supranuclear Palsy, and can initially even be the sole manifestation. There is a gradual deterioration of brain cells in a few small locations in the brainstem. One of these areas, the substantia nigra, is also affected in Parkinson's disease. Damage to this region of the brain accounts for the motor symptoms that Progressive Supranuclear Palsy and Parkinson's Disease have in common. In addition to gaze palsy and early postural instability in Progressive Supranuclear Palsy, absence of levodopa-induced dyskinesia, frontalis muscle overactivity, primitive reflexes, visuospatial impairment, and substantial frontal behavioural disturbances differentiated almost all patients with this disorder from Parkinson's Disease.

 

CREUTZFELDT-JAKOB DISEASE

Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. CJD belongs to a family of human and animal diseases known as the transmissible spongiform encephalopathies (TSEs). Spongiform refers to the characteristic appearance of infected brains, which become filled with holes until they resemble sponges under a microscope. CJD is characterized by rapidly progressive dementia. Initially, patients experience problems with muscular coordination; personality changes, including impaired memory, judgment, and thinking; and impaired vision. People with the disease also may experience insomnia, depression, or unusual sensations. CJD does not cause a fever or other flu-like symptoms. As the illness progresses, the patientsí mental impairment becomes severe. They often develop involuntary muscle jerks called myoclonus, and they may go blind. They eventually lose the ability to move and speak and enter a coma. Pneumonia and other infections often occur in these patients and can lead to death. For more information go to : Creutzfeldt-Jakob Disease. The symptoms of Parkinson's Disease can sometimes occur simultaneously with CJD, and may occur as a result of the neuronal loss that CJD can cause.

 

MULTIPLE SYSTEM ATROPHY

Multiple System Atrophy is associated with the degeneration of nerve cells in specific areas of the brain that shrink (atrophy). When brain tissue of a person with Multiple System Atrophy is examined under a microscope, structures called glial inclusion bodies can be seen. This cell degeneration causes problems with movement (such as stiffness, rigidity and tremor), loss of balance and coordination, impaired speech, breathing and swallowing difficulties, blurred vision, male impotence, constipation, urinary difficulties, and orthostatic, or postural, hypotension (an excessive drop in blood pressure when the patient stands up that causes dizziness or momentary blackouts). For more information go to : Multiple System Atrophy..Other terms were formally used to refer to Multiple System Atrophy, based on the most prominant systems : Striatonigral degeneration - in which there is predominating Parkinsonism. The substantia nigra is only mildly affected, while some other areas of the brain show more severe damage; Shy-Drager syndrome, characterised by Parkinsonism and more pronounced autonomic dysfunction; Olivopontocerebellar atrophy, characterised by difficulty in articulating words). Symptoms of Parkinson's Disease can occur in people with Multiple System Atrophy. There is a distinct profile of Parkinsonism in Multiple System Atrophy, with greater severity and disability compared with Parkinson's Disease. Differences between Multiple System Atrophy in comparison to Parkinson's Disease include far more frequent falling, far less limb tremor, less facial expresion (hypomimia), atypical rest, postural or action tremor, more symmetrical symptoms, greatly reduced response to L-dopa, early motor fluctuations, absence of dementia, autonomic features, faster disease progression.

 

CORTICOBASAL DEGENERATION

Corticobasal degeneration (CBD) is a rare neurological disease in which parts of the brain deteriorate or degenerate. CBD is also known as corticobasal ganglionic degeneration, or CBGD. The cortex, or outer layer of the brain, is severely affected, especially the fronto-parietal regions, located near the center-top of the head. Other, deeper brain regions are also affected, including parts of the basal ganglia, hence the name "corticobasal" degeneration. The combined loss of brain tissue in all these areas causes the symptoms and findings seen in people with CBD. Symptoms of CBD usually begin after age 60. The initial symptoms of CBD 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 and mouth, or walking and balance difficulties. Symptoms usually begin on one side of the body, and spread gradually to the other. Some patients (probably more than commonly recognized in the past) may have memory or behavioral problems as the presenting symptoms. For more information go to : Corticobasal Degeneration. People with Corticobasal degeneration usually exhibit some or all of the symptoms of Parkinson's Disease.

 

WILSON'S DISEASE

Wilsonís Disease is a genetic disorder in which there is an abnormal accumulation of copper. Copper begins to accumulate immediately after birth. It first affects the liver, and can then affect the brain. This can result in resulting in hepatitis, psychiatric symptoms (including depression and agresssion), neurologic symptoms, jaundice, abdominal swelling, vomiting of blood, and abdominal pain. It can cause tremors and difficulty in walking, talking and swallowing. Women may have menstrual irregularities, absent periods, infertility, or multiple miscarriages. For more information go to Wilson's Disease. Symptoms of Parkinsonís Disease can often occur with Wilsonís Disease. This is because the excess copper that occurs in Wilsonís Disease can cause the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome.

 

HIV/AIDS

Human immunodeficiency virus or HIV is a retrovirus that can cause Acquired Immunodeficiency Syndrome (AIDS), a condition in which the immune system begins to fail, leading to potentially fatal infections. For more information go to : HIV/AIDS. Symptoms of Parkinson's Disease can sometimes occur as a result of HIV/AIDS. Subclinical nigral degeneration is common in AIDS and would explain the heightened susceptibility to Parkinsonism, as this would lead to dopaminergic dysfuntion.

 

FTDP-17

Frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) is a genetic disorder, that has three cardinal features : behavioural changes, cognitive impairment, and Parkinsonism. It is caused by mutations in the tau gene, which encodes a microtubule-binding protein. For more information go to : FTDP-17. FTDP-17 can be further differentiated from Parkinson's Disease by there being a poor response to L-dopa, progressive speech difficulties from the onset, and seizures that are poorly controlled with standard anticonvulsant therapy.  FTDP-17 may be able to cause Parkinson's Disease symptoms when the dysfunction affects the dopaminergic neurons.

 

 

 

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