Rapid Review of 'Advanced(2)' Pearls on Parkinsonism for MRCP
Multi System Atrophy
- Parkinsonism+Autonomic+Urinary+
Stridor(Laryngeal dystonia)+myoclonus
- Parkinsonism:
Tremor= jerky postural tremor, Falls, ataxia,slurring, REM sleep behaviour
disorder
- Autonomic:
Postural hypotension, Erectile dysfunction (Shy drager Syndrome)
- Urinary:
Urinary incontinence, imcomplete bladder emptying
- Less
response to L-Dopa
- Mean survival:
6-9 years ( Olivo-Ponto-Cerebellar atrophy = 10 years), (OPCA≅
Spinocerebellar atrophy)
- If
Parkinsonism prominent = Nigrostriatal degeneration ( MSA-P)
- If
Cerebellar prominent = Olivo-Pontocerebellar Atrophy (MSA-C)
- If
Autonomic prominent = Shy-Drager Syndrome (MSA- A)
·
Investigation:
·
MRI= normal, exclude CVD; T2 hyperintense@putamen=MSA + Extra
Pyramidal system involes
·
PET (F18) : to differentiate MSA vs PD , in MSA ↓
Putamen F18
·
Autonomic Function testing : to see the sympathetic and
parasympathetic distribution
·
Sphincter electromyography: hyperreflexia of detrusor; required
during Mx of bladder dysfunction
No comments