Friday, July 17, 2009

Question 12


(Source: Professor Yasser Metwally, 2008)


83 year old woman is brought to the clinic with abnormal movements of hand. She complains that she has difficulty in walking and doing things for some months. She denies any history of fever or neck stiffness. She has a past history of DM, HTN, Rheumatoid arthritis for several years. She is taking metformin, thiazide, aspirin and multivitamin daily. She lives with her son and daughter in law since her husband passed away 7 years ago and says that her kids are "very caring" and nice to her. During the interview, the physician notes that she shows no affect while talking, and her hands are constantly shaking. Her memory appears to be intact. When asked to walk she walks with a typical gait as shown above in the media. An appropriate diagnosis is made and treatment is begun. What is the pathophysiology of the disease under consideration?



A) Trinucleotide repeat
B) Degeneration of Substantia Nigra
C) Decreased Dopamine and increased Acetylcholine
D) Copper deposition
E) Iron deposition
F) Drug induced
G) Old age changes



For Answer click comments :)

1 comments:

Usmle Challenger July 19, 2009 at 5:59 PM  

Answer: B) Degeneration of Substantia Nigra.

The patient is shown to have typical shuffling gait, which is feature of Parkinsonism. The other features seen in Parkinsonism are pill rolling tremors, mask like face, akinesia and cog wheel rigidity. There may be dementia associated. Degenration of neurons in substantia nigra is seen and presence of lewy bodies. There is deficiency of Dopamine. Dopamine analogues are first line treatment, eg: Carbidopa & Levodopa. Other drugs used in treatment are Bromocriptine, Amantadine, Selegeline, & COMT inhibitor.

Points to note:
1) Learn the classical findings of Parkinsonism
2) Treatment:
* First Line: Dopamine analogues
* COMT inhibitors: Increase dopamine in brain
3) Degeneration of Substantia Nigra & presence of Lewy Bodies
4) MPTP can cause irreversible parkinsonism.
5) Low potency anti-psychotics can cause parkinsonism like features: Rx these with Benztropine
6) Parkinsonism + Dementia + Hallucinations = Lewy Body dementia

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