Parkinsonism

Clinical Scenario

• Disorientation for last 4 months
• Inability/decreased urge to move about

• Bed ridden
• Fixed posture
• Mask like face
• Generalized hypertonia, with equal resistance throughout the passive motion
• Positive Glebellar Tap
• ? palmomental reflex
• Eye movements could’nt be assessed as patient is not following command.

Past Medical History:

• Hypertensive: on some medication, could’nt be identified
• Ex-smoker
• Prior history of right sided CVA

Questions at WARD ROUND

• What are the essentials of diagnosis?
• What are the other variants? Name three sydromes categorized as Parkinson Plus
• What are the commonest side effects of Levodopa/Carbidopa?
• What medicine should be stopped in case, if patient develops symptoms of urinary retention.?
• What are the poor prognostic signs?
• Can it cause dementia? is it reversible?
• Name reversible causes of dementia