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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
In addition to the above cardinal features, the following motor signs are frequently associated with parkinsonism: Gait abnormalities: freezing, festinating, short/shuffling steps, slower speed.Flexed posture of limbs, neck, and trunk.Masked facial features (hypomimia), decreased blink rate.Progressively smaller handwriting (micrographia).Softer speech (hypophonia).
Chikungunya virus and Japanese encephalitis virus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
As mentioned in Section 15.3.3, the vast majority of JEV infections are asymptomatic. Estimates of around 1% (0.1%–4%) [34] are clinically overt. The incubation period after the bite of an infected mosquito is around 1–2 weeks. Initial symptoms of fever, myalgias, chills, headache, and/or vomiting are nonspecific. Children commonly also have gastrointestinal symptoms. After several days, neurologic deterioration occurs. Level of consciousness becomes rapidly depressed and meningismus becomes apparent. Seizures, usually generalized, are common in both adults and children in some studies [37] and uncommon in adults in other reports [34]. Rigidity and paralysis may also accompany and are associated with poor prognosis. Parkinsonian features, especially hypomimia, cogwheeling, and tremor, are classically associated with the disease, and additional features, such as opisthotonus, dystonia, choreoathetosis, and opsoclonus-myoclonus, have also been associated. From there, progression can be to brainstem involvement and/or herniation. Indeed, respiratory and/or pupillary abnormalities, loss of oculocephalic reflexes, and abnormal posturing are all poor prognostic signs.
Parkinson’s Disease and Rehabilitation
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Biemiller Rachel A., Irene Hegeman Richard
Slowness of movement, or bradykinesia, is the last “cardinal” feature of PD. Some patients may attribute their slowing to “old age” and tend to ignore this symptom at first; however, careful questioning can reveal that this gradual process occurs much faster than expected age-related slowing. Patients may find that they are falling behind when walking with their spouses or friends when a year or two ago they could keep pace. Others may notice that it takes them longer to do things such as cook or clean the house. On examination, patients may have decreased facial expression, also known as masked facies or hypomimia. This can range from a decreased blink rate to a complete lack of facial expression. There may be a general paucity of movements with decreased spontaneous gesturing, particularly of the more affected side. One can assess for bradykinesia by having the patient perform finger taps. They should be asked to tap the index finger to the thumb at least 10 times (one side at a time) as fast as they can while keeping the excursion as wide as possible. In patients with PD, this task will be associated with reduced amplitude, speed, and rhythm. Heel tapping (raising the foot about 3 inches off of the floor) can be done to assess the lower extremities in the same way [12,13].
Thyroid hormone levels and structural parameters of thyroid homeostasis are correlated with motor subtype and disease severity in euthyroid patients with Parkinson’s disease
Published in International Journal of Neuroscience, 2021
Yinyin Tan, Lei Gao, Qingqing Yin, Zhanfang Sun, Xiao Man, Yifeng Du, Yan Chen
Thyroid disease refers to the endocrine dysfunction, which is most frequently associated with PD [6]. In PD patients, the hypothyroid symptoms may be ambiguous, because the parkinsonism and hypothyroidism share some common clinical features, such as bradykinesia and hypomimia [6]. Considering this coexistence, the uncommon phenomenon should be expected: the estimated prevalences of both the disorders tend to increase with advancing ages. Prevalence of hypothyroidism among adults varies between 2.3% and 18%, while the prevalence of PD ranges from 0.1% to 1.4% [7,8]. In contrast, hyperthyroidism would worsen the parkinsonian tremor and cloud the levodopa responses in newly diagnosed PD patients [9]. Occurrence of hyperthyroidism in elderly PD patients may be overlooked due to subtle symptoms and signs [10]. Overall thyroid function has also been determined in patients with PD, though not any conclusive answer has been driven in regard to what role, if any, the thyroid function plays in the pathogenesis of PD. Several studies have shown that there is no significant relationship between the thyroid function and PD pathogenesis [11–13], while others have demonstrated association between them[14,15]. Compared with normal subjects, subclinical hyperthyroidism is more prevalent in the PD patients, and the free thyroxine (fT4) levels are elevated in the de novo, medication-free PD patients [14,16].
Manganese and copper levels in patients with primary biliary cirrhosis and primary sclerosing cholangitis
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Milan Dastych, Libuše Husová, Květoslava Aiglová, Tomáš Fejfar, Milan Dastych
Metabolism and homeostasis of essential trace elements, such as Mn and Cu, is strongly influenced by proper liver function as well as bile formation and excretion into the intestine because the liver and the biliary tree form their main excretory route. Clinical manifestations of Mn neurotoxicity are not only caused by occupational exposure of workers from the metallurgy industry, but also caused by the increased levels of Mn in drinking water or by long-term parenteral nutrition with very high daily doses of Mn [18,24–26]. The symptoms are primarily neurological, similar to those of Parkinson’s disease: fine tremor, cock-walk gait, dystonia, dysarthria, rigidity, bradykinesia, hypomimia, and monotone speech [27]. The four most frequently observed neurological signs in our patients were fine tremor, rigidity, dysarthria, and hypomimia.
Novel POLG mutation in a patient with early-onset parkinsonism, progressive external ophthalmoplegia and optic atrophy
Published in International Journal of Neuroscience, 2020
Lin Ma, Wei Mao, Erhe Xu, Yanning Cai, Chaodong Wang, Jagadish K. Chhetri, Piu Chan
Neurological examination revealed cognitive deficits, with Montreal Cognitive Assessment (MoCA) score of 16/30 (decline in calculation and delayed recall). Hypophonia, hypomimia, bilateral blepharoptosis and external ophthalmoplegia with diplopia were found. Presence of hypopsia (Vision acuity: right 0.05, left counting fingers/2 centimeters), mild symmetrical proximal muscle weakness (Medical Research Council grade 4/5), with diminished deep tendon reflexes was found. Presence of rest tremor in all limbs, slowing and amplitude decrements during finger tapping and hand pronation-supination movements, and postural instability were found. Reduced bilateral arm swing during walking could be seen. The patient had a positive response to levodopa accompanied by peak-dose dyskinesia in limbs and trunk.