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Parkinsonism

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability.

Signs and symptoms
Parkinsonism is a clinical syndrome characterized by the four motor signs that are found in Parkinson's disease: tremor, bradykinesia (slowed movements), rigidity, and postural instability. • Difficulty sleepingDry skinApathyLack of facial expressionsBalance problems • Frequent fallsVery small handwritingRigid, stiff musclesCogwheeling (jerky feeling in arm or leg) • Upgaze impairment • Plastic, dead feeling resistance known as "lead-pipe rigidity". == Conditions==
Conditions
Parkinsonism occurs in many conditions. Neurological Neurodegenerative conditions and Parkinson-plus syndromes that can cause parkinsonism include: • Corticobasal degenerationFrontotemporal dementia (Pick's disease) • Gerstmann–Sträussler–Scheinker syndromeProgressive supranuclear palsyEncephalitis lethargicaJapanese encephalitis Toxins Evidence exists to show a link between exposure to pesticides and herbicides and PD; a two-fold increase in risk was seen with paraquat or maneb/mancozeb exposure. Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities. This condition is not responsive to typical therapies used in the treatment of PD, suggesting an alternative pathway than the typical dopaminergic loss within the substantia nigra. A mutation of the SLC30A10 gene, a manganese efflux transporter necessary for decreasing intracellular Mn, has been linked with the development of this parkinsonism-like disease. The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism. Other toxins that have been associated with parkinsonism are: • AnnonaceaeCarbon monoxideMercuryRotenoneToluene (inhalant abuse: "huffing") Vascular Vascular Parkinsonism is typically caused by mini strokes. It typically affects gait, often marked with rigidity. Multiple conditions related to Vascular Parkinsonism include: • Binswanger's disease (subcortical leukoencephalopathy) • Dural arteriovenous malformation / dAVM (reversible through dAVM treatment) Other Chronic traumatic encephalopathy (boxer's dementia or pugilistic encephalopathy) basal ganglia (especially globus pallidus) and the thalamus. • HypothyroidismParaneoplastic syndrome: neurological symptoms caused by antibodies associated with cancers • Rapid onset dystonia parkinsonism • Autosomal recessive juvenile parkinsonism ==Differential diagnosis ==
Differential diagnosis
Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism. Drug-induced parkinsonism About 7% of people with parkinsonism developed symptoms as a result of side effects of medication, mainly neuroleptic antipsychotics, especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupentixol and zuclopenthixol) and butyrophenones (such as haloperidol); and rarely, antidepressants. Yet another drug that can induce parkinsonism is the antihistaminic medication cinnarizine, usually prescribed for motion sickness; this is because besides antagonizing histamine receptors this drug antagonizes the dopamine D2 receptors. Implicated medications include: • AntipsychoticsMDMA (addiction and frequent use) • TetrabenazineCinnarizine{{cite journal |first1=José F. |first2=Juan J. |url=https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.870130313 |journal=Movement Disorders |publisher=International Parkinson and Movement Disorder Society/Wiley |issn=1531-8257 |editor1-first=A. Jon |editor1-last=Stoessl |editor2-first=Christine |editor2-last=Klein |editor3-first=David G. |editor3-last=Standaert |publication-place=Vancouver, British Columbia, Canada |title=Cinnarizine-induced parkinsonism: ten years later |last1=Martí-Massó |last2=Poza |doi=10.1002/mds.870130313 |pmid=9613736 |date=1 May 1998 |volume=13 |issue=3 |pages=453–456 == Society and culture ==
Society and culture
In the United States, the 2021 National Defense Authorization Act (NDAA) added parkinsonism to the list of presumptive conditions associated with Agent Orange exposure, enabling affected service members to receive Veterans Affairs disability benefits. == References ==
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