It is easy to recognize the disease when it is flowery. Typical deadpan face, stooping posture, generalized rigidity and shaking of hands are diagnostic. Secondary functions like excessive salivation (due to excess cholinergic), the infrequency of normal eye blinking, micrographia (written becoming small and distorted letters), Seborrhea and appearance of the primitive reflexes are diagnostic. Glabellar tap is a primitive reflex diagnostics that can be easily aroused. The nose is exploited gently and this evokes the eyes flashing. Tapping in the normal individual leads to the Elimination of this response, considering that in Parkinsonism this response can be raised repeatedly.
Differential diagnosis: Parkinsonism Postencephalitic is recognized by the history of encephalitis in the past and the presence of ocular manifestations as oculogyric crisis. This is sudden jerking movements conjugated eyes, occurring generally upward, less frequently in other directions as well. Parkinsonism may occur as part of other neurological diseases. It can coexist with atherosclerosis - used to be known as arteriosclerotic parkinsonism. There was no consensus of opinion if Parkinsonism is caused by atherosclerosis.
Clinical features
Four Cardinals of Parkinsonism characteristics hypokinesia, tremors, rigidity, postural riots.
1 Hypokinesia or bradykinesia: these terms relate to poverty automatic movements and Detective voluntary due to motor planning. Voluntary movements are slow to start, reduced, and lack of precision. Movements associated in footer (for example, balancing arms, etc.) has been reduced considerably. While voluntary activity is difficult and time-consuming, reflex activity remains normal for considerable periods. Although voluntary movements are slow, power is usually normal.
2 Rigidity: Increase in tone, which manifests itself as the rigidity of the limbs and the trunk is characteristic of parkinsonism. This rigidity is present in the range of motion (lead pipe stiffness), unlike spasticity injury of upper motor neuron where increased tone feels the most at the beginning of the movement. When increased tone associated with tremor, results in cogwheel rigidity type. The facial muscles stiffness gives rise to a mask with no expression-like facies.
3 Tremor: The characteristic tremor occurs at rest. Initially, sees the trembling hands, but later that this extends to the lower extremities. The thumb moves transversely across the fingertips bending rhythmically and this is appropriate describe it as the pill the rolling motion. Later, tremor becomes the largest and also in the limbs, face, lips and also tremulous language.
4. The alteration of the position: patient assumes a generalised flexion attitude makes lower us forward. Walks with short steps and walk, he gains speed, and tends to give forward. This phenomenon is called festination. Terms and retropulsion propulsion are used to denote the phenomenon seen when the patient standing is gently pushed forward or backward. The patient is moved forwards or backwards without control. Due to stiffness in movement, the patient it is difficult to turn around when walking. He tends to fall with more frequency and postural adjustments become difficult. Deep reflexes are usually affected. Normally higher faculties, as intelligence and memory are preserved. Speech becomes slow and boring. There is lack of initiative and the patient tends to restrict its activity gradually.
The normal response body to the depletion of dopamine is increasing the number of dopamine receptors. Parkinsonism symptoms only appear when it fails this compensatory mechanism. Available medications nowadays do not treat the cause of the disease. They can even reduce dopamine receptors when used in a long term basis. They can therefore fail drugs alleviate the symptoms in advanced cases. In terms of functional inability, Parkinsonism remains a disease with a poor prognosis.
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