0071643192.pdf

DIAGNOSIS

■ Suspect in patients with two episodes of differing neurologic symptoms

occurring at different times.

■ MRI may show multiple white matter lesions (better than CT).

■ Lumbar puncture: CSF cell counts, protein and glucose are typically normal;

CSF may show oligoclonal bands of IgG and/or myelin-based proteins.

TREATMENT

■ High-dose methylprednisolone burst with taper for acute exacerbations

PARKINSON DISEASE

Parkinson disease is a chronic neurodegenerative disease of the elderly resulting

from damage to dopaminergic neurons in the substantia nigra. Environmental

and genetic factors play a role.

SYMPTOMS/EXAM

■ Four characteristic findings:

■ Resting tremor (“pill-rolling”)

■ Cogwheel rigidity

■ Bradykinesia or akinesia

■ Postural instability

■ Other common findings include depression, muscle fatigue.

DIAGNOSIS

■ Based on clinical findings

■ CT/MRI is not definitive.

TREATMENT

■ Agents to increase CNS dopamine and anticholinergics to decrease central

muscarinic activity; see Antiparkinsonism Drugs, Chapter 6.

COMPLICATIONS
■ Include dementia, falls, DVT/PE, aspiration
NEUROLOGY

Multiple sclerosis:

Neurologic symptoms

separated by “space and

time”

Parkinson disease

findings—

TRAP

Tremor

Rigidity

Akinesia

Postural instability