Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Paralytic Poliomyelitis Parkinson’s Disease and Parkinsonism 1137

toxicity is suggested by history of exposure; multifocal motor neu-

ropathy has a more prolonged course

management

■Assess adequacy of ventilation; provide support if needed

■Supportive care

■Notify local public health/communicable disease control unit

specific therapy

■None available

follow-up

■Depends on severity of disease

complications and prognosis

■Mortality <10% except in bulbar cases, when it approaches 50%

■Survivors may develop increasing weakness after some years in

affected limb (“postpolio syndrome”)

PARKINSON’S DISEASE AND PARKINSONISM

CHAD CHRISTINE, MD

history & physical

■Tremor at rest

■Slowness of voluntary movement (bradykinesia)

■Stooped posture, short steps

■Reduced facial expression

■Hypophonia

■Increased muscle tone; cogwheel rigidity

■Reduced postural stability

■Dementia may occur

tests

■Diagnosis made clinically

■Lab: blood tests unremarkable

■Imaging: CT or MRI of brain is typically unremarkable

■Specific tests: genetic tests available for rare familial forms (research)

differential diagnosis

■Degenerative diseases such as progressive supranuclear palsy, multi-

system atrophy, corticobasal ganglionic degeneration, dementia w/

Lewy bodies excluded clinically