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