神經發言 Nervestalk

NE & Clinical Evaluation

• Parkinsonism (NE)
  • Bradykinesia
  • Rigidity
  • Tremor: Resting, Action, Re-emergence
• Hx 必問
  • Constipation
  • Olfaction (+NE)
  • RBD
  • Depression
  • Falling (or motor milestones)
• DLB
  • Dementia: Attention, Executive, Visuospatial
    • Luria test
    • Digit span
    • Drawing, Balint syndrome, Gerstmann
  • 病史詢問 : Fluctuation cognition, RBD
• PSP
  • Corrugator sign, Procerus sign
  • Staring eyes
  • Applause sign
  • 會 Pivot on turning (和PD turn en bloc 不同)
  • OKN disspeared
  • Eye opening apraxia
  • O: Vertical supranuclear gaze palsy, SWJ
  • P: Postural instability by pull test
  • A: Gait freezing type, Tremor, Akinetic rigid
  • C: nf-PPA, bv-FTD, (Pathological laughter)
• MSA
  • Autonomic dysfunction
  • Early bulbar involvement
  • Stridor, Inspiratory sighs
  • Pseudobulbar palsy
  • Cold discolored hand and feet
  • Unexplained babinski sign
• FTD
  • Dementia tests
  • bv-FTD: A, B, C, D, E, F 口訣
• CBD
  • Cortical sensory
  • Orolingual, limb Apraxia
  • Asymmetrical dystonia
• Other hints
  • 要記得摸肝脾

Etiology & Differential Diagnosis

• Primary
  • Idiopathic parkinsonism (Sporadic)
  • Familial parkinsonism
    • AD: LRRK2
    • AR: GBA, PARKIN
• Secondary
  • Hydrocephalus, NPH
  • Drugs (GI, PSY, ENT)
  • Metabolic (Hypothyroidism, Hypermagnesemia, Parathyroid dysfunction with calcium deposition)
  • Infection (CJD, HIV) — 記得萬用的HIV
  • Toxin (Mn, CN, CO, CS2, MPTP, Rotenone, Hypoxia)
  • Vascular parkinsonism
  • Trauma
  • Tumor
  • Paraneoplastic (Ma2)
• Parkinsonism plus
  • MSA — 要記得量血壓
  • PSP — Corrugator sign, Applause sign
  • PSP-Alikes (MAPT, GRN, Perry syndrome, NPC, GSS)
  • CBS — Ideomotor Apraxia, 可以拿筆請他寫、開瓶子
  • FTD
  • DLB
  • Lytico-Bodig syndrome (PD-Dementia-ALS)
• Neurodegeneration
  • AD:
    • Huntington’s disease
    • Wilson’s disease
    • DRD (DDx with young PD)
    • SCA 系列 (2, 3, 12, 17, 21)
    • C9orf72
  • AR:
    • NBIA (NF [AD], PLAN, ACP)
    • 儲積疾病 (NCL, Gaucher, GM1, GM2, NPC)
  • Mitochondria:
    • Leigh disease
• Parkinsonism-Dystonia
  • X-linked: Lubag disease
  • AD: GCH1, ATP1A3
  • AR: PRKRA, DJ-1, PINK1, PARKIN
• Others
  • Hemiparkinson-Hemidystonia syndrome
  • Mitochondrial cytopathies with striatal necrosis
  • Neuroacanthocytosis
  • Enzymatic deficiency
• YOPD
  • DYT 3, 5, 12
  • PARK 系列
  • SCA (2, 3, 6, 8, 17)
  • HD, WD
  • NBIA
  • NPC, NeuAc
  • AD: SNCA, LRRK2, VPS35
  • AR: PINK1, DJ1, PARKIN