Parkinsonism

Parkinsonism is a syndrome characterized movement disorders, increased muscle tone, disorder of autonomic and mental functions. Parkinsonism is known as an independent disease, called the shaking palsy, or Parkinson's disease (see), and as Parkinson's syndrome, growing at epidemic encephalitis, atherosclerosis of cerebral vessels, manganese poisoning, large doses of chlorpromazine with long-term it is received. The disease develops as a result of inflammatory or degenerative lesions of the basal ganglia of the brain hemispheres.
The clinical picture is from the vibrations and the tone (rigidity) of the muscles. Shake usually starts with the fingers and hands. Shake small, rhythmic. It disappears when voluntary movements and increases with emotional reactions. Often jitter causes rhythmic friction thumb on the other fingers like the movement in rolling pills. In advanced cases, you receive the trembling lips, the head. Gradually increases tonus and developing muscle stiffness of the limbs, neck, face, spine. During passive movements of the limbs is found growing resistance ("symptom gears"). Random movement is difficult and slow. The person becomes masloobraznyj, mimicry, sebaceous, you receive increased salivation. It is quiet, monotonous. In advanced cases the head, upper body, arms bent. When walking the first steps patient does with difficulty, and then begins to move in small steps. To stay patient as difficult as and start walking. While walking there are no friendly hand movements. The patient is especially difficult to make small movement, dress, shoes, bring a spoon to his mouth. Handwriting is malorastvorim, small. Sometimes patients complain of pain in the extremities, which is caused by muscle rigidity. Sometimes tremors and rigidity of muscles appear on one side, in the future they will be bilateral. The characteristic slowness of mental processes.
The disease gradually progresses and in the final phase, the rigidity is so great that the patient can only still be in bed or to sit in the chair. Death occurs in many years from acceding diseases, mostly from pneumonia.
When the diagnosis is often difficult to distinguish the syndrome of Parkinson's disease and Parkinson's disease. You need to properly collect history, paying attention to a previous infection, in particular encephalitis, etc.
Treatment of symptomatic. You want to prevent alcohol and Smoking are shown therapeutic exercise, but this procedure should be done so that the patient from it did not get tired. Medicines prescribed drugs group belladonna; tablets : "Corbelli" (tablet contains 0.001g alkaloids root herb in terms of atropine), start with 1 pills at night, gradually increasing the dose from 3 to 5 tablets per day; tropatsin 1 tablet (0.01 g), 2 times a day. Synthetic atropinopodobnye drugs recommended Artan or trihexyphenidyl, start with one tablet to 0.001 g gradually add up to 5 or 6 tablets per day. To strengthen the effectiveness of medications can be added diphenhydramine 0,025-0,05 g 2 times a day. Nowadays surgical treatment, which is held in specialized neurosurgical institutions.

Parkinsonism [on behalf of the English. doctor Parkinson (J. Parkinson, 1755 - 1824)] is a syndrome characterized by a peculiar, impaired motor sphere, muscle tone, a number of changes of vegetative and mental functions. The symptom of Parkinson's disease occurs in inflammatory, vascular or other processes in the basal ganglia of the brain.
Clinical manifestations of Parkinson's syndrome is close to the shaking palsy (see), that is, Parkinson's disease, which is independent nosological form with characteristic pathogenesis and pathomorphology. Parkinsonizma symptoms (i.e. signs similar to those characteristic of the shaking palsy) is observed most often as a consequence of the epidemic lethargic encephalitis (see Encephalitis). This syndrome is called postentsefaliticheskom P. and has been described in connection with the epidemic lethargic encephalitis. In the future, the Parkinson's disease was described in the number of organic brain damage (in particular, intoxication) with the localization process in lower divisions.
Parkinson's postentsefaliticheskom P. and other types of symptomatic P. have pathomorphological features. So, in Parkinson's disease are observed sclerotic changes of vessels; inflammatory-degenerative - when postentsefaliticheskom parkinsonism; swollen and destructive - in other types P.
The symptoms are mainly hypertonic-akineticalkie violations. Very typical malorechenskoe shake (see) of the limbs, especially the top. For the hand movements in parkinsonism typical and bringing thumb ("riding pills"). Shake covers the head, the muscles, such as language, age, the soft palate. There is an increase of plastic tone (see Tone). The body of the patient is fixed in a bent position, given shoulders, legs bent at the elbow and knee joints. Much less frequent violent deviation head back and trunk extension.
Muscles when passive, especially repeated, movements growing plastic tone. Characteristic phenomena of amimie, rare blinking, no friendly movements while walking (characins). Abnormal muscle statics, but there is no paralysis. There is the so-called homeostatically syndrome: violation fixtures muscle tone and posture limbs to a certain pace and direction of movement. Movement in parkinsonism slowed down (bradykinesia).
Gait may vary from slow to fast, to run (propulse). Possible involuntary rapid steps towards (laterifolia) and posterior (Metropolia). The walk can be accompanied by shuffles feet, a Crouch. Maybe obezbecenje patient at different periods of time (rigid-akineticalkie syndrome). Stop motion patients the most frequent cornering, during the first steps.
It is noted a number of hyperkinesia: various tics of muscles of the face, most often the blinking eyes, sometimes short-reinforced flashing, long muscles batting eyelids. Often tonic spasms of the neck type torticollis. Especially characteristic postentsefaliticheskom of parkinsonism "spasm of sight convulsions eye muscles, when the eyeballs are discharged upwards
or to the side in seconds or minutes. It is observed with other forms of P. Frequent Tiki language myoclonic type or to the same effect of mioclonii soft palate. Sometimes there is more complicated violent moving acts: chewing, swallowing, yawning and a variety of dyskinesia.
When postentsefaliticheskom parkinsonism observed and vegetative disorders: increased salivation, increased saloobrazovanie on the head, especially on the face, cold and sweating of the hands and feet, excessive weight loss, and in more rare cases, and obesity. Describes violations of inhibition reaction. Pupillary reaction can be sluggish, sometimes there is the Argyll Robertson's syndrome (see) and a reverse symptom preserving the light reaction and lack of reaction to convergence. Marked increases, decrease of breath, palpitations, constipation. Described amenorrhea and other endocrine disorders.
Speech disturbance (see) wide from failure modulation (monotonous character of speech) to sharp slowness and bezzvuchno speech; sometimes there patter with long pauses, sometimes it loses clearselected, in some cases there is a tendency to multiple repetition of the same word with gradually fading volume (palilalia). Sometimes patients repeat the words and phrases (echolalia). Handwriting patients lose their usual character. Patients often write large or very small, minute handwriting. Further, the handwriting is illegible, broken.
Changing the mentality of the patient. Interests narrowed his focus around the disease. The patient loses the sense of tact, becomes sticky, annoying, Intrusive, selfish. Memory and formal mental abilities saved. There is reduction of the use of sick of his vocabulary. In very severe cases develop delusions and there is a need for placement in a psychiatric hospital.
The diagnosis. Sometimes parkinsonism difficult to distinguish from Parkinson's disease. Old or older age of the patient rather speaks for Parkinson's disease. If her symptoms are less dramatically, there is a great their uniformity, are less predominant lesion of one or the other, rarely observed isolated defeat some of the cranial nerves, is much less pronounced vegetative violations. Less dramatically speech is impaired and it is not so apparent as in parkinsonism, personality changes.