1. peripheral decarboxilase inhibitors
1.1. e.g. carbidopa
2. Step4: Hypothesis organization
2.1. parkinsonism
2.2. Huntington
2.3. metallosis
3. Step5: Learning Objectives
3.1. To know about parkinsonism and huntington disease
3.1.1. define
3.1.2. sign&symptoms
3.1.3. pathophysiology
3.1.4. causes
3.1.5. investigations
4. Step6: Review
4.1. Parkinsonism
4.1.1. cardinal manifestation
4.1.1.1. TREMOR
4.1.1.2. RIGIDITY
4.1.1.2.1. shuffling gait
4.1.1.2.2. mask face
4.1.1.3. BRADYKINESIA
4.1.1.4. POSTURAL INSTABILITY
4.1.2. MANIFESTATION
4.1.2.1. motor symptoms
4.1.2.1.1. shuffling gait
4.1.2.1.2. resting tremor
4.1.2.1.3. craniofacial
4.1.2.1.4. visual
4.1.2.1.5. MSK
4.1.2.1.6. gait
4.1.2.2. non motor symptoms
4.1.2.2.1. depression
4.1.2.2.2. anxiety
4.1.2.2.3. anosmia
4.1.3. pathophysiology
4.1.3.1. neurodegeneration
4.1.3.2. accumolation of body fluid
4.1.3.3. nigrostriatal pathway. is affected
4.1.3.3.1. indirect pathway predominate on the direct pathway
4.1.3.4. lewy bodies
4.1.3.4.1. accumolate in the olfactory tract first
4.1.3.5. genetics
4.1.3.5.1. park1
4.1.3.5.2. park2
4.1.3.5.3. park5
4.1.3.5.4. park8
4.1.3.6. ubiquitin
4.1.3.6.1. not degradation for misfolded
4.1.3.7. dopamine depletion
4.1.4. epidemiology
4.1.4.1. 12000/100000
4.1.4.2. over 60
4.1.4.2.1. 1%
4.1.5. causes
4.1.5.1. idiopathic
4.1.5.2. secondary causes
4.1.5.2.1. mptp
4.1.5.2.2. heroin
4.1.5.2.3. anti psychotic drugs
4.1.5.2.4. trauma
4.1.6. diagnosis
4.2. Huntington's disease
4.2.1. define
4.2.1.1. autosomal dominant
4.2.1.2. neurodegenerative disease
4.2.1.3. affect the indirect way
4.2.1.4. progressive
4.2.1.5. disease of adult hood
4.2.2. pathology
4.2.2.1. head of caudate nucleus affected
4.2.3. complications
4.2.3.1. psychological effect
4.2.4. sign and symptoms
4.2.4.1. chorea
4.2.4.1.1. disappear late in the disease
4.2.4.2. dementia
4.2.4.3. late appearing
4.2.4.3.1. dystonia
4.2.4.3.2. myoclonus
4.2.5. life expectency is around 15yo
4.2.6. investigations
4.2.6.1. having family history
4.2.6.2. genetic testing
4.2.6.2.1. 4q22
4.2.6.3. imaging
4.2.6.3.1. MRI
5. Step7: Inquiry plan
5.1. HISTORY
5.1.1. 69yo
5.1.2. suburban
5.2. PHYSICAL EXAMINATION
5.3. INVESTIGATION
6. Step8: Diagnostic decision
7. Step9:review
8. Step10: management
8.1. symptomatic treatment
8.1.1. the gold standard
8.1.1.1. carbidopa/levodopa
8.1.1.1.1. 25/100
8.1.1.1.2. used
8.1.1.1.3. givien in an empty stomach
8.1.1.1.4. freezing phenomonon
8.1.1.1.5. can't be used for long time
8.1.2. start with non-dopamenergic drugs
8.1.2.1. anticholinergic drugs.
8.1.3. dopamin agonist
8.1.3.1. ergot derivatives
8.1.3.1.1. valvulopathies
8.1.3.2. non-ergot derivatives
8.1.4. MAO inhibitors
8.1.4.1. high possibility of hallucination when used with levodopa
8.1.5. COMT inhibitors
8.1.5.1. entacapone
8.1.5.1.1. act peripherally
8.1.5.1.2. tolacapone
8.1.6. non-motor symptoms
8.1.6.1. to prevent hallucination
8.1.6.2. dementia
8.1.6.2.1. anticholinestrase inhibitors
8.1.6.3. seboric dermatitis
8.1.6.3.1. steroid cream
8.1.6.4. urinary urgency
8.1.6.4.1. oxybutinin
8.1.6.5. constipation
8.1.6.5.1. fluid intake
8.1.6.5.2. exercise
8.1.6.6. GI problem
8.1.6.6.1. domperidone
8.1.6.7. sailorrhea
8.1.6.7.1. oral anticholinergic
8.1.6.8. sexual dysfunction
8.1.6.8.1. either stopping the medications
8.1.6.8.2. sildenafil
8.1.6.9. orthostatic hypotenstion
8.1.6.9.1. stopping antihypertensive drugs
8.1.6.9.2. domaperidone
8.1.6.10. pain
8.1.6.10.1. gapapentin
8.1.6.11. sleep disturbances
8.1.6.12. PSYCHOSIS
8.1.6.12.1. antipsychotic drugs
8.2. non-pharmacological treatment
8.2.1. cognitive behavioral therapy
8.2.1.1. reduce anxiety
8.2.2. surgical therapy
8.2.2.1. transplanted SN
8.2.2.2. pallidetomy
8.2.2.3. thalmotomy
8.2.2.4. subthalatomy
8.2.2.5. D B S
8.2.3. exercise
8.2.4. patient education
8.2.5. social support
8.2.6. canes and walkers
8.2.7. occupational therapy
9. Resources
9.1. Harrison's
9.2. medscape
9.3. kumar
9.4. up-to-date
9.5. mayoclinic
9.6. parkinson.org
9.7. medicine.net
10. Step1
10.1. difficult words
10.1.1. with suffle
10.1.2. clumsy:moving and doing things in careless way
10.1.3. clenching
10.2. cues
10.2.1. 1- retied soldier
10.2.2. 2- he skipped a dental examiation
10.2.3. 3- 69yo
10.2.4. 4- posterior teeth discomfort in the last 6months .
10.2.5. 5- is appearant ige is considered more than the actual age.
10.2.6. 7- slowing down
10.2.7. 8- seems clumsy
10.2.8. 9- wooden face
10.2.9. 10-clenching his teeth is a habit for long time
10.2.10. 11recent deterioration in his oral hygen
10.2.11. 12-complain his face is stiff
10.2.12. symptos
10.2.12.1. 6-walking with a shuffle
11. Step2: problem formulation
11.1. 69yo retired soldier, whose appearant age seems older than his actual age, was refferd from a dentist to seek medical care for many changes including posterior teeth discomfort. shuffling gate was noticed and he is clumsy. wooden face with a habit of clenching his teeth.
12. Step3: Hypothesis generation
12.1. by Yousef
12.1.1. movement disorder related to age
12.1.2. muscle regidity
12.1.2.1. more release of ACH
12.2. by R. alsulamy
12.2.1. problem related to damage for
12.2.1.1. substantia nigra
12.2.1.2. Red nucleus
12.2.1.3. pyramidal and extrapyramidal tract
12.3. by Homoud
12.3.1. might be a prolem affecting
12.3.1.1. basal ganglion
12.3.1.1.1. activated(direct) or inactivated(indirect) by Dopamin
12.3.1.2. cerebellum
12.4. by Hassan
12.4.1. basal ganglia and substantia nigra are affecting the coordination
12.5. by Essam
12.5.1. movement disorder
12.5.1.1. mainly parkinson's
12.5.2. by Faris
12.5.2.1. infections or environmantal factors may lead to this pesentation
12.5.2.1.1. mercury disolvment
12.6. By kashi
12.6.1. neurological problem
12.6.2. generalized musculer problem
12.6.3. central problem
12.7. by Adeeb
12.7.1. more investigation to find the diagnosis