Parkinson’s disease

  • Progressive neurodegenerative movement disorder
  • Involves basal ganglia
  • Hypokinetic disorder
  • Impaired initiation of movement
  • Reduction in amplitude and velocity of movement
  • 1.5 times more common in men
  • Usually after 60 years age
  • Degeneration of cells in pars compacta of substantia nigra
  • Symptoms appear after 50% of dopaminergic neurons and 80% of striatal dopamine is depleted
Clinical picture
  • Asymmetry
  • Resting tremor
  • Good response to dopamine replacement therapy
  • Fatigue
  • Depression
  • Lack of coordination
  • Axial posture progressively flexed
  • Decreased swallowing, excess saliva and drooling
  • Constipation
  • Sweating abnormalities
  • Sexual dysfunction
  • Sleep disturbances
  • Seborrheic dermatitis
  • Swallow tail sign: Normally nigrosome (N1) has low iron content in substantia nigra pars compacta. Nigrosome is surrounded by iron rich pars reticulata demonstrating an intrinsic contrast. Loss of this contrast due to mineralization of nigrosome is seen in Parkinson’s
  • Mainstay is levodopa
  • Intractable cases – deep brain stimulators used. DBS seen in chest radiographs with leads ascending with tips in the region of subthalamic nuclei.