Rural Emergency Medicine

This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder.
Parkinsons: Dopamine stops working deep in brain, movement centres fail, shake at rest, slow down and ratchet. Time drugs perfectly. @Elytherius

PATHO: Progressive degeneration of DA neurons in S.nigra with loss of catecholaminergic neurons & gliosis. Synuclein and parkin genes involved. Lewy bodies (α-synclein aggregates).

CFs: Tremor, Rigidity Ankinesia/Bradykinesia, Postural instability, ANS dysfunction, Depression. DGEMMS of PD.
D ysphagia, drooling, ↓ voice
G ait: hesitation
E ye: no blink, flutter when closed
M icrographia
M ask-like faces
S ubcortical dementia

Dx Criteria: 2+ of Tremor, rigidity or badykinesia

  1. Male
  2. FHx
  3. Head injury
  4. Rural
  5. Pesticide exposure

Tx: Assess disability, medical therapy, respite care, surgery (DBS), exercise 
Meds: Levodopa – replaces DA in S.nigra. can be combined with carbidopa.
  • DAR antagonists – monotherapy or with L-Dopa
  • Amantadine, COMT inhibitors
  • MAOi – inhibit breakdown of DA
  • Anticholinergics: Early PD

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