Chapter: Medicine and surgery: Nervous system

Extrapyramidal signs (Parkinsonism) - Patterns of sensory loss

Appearance: Expressionless face. Drooling saliva. Resting tremor which is slow and classically pill rolling (abduction-adduction of thumb with flexion– extension of the fingers).

Extrapyramidal signs (Parkinsonism)

Appearance: Expressionless face. Drooling saliva. Resting tremor which is slow and classically pill rolling (abduction-adduction of thumb with flexion– extension of the fingers). The tremor is improved with action, but worse on concentration (ask the patient to count backwards from 100 in serial 7’s).

Speech: Monophonic, quiet. Tendency to peter out. Tone: Cogwheel rigidity due to increased tone together with tremor. Power, reflexes, sensation and co-ordination are normal.

Bradykinesia (slowness in movements) is noticeable when doing alternate hand tapping movements, or touching the thumb to each finger in turn. Micro-graphia (small, spidery handwriting).

Gait and posture: A flexed position with head drooped, shoulders and spine flexed, knees slightly flexed. Initiation of movement is impaired (hesitancy) with the appearance of falling into walking. The gait is slow and shuffling with reduced arm swing. A festinating gait is when the patient looks as though they are shuffling in order to keep up with their centre of gravity, and then has difficulty in stopping and turning round.

Tremor

The three groups of tremor are distinguished by observation (see Table 7.4).

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail

Medicine and surgery: Nervous system : Extrapyramidal signs (Parkinsonism) - Patterns of sensory loss |