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Parkinson's Disease Clinical Features
- rest tremor
- bradykinesia
- rigidity
- asymmetric onset
- substantial improvement with levodopa
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Parkinson's Disease Dx
no reliable diagnostic test, Dx purely on clinical grounds
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Parkinsons Disease Macroscopic Pathology
loss of pigment in substantia nigra and locus coeruleus
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Parkinson's Disease Microscopic Pathology
cell loss in substantia nigra, other brainstem nuclei, nucleus basalis of meynert, hypothalamus, sympathetic ganglia, olfactory bulb
lewy bodies and lewy neurites
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Parkinson's Disease Pathophysiology
Lewy bodies contain alpha-synuclein, ubiquitin and some other proteins and are involved in pathogenesis
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Progressive Supranuclear Palsy Clinical Features
- parkinsonism
- supranuclear gaze palsy
- prominent truncal rigidity
- dysarthria, dysphagia early
- progressive (8 years until wheelchair)
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Progressive Supranuclear Palsy Macroscopic Pathology
atrophy, depigmentation
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Progressive Supranuclear Palsy Microscopic Pathology
neuronal loss, neurofibrillary tangles, other tau deposits
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Progressive Supranuclear Palsy Pathophysiology
tau gene mutations (4-repeat isoforms) of tau present
signs of oxidative stress at autopsy
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Corticobasal Degeneration Clinical features
- clumsiness, stiffness, or jerking of one arm
- dystonia
- hemispatial neglect when left body affected
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Corticobasal Degeneration Macroscopic Pathology
- atrophy frontal and parietal cortex, often asymmetric
- depigmentation substantia nigra and locus coeruleus
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Corticobasal Degeneration Microscopic Pathology
- tau inclusions
- swollen neurons; resemble those of Picks disease
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Multiple System Atrophy Clinical Features
combination of parkinsonism, cerebella dysfunction, autonomic insufficiency
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