Limb tremors
Introduction
Introduction Parkinson's disease is a degenerative disease of the substantia nigra and nigrostriatal pathways in adults over the middle age. The American APDA said that people who were younger than 40 years old began to have young Parkinson's disease. The etiology of primary tremor paralysis is not known. About 10% of patients have a family history; some patients may have encephalitis, cerebral arteriosclerosis, brain trauma, hypoparathyroidism, carbon monoxide, manganese, mercury, cyanide, and blood. Ping, phenothiazine poisoning and antidepressants (methylamine oxidase inhibitors, etc.) can cause Parkinson's disease-like Parkinson's syndrome.
Cause
Cause
The cause of Parkinson's disease is not yet clear. It is currently recognized that the cause of the disease is the degeneration of nerve cells, the main lesions in the substantia nigra and striatum. There is a kind of nerve cells called substantia nigra cells, the gradual decrease in the number of substantia nigra cells and the gradual loss of function, resulting in a decrease in a substance called dopamine, which causes the above symptoms. According to animal experiments and epidemiological results, Parkinson's disease has a certain relationship with heredity.
Examine
an examination
Related inspection
CT examination of anti-neuronal nuclear antibodies (Hu,Ri)
A report on the epidemiological study of Parkinson's disease in China shows that the total number of people suffering from Parkinson's disease in China has reached 1.72 million, and the prevalence of Parkinson's disease in people over 55 years old is nearly 1%. However, patients with Parkinson's disease have mixed some of the early symptoms of Parkinson's disease into normal aging of bodily functions, which has delayed the timing of treatment.
Diagnostic criteria for Parkinson's disease
(1) Clinical manifestations: Most patients with Parkinson's disease develop after the age of 60, and occasionally those who are in their 20s. The onset is more insidious, showing a slow development and gradually increasing. Mainly manifested as: tremor (often the first symptom), muscle rigidity, bradykinesia, abnormal posture gait, mouth, pharynx, diaphragmatic dyskinesia.
(2) Auxiliary examination: High-performance liquid chromatography (HPLC) can detect the decrease of HVA (high vanillic acid) content in cerebrospinal fluid and urine. Brain CT can have widening of the sulcus and enlargement of the ventricles.
(3) Excluding Parkinson's syndrome caused by encephalitis, cerebrovascular disease, poisoning, trauma, etc., and distinguish it from snoring, tension, and senile tremor.
Diagnosis is mainly based on typical symptoms, and sometimes it is necessary to use an auxiliary examination for identification.
Diagnosis
Differential diagnosis
Mainly differentiated from Parkinson's syndrome and idiopathic tremor, benign tremor.
(1) Parkinson's syndrome after encephalitis:
The Parkinson's syndrome caused by lethargy encephalitis has not been reported for nearly 70 years, so Parkinson's syndrome disappears after encephalitis caused by this encephalitis. In recent years, patients with viral encephalitis have been reported to have Parkinson-like symptoms, but this disease has obvious infection symptoms, which may be accompanied by symptoms of nervous system damage such as cranial nerve palsy, limb paralysis, convulsions, coma, etc. Cerebrospinal fluid may have a small number of cells ~ Increased degree, increased protein, reduced sugar, etc. After the condition is relieved, the Parkinson-like symptoms are relieved and can be differentiated from Parkinson's disease.
(2) Hepatolenticular degeneration:
Recessive hereditary diseases, about one-third of family history, adolescent onset, may have increased limb muscle tone, tremor, mask-like face, torsion and other extrapyramidal symptoms. It has characteristic features such as liver damage, corneal KF ring and serum ceruloplasmin decrease. Can be identified with Parkinson's disease.
(3) Essential tremor:
Is a dominant genetic disease, manifested as head, jaw, limb involuntary tremor, tremor frequency can be high or low, high frequency is similar to hyperthyroidism; low frequency is similar to Parkinson's tremor. The disease has no reduction in exercise, increased muscle tone, and posture reflex disorder, and disappears after drinking, and the treatment of cardiotonic treatment can be differentiated from primary Parkinson's disease.
(4) Progressive supranuclear palsy:
The disease is also common in middle-aged and elderly people, and the clinical symptoms may include extrapyramidal symptoms such as muscle rigidity and tremor. However, this disease has prominent eye gaze disturbance, muscle rigidity is heavy on the trunk, limb muscle involvement is light, and the flexibility of the limb is maintained, the neck extensor tension is increased, and the neck overextension and Parkinson's disease neck flexion are apparent. Different, can be identified with Parkinson's disease.
(5) Shy_Drager syndrome:
Clinically, there are often extrapyramidal symptoms, but because of prominent autonomic symptoms, such as: syncope, orthostatic hypotension, sexual function and bladder dysfunction, levodopa preparations are ineffective, and can be differentiated from Parkinson's disease.
(6) Drug-induced Parkinson's syndrome:
Excessive use of reserpine, chlorpromazine, haloperidol and other antidepressants can cause extrapyramidal symptoms, due to a significant history of medication, and can be identified after withdrawal.
(7) Benign tremor:
Refers to physiological tremors (invisible to the naked eye) and functional tremors without brain organic lesions. Functional tremor includes:
1. Physiological tremor is enhanced (visible to the naked eye), and most of the posture tremor is related to the enhanced response of adrenergic; also seen in certain endocrine diseases such as pheochromocytoma, hypoglycemia, hyperthyroidism;
2. Cocaine and alcoholism and side effects of some drugs. Caries tremors, mostly heart-induced causes, distracting can alleviate tremors.
3. Others: tremors when emotions are intense and when doing fine movements. Benign tremor is clinically characterized by no such manifestations as Parkinson's disease such as myotonia, decreased movement, and abnormal posture.
