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Differential

Parkinsons
Atypical Parkinsons
Dementia with Lewy Body
Progressive Supranuclear Palsy
Multiple System Atrophy
Corticobasal Syndrome
Parkinsons Disease

Symptoms: Bradykinesia, Postural Instability, Tremor, Rigidity


Why: loss of dopamine in substantia nigra. Lewy bodies made of alpha-synuclein
Mostly idiopathic, some genes include: alpha synuclein, parkin, DJ-1, PINK1 (PTEN-induced
kinase), UCH-L1 (ubiquitin car- boxy-terminal esterase L1), and LRRK2 (leucine rich repeat
kinase 2)
Treatment: start with Sinamet (Levadopa/carbidopa), then move to dopamine agonists
Anticholinergics for tremor
DBI for STN, GPi, thalamus
Progressive Supranuclear Palsy

AKA Steele Richardson Olszewlski Syndrome


Vertical supranuclear gaze palsy
Buildup of tau protein in the frontal lobes, brainstem, and substantia nigra.
Essentially all patients with PSP have H1 haplotype of the MAPT that codes for tau
protein Chr 17.
but a lot of the population has this, so it isnt sufficient to just have this
No treatment- just work on symptoms
Falls are usually an early sign
Criteria
Parkinsons vs PSP
Treatment

No treatment really, just symptoms


Amantadine can help with gait, dysphagia, apathy. not the best for elderly
Levadopa/carbidopa could help with rigidity, not as helpful as in PD
Antifall measures are very important in these patients
Hummingbird Sign
Fun Fact

Charles Dickens may have been the first person to write about PSP in The Lazy Tour
of Two Idle Apprentices
chilled, slow, earthy, fixed old man. A cadaverous man of measured speech. An old man who
seemed as unable to wink, as if his eyelids had been nailed to his forehead. An old man whose eyes
two spots of fire had no more motion that [sic] if they had been connected with the back of his skull by
screws driven through it and riveted and bolted outside, among his grey hair. He had come in and shut
the door and he now sat down. He did not bend himself to sit, as other people do, but seemed to sink
bolt upright, as if in water, until the chair stopped him.
References

Boeve, Bradley F. "Progressive supranuclear palsy." Parkinsonism & related disorders 18 (2012): S192-S194.

Burn, David J., and Andrew J. Lees. "Progressive supranuclear palsy." Handbook of clinical neurology 84 (2007): 327-349.

Golbe, Lawrence I. "Progressive supranuclear palsy." Seminars in neurology. Vol. 34. No. 02. Thieme Medical Publishers,
2014.

Duvoisin, Roger C., Lawrence I. Golbe, and Frederick E. Lepore. "Progressive supranuclear palsy." Can J Neurol Sci14.3
Suppl (1987): 547-54.
Thank you!