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Parkinsonizm
Dr Mehmet Güney ŞENOL
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Dr Mehmet Güney ŞENOLE-mail: [email protected] Tel: +902165422020 – 3803
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Sunum Planı
• Patofizyoloji• Tanı• Klasifikasyon• Görüntüleme
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Dopaminerjik Sinaps
Hücresel cevap
D3
D2
D3
Dopamin Taşıyıcı
D1AD2D4
Tyrozin
L-Dopa
Dopamin
DaTSCAN
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Beyin Bankası Kriterleri
• Basamak 1Parkinson sendromunun tanısı
• Basamak 2İdiopatik parkinson hastalığının dışlanması
• Basamak 3İdiopatik parkinson hastalığını destekleyici kriterler
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Basamak 1-Parkinson sendromunun tanısı
• Bradikinezi + en az 1 tane takip eden kriter• Kas rijiditesi• 4 –6 Hz İstirahat tremoru• Postural instabilite
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Basamak 2-dışlama kriterleri
• Tekrarlayan inme• Tekrarlayan kafa travması• Ensefalit tanısı konulması• Serebellar belirtiler• Erken otonomik tutulum• Supranükleer bakış felci• Nöroleptik ilaçlar• Levodopaya cevapsızlık
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Basamak 3-olumlu destekleyici kriterler
• [>3 ‘kesin’ PH ]• Tek taraflı başlangıç• İstirahat tremoru• İlerleme • Israr eden asimetri• Mükemmel levodopa cevabı• Levodopa ilişkili kore• Levodopa cevabı >=5 yıl• Klinik gidiş >= 10 yıl
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Tanının doğruluğu
• Beyin bankası post mortem serileri• % 24 hata oranı• % 10 sonraki çalışmalarda • % 2 hareket bozuklukları uzmanı
• Topluluk serileri• > % 50 hata oranı
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Tanı doğru mu?
• PH tanısı konması zor• Tanı için test yok• Tanı klinik olarak yapılıyor• DAT spect incelemesi kısıtlı• Hata oranı yüksek nörologlar arasında %25• Takip ve tanıyı gözden geçirme önemli
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• Kalsiyum kanal blokerleri (diltiazem, nifedipine, verapamil), • Manoamin baskılayıcılar (reserpine, tetrabenazine), • Antiaritmikler (amiodarone),• Antikonvulzanlar (phenytoin, sodium valproate), • İmmunsupresan veya kemoterpötikler (cyclosporine,
vincristine, busulfan, cytosine arabinoside, doxorubicin), • Lityum, prokain, α-metildopa, klorokin, buspirone, ve yüksek
doz diazepam
• Gizli nöroleptik – metoklopromid, proklorperazine
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Dopamin Transport Görüntüleme
•Parkinson hastalığı•Progressif Supranükleer Palsi•Multi Sistem Atrofi
•Esensiyal Tremor•Nöroleptik İlişkili Parkinsonizm•Vasküler hastalıklar
Anormal Normal
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Sorulacak 9 soru
• Bulgular simetrik başlamış mı?• Aile öyküsü var mı?• İlaç• Ortostatik hipotansiyon inkontinans impotans• Piramidal bulgu• Erken postural instabilite• Bakış felci• Erken başlangıçlı demans, apraksi var mı?• Levodopaya cevap var mı?