2023-10-31 15:58:35 Lianhe Daily Special Correspondent Huang Anqi/Reported by Chiayi Many patients will develop symptoms similar to Parkinson’s disease after stroke, and some patients only regard these symptoms as the sequelae of stroke.
Whenever the season changes from autumn to winter, it enters the peak period of stroke incidence when the temperature difference changes greatly. Grandma Li, who is in her 60s, often felt unable to use half of her limbs after a stroke, and her walking was slightly affected. Her family thought it was a sequelae of the stroke and only urged her to exercise more for rehabilitation without thinking too much about it. Unexpectedly, a few months later, Grandma Li’s physical condition deteriorated further, and she frequently experienced unsteady steps or tripping over herself. It was not until she went to the doctor again that it was discovered that her symptoms were caused by Parkinson’s disease. Fortunately, the condition gradually improved after treatment with Parkinson’s disease drugs.
STEP1 Know why it is easy to be confused
Xie Zongda, the attending physician of the Movement Disorders and Dementia Department of the Department of Neurology, Chiayi Chang Gung Memorial Hospital, explained that many patients will develop symptoms similar to Parkinson’s disease after stroke, such as stiffness of the limbs, slow movements, unsteady gait, etc. Patients only regard these symptoms as the sequelae of stroke without in-depth examination or follow-up. In some cases, Parkinson’s disease was diagnosed only after several years, delaying the golden treatment period.
The reason for the delay in diagnosis, Xie Zongda said, is that some patients may have underlying degenerative conditions in the brain of Parkinson’s disease, but the symptoms are relatively mild and do not affect daily life functions and may often be ignored. It was not until the patient developed progressively worsening gait instability and prone to falling in a relatively short period of time that he was diagnosed with the disease through a neurologist’s professional medical history inquiry, clinical neurological examination, and brain imaging tomography. Is it classic Parkinson’s disease, vascular Parkinson’s syndrome, or a mixed type.
STEP2: Identify the differences in symptoms
Xie Zongda, attending physician at the Department of Movement Disorders and Dementia, Department of Neurology, Chiayi Chang Gung Memorial Hospital.Image source/provided by Dr. Xie Zongda
Parkinson’s disease-like symptoms after stroke do still differ from typical Parkinson’s disease. Xie Zongda said that typical Parkinson’s disease will present symptoms of resting tremors of the hands and feet, stiffness of the limbs and slow movements, and it is usually asymmetrical. It starts on one side at first. In the middle stage of the disease, the gait will be unstable and it will be difficult to maintain a stable posture. And prone to falls, etc., which is a typical course of Parkinson’s disease.
However, symptoms similar to Parkinson’s disease that occur after a stroke are called vascular Parkinson’s syndrome. They usually occur after multiple strokes, and the locations of strokes are mostly around the periventricular, subcortical white matter, and basal ganglia. The main affected area is the lower body, also known as lower limb Parkinson’s syndrome. The main symptoms are unsteady gait, limb weakness, spasm, crooked face, mouth, slurred speech and other stroke sequelae; while upper limb asymmetrical tremors, Symptoms such as stiffness and slow movement are less common.
STEP3 Understand different treatment methods
Xie Zongda said that Parkinson’s “disease” is different from Parkinson’s “syndrome”. Typical Parkinson’s disease is a disease; syndrome represents a group of symptoms, such as slow movement, stiffness of limbs, tremors, etc. The causes behind these symptoms There are many types, which may be caused by stroke, drugs, infection, etc. It is necessary to clarify the factors behind it and take treatment.
Vascular Parkinson’s syndrome treatment:
Similar to stroke, drug treatment combined with rehabilitation exercises and control of stroke risk factors: e.g.
📍Control three highs
📍Quit smoking
📍Drink in moderation
📍Healthy eating
📍Exercise regularly
📍Control weight
📍Good sleep quality
Treatment of classic Parkinson’s disease:
Rehabilitation is also done through medication and exercise. The drugs mainly use two major drugs, namely levodopa and dopamine receptor agonists. It is worth noting that the treatment of typical Parkinson’s disease requires dosage adjustments at any time according to the course of the disease and the patient’s condition. Patients should maintain close communication with their doctors and put forward their own needs. For example, younger patients may consider using dopamine receptor agonists first to maintain a stable drug concentration in the body and avoid using higher doses of levodopa too early, which may cause drug effect fluctuations and dyskinesias. However, if this type of drug is used to treat vascular Parkinson’s syndrome, the degree of control is limited.
Whether it is Parkinson’s disease or Parkinson’s syndrome, Xie Zongda suggested that in order to detect suspected symptoms and confirm the diagnosis early, you can refer to the “Parkinson Finger Test” or “Parkinson Self-Assessment Scale” of the Taiwan Movement Disorder Society for testing. Actively controlling the factors that cause stroke after a stroke can reduce the damage caused by another stroke in the future and reduce the chance of developing vascular Parkinson syndrome.
STEP4 What types of Parkinson’s disease are there? Let’s see at once
Parkinson’s disease can be roughly divided into three categories according to different causes. Among them, many categories are subdivided according to different pathogenic mechanisms as follows:
Primary Parkinson’s disease (classic Parkinson’s disease):
📍Typical Parkinson’s disease: onset age is after 41 years old.
Early-onset Parkinson’s syndrome is called early-onset Parkinson’s syndrome if it occurs before the age of 41, and is divided into:
📍Young-onset Parkinson’s disease: The onset age is between 21 and 40 years old. The symptoms of juvenile-onset Parkinson’s disease are similar to those of typical Parkinson’s disease. It is due to the presence of Lewy bodies in the substantia nigra of the brain.
📍Juvenile Parkinson’s syndrome: The onset is before the age of 20. It is a mixture of symptoms similar to Parkinson’s disease and many different pathological characteristics. The patient does not have Lewy bodies in the brain that are unique to Parkinson’s disease patients, so it is called Parkinson’s syndrome. .
Atypical Parkinson’s disease (also known as Parkinson’s plus syndrome):
It is a type of progressive neurological disorder that commonly occurs in adults. During the course of the disease, it will cause a lack of dopamine in the striatum, resulting in clinical manifestations similar to Parkinson’s disease. In addition, there are other symptoms, also known as Parkinson’s syndrome.
Patients may initially be diagnosed with Parkinson’s disease, but as the disease progresses, 15% of patients will develop other atypical symptoms.
📍Multiple system degeneration: Symptoms combined with autonomic nervous system disorders, such as sexual dysfunction, dysuria, postural hypotension, balance disorder, etc.
📍Progressive superior ophthalmic nerve nucleus palsy: The patient’s eye movement will be restricted, especially the movement in the vertical direction. This type of patient progresses quickly and will be bedridden within 5 to 10 years of the onset.
📍Corticobasal degeneration: In addition to the general symptoms of Parkinson’s disease, there are also symptoms of unilateral limb stiffness and cerebral cortex abnormalities.
📍Diffuse Lewy body disease: Parkinson’s disease symptoms such as cognitive dysfunction such as dementia, depression, and hallucinations, fluctuating consciousness and slow movement, stiffness, tremors, and autonomic nervous system disorders.
Secondary Parkinson’s disease:
It is caused by various factors, including normobaric hydrocephalus, brain tumors, stroke, drugs or infection.
📍Normobaric hydrocephalus: Due to the accumulation of cerebrospinal fluid, damage to brain nerve tissue is caused. In addition to unstable gait, the symptoms are also accompanied by dementia, urinary incontinence, etc. The walking distance will become smaller, just like feet. Feeling like being stuck to the floor, rushing forward with broken steps. The symptoms are mainly difficulty in walking and less trembling.
📍Brain tumor: Brain tumors grow near the basal ganglia of the brain, which can compress motor nerves and cause movement disorders similar to Parkinson’s disease.
📍Stroke: Cerebral blood vessel occlusion leads to obstruction of blood flow in the blood vessels, resulting in symptoms such as a crooked face, slurred speech, unilateral limb weakness, and abnormal sensation. If the stroke occurs near the basal ganglia, which controls movement, the symptoms will be similar to Parkinson’s disease. Since the symptoms mainly occur in the lower limbs, it is also called lower limb Parkinson’s syndrome.
📍Drug: Drug-induced Parkinson’s disease usually occurs on both sides of the body, which is different from the unilateral onset of typical Parkinson’s disease. Commonly caused drugs are antipsychotics and antiemetics.
📍Toxins and infections: Like manganese and other metals, carbon monoxide and other compounds and infections, including AIDS, tuberculosis, etc., symptoms of Parkinson’s disease such as slow movement, stiffness, and unstable posture may also occur.
Parkinson’s disease, stroke, limb stiffness, regular exercise, cerebral vascular obstruction
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2023-10-31 07:58:35
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