Parkinson's disease

Pathology

• Idiopathic, degenerative
• progressive death of dopaminergic neurone in substantia nigra
• relative excess of acetylcholine

Onset usually around 6th-7th decade

Triad of classical symptoms

• akinesia/bradykinesia (usually upper body)
  
• resting tremor (asymmetrical, abolished by movement)
  
• rigidity (asymmetrical)

Other features

• lack of arm swing
• short step
  
• Parkinsonian face (flat face?)
• postural instability
• dementia

Examination

• bradykinesia: do alternate supination/pronation tap
• rigidity: check tone, remember to distract the patient

Investigation

• therapeutic trial of levodopa (walking test before and after taking levodopa)

Management

• education and support
• physiotherapy, occupational therapy, speech and language therapy
• drugs (levodopa, sinemet, selegiline)

Differentials

• essential tremor
• Alzheimer
• drug
• Lewy body dementia
• multisystem atrophy
• progressive supranuclear palsy
  

Headache

• commonest headache - tension headache
• commonest debilitating headache - migraine
• commonest brain tumour - brain mets

1 question that would distinguish between different types of headache:

what would you do when you get the headache?

• lie down and sleep - migraine
• keep on doing activity as before - tension headache
• bang head with hand/on the wall - cluster headache