Parkinson's disease

• Facts:
  Progressive loss of dopaminergic neurons in basal ganglia (substantia nigra)
  
  Characterized by overactivity of cholinergic neurons, and under activity of dopamine neurons
• History / PE:
  Resting (pill-rolling) tremor
  Rigidity, bradykinesia
  Hypokinetic, shuffling gait (narrow-based, NO arm swinging)
  Postural instability
• Diagnosis:
  Clinical diagnosis
  Lewy bodies (intraneuronal eosinophilic inclusions)
• Treatment:
  L-dopa (greater risk of dyskinesia )
  Trihexyphenidyl (anticholiinergic medication that is used in younger patients with resting tremor as primary complaint)
• See Also:
  Dopamine pathways
  Dementia diseases
• Associated With:
  Seborrheic dermatitis
• Differential Diagnosis:
  Lewy body dementia (visual hallucinations)
  Normal pressure hydrocephalus (wide-based gait)