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Parkinson's disease

Resolved Question:

My GP’s guess is that I have Parkinson’s and has referred me to a specialist. I told him I thought it might be MS. That was his second guess. I would like a second opinion since I have to wait so long to see the specialist. I realize that a firm diagnosis may take years but I want to end some uncertainty if I can.

Test Results:
BP: 157/124 (now 122/75 after med)
MICROALBUMIN, UR, QN, DETECTION LIMIT <= 20 MG/L: 34.4
CREATININE, URINE: 270.5
MICROALBUMIN/CREATININE: 12.7
C-REACTIVE PROTEIN: 1.2
ESR: 1
HGBA1C: 6
SODIUM: 142
POTASSIUM: 3.8
CREATININE: 1.13
GLOMERULAR FILTRATION RATE: 68
ALT: 40
CHOLESTEROL: 221
HDL: 51
LDL: 132 (Dr is going to put me on med’s)
TRIGLYCERIDE, NONFASTING: 221
CHOLESTEROL, NON-HDL: 170
TSH: 2.22

Presented Symptoms:
• Neurology appointment not until the end of Feb. MRI scheduled for next week. Neck x-rays already done. No recent known physical damage.
• Severe symptoms started with a cold on 12/18. They could have been masked and very minor for up to 5 years. Symptoms started with extreme overall body fatigue.
• My overall muscle control mirrors that of someone tipsy; at worst I weave, I stumble, I knock over things, I reach for something and miss, walk like a landlubber on a ship. This tends to come and go in waves. It can almost disappear before bed or in early AM.
• Right-side/arm most affected, right leg next most, to a degree hips and left to a minor extent occasionally.
• No loss of control of tongue or smile. Dr. tested cranial control and all seemed OK. Checkup from next up OK
• Skin feels itchy-dry, slightly tingling from right zygomatic bone to across chest and shoulder.
• When reaching for something my right hand hunts, bobs and jerks 1-2” upto 3” in different directions off track.
• Walking mid-day my hips have a wobble and right leg seems to miss mark sometimes, and I develop a slight right sided limp. Left leg has no ACL but seems stronger/dominate now.
• When out of sight my hand tends to miss objects reached for more often. More control when object is in sight and concentrated on. My right side is now much weaker than my left.
• Feeling fatigued. Sensation like one feels after over exercise vs lack of sleep. Worse in mid-day after being active, but I also frequently need naps in mid-day now.
• Fatigue comes and goes, I can spend a few hours at the zoo and only feel like I need a nap on one day but a one block drive to the grocery can leave me exhausted and breathing heavy on the next. (Blood O2 good)
• Arms feel heavy like wearing weights. Muscles lack energy. Since 1/12 have noticed a mild knotted feeling in some muscles (back, neck, arm) but still have good range of motion.
• Don’t feel like I’m getting enough air. Lungs feel “tired”, I get winded easily, Inhale easy, exhale quickly.
• Occasionally get cramps in throat while eating resulting in coughing up food with phlegm.
• Restless leg
• Eyes seem OK, but fast movements are annoying like I have a painless migraine affecting vision. Less tolerant of noises like noisy restaurants as well.
• Unusual diminished ability to think creatively, zones out like a day walking zombie

• The following preexisting conditions have masked or allowed me to excuse away the symptoms for a long time:

o I have dysthymiac depression (drugs seem ineffective and I get hit hard by side effects so my quality of life is far better without meds) but am familiar with the extent of my symptoms and they are well managed. Recent life events haven’t made this easier but I feel the symptoms are not directly connected.
o I work rotating shifts and have 12hr jet lag weekly causing disrupted sleep but have managed that for a very long time and I feel the symptoms are not directly connected.
o I am overweight and have lost 6lb since Christmas. My weight has had a minor effect on my sleep but not severe.
o I have eczema.
o I had essential tremor which has pretty much disappeared.


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hi,

Thank you for posting your query at DoctorSpring.com. I have read your detailed symptom list and I must appreciate that, as it was very helpful.

I would agree with your GP that these symptoms suggest a diagnosis of Parkinson's disease (PD).

However, in view of high BP and cholesterol, we also need to exclude a diagnosis of vascular parkinsonism, which is caused due to brain ischemia (lack of blood flow to brain).

PD is a neuro-degenerative disease, where the neurons producing dopamine are damaged, and so, PD tends to get worse over time. Vascular parkinsonism, on the other hand, improves with treatment. MRI of brain would help in final diagnosis.

Even though, I do not think it is MS, that can also be excluded with MRI studies.

I hope it helps. Please get back if you have any follow up queries.

Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Thank you for the reply. My symptoms are mostly upperbody and my primary symptom is shake. Would that make Vascular less likely than stanard PD?


Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back.

Yes, you are correct. In cases of vascular parkinsonism, the lower body is more affected.
Shake could occur in both- PD as well as vascular parkinsonism.

Best wishes, Would be glad to answer if you have any further queries.
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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