Edema in Parkinson's Disease
Vegetative failure in Parkinson's disease. Forms of Parkinson's Disease.
The majority patients with Parkinson's disease As the disease progresses, symptoms of autonomic failure appear: constipation, impotence, orthostatic hypotension, thermoregulatory disorders.
Constipation in patients with Parkinson's disease associated with degeneration of neurons mesentericplexus and sometimes a paradoxical contraction (dystonia) of the pelvic musculature. Disorders of urination are associated with impaired function of the frontal lobe, regulating the function of detrusor of the bladder. A decrease in the production of dopamine in a black substance causes hyperreflexia of the detrusor, which is manifested by frequent urination and nicture. Less marked decrease in detrusor activity and dysfunction of the sphincter of the urethra.
Sexual disorders in Parkinson's disease arise as a result of the depression that often accompanies this disease, as well as as a result of the side effect of the beta-blockers used for suppressing tremor.
Orthostatic hypotension in Parkinson's disease can occur as a result of neuronal degenerationsympathetic ganglia, and in some cases - neurons of the hypothalamus. Dysfunction of the sympathetic system leads to a decrease in heart rate and cardiac output, a violation of the release of renin. With severe orthostatic hypotension, the disease must be differentiated from the syndrome of progressive autonomic failure with multisystem atrophy.
Violations thermoregulation in Parkinson's disease manifestations of sensations of chills, heat, violationsweating. In more severe cases, a malignant hyperthermic syndrome (similar to a malignant neuroleptic syndrome) is associated with blockade of DA-ergic neurons of the hypothalamus. It is manifested by a combination of fever, akinesia with dysphagia, water-electrolyte disorders, edema of the lung and brain, oliguria. Salivation, hyperhidrosis, greasiness of the skin, vasomotor lability, and rheology of the blood are observed.
Pain syndrome in Parkinson's disease. as a rule, is associated with muscular dystonia,which often occurs in the muscles of the legs, less often - the trunk and is often the result of inadequate therapy with levodopa. Other subjective disorders of sensitivity may be manifested by paresthesias, numbness, deep aching pains in the limbs.
In the "pure" form clinical forms. corresponding to the three main symptoms -trembling, rigid and akinetic - are observed only at the initial stage of the disease. As you progress in the clinical picture, a combination of these symptoms is usually observed, and then the clinical form is determined depending on the prevalence of certain symptoms: akinetic-rigid, rigid-trembling, trembling-rigid, trembling forms. Of course, with the progression of BP in the clinical picture, all the main symptoms can be combined. Therefore, some authors formulate the name of the clinical form of the three terms, placing them in a sequence that corresponds to the predominant symptom (for example, akinetic-rigid-jittery).
The data of different authors on the frequency clinical forms are contradictory. According to our observations, at the first treatment of patients to the doctor, the tremor-rigid form is noted in 37% of cases, akinetic-rigid in 32%, rigid-trembling - in 21% and akinetic - in 2% of cases.
Thus, more often "mixed" clinical forms of parkinsonism. It should be noted that, contrary to the opinion of someauthors that usually the clinical form of BP does not change throughout the life of the patient, in some patients with a prolonged course of the disease, one can observe the transformation of one clinical form into another.