| Abstract | Parkinsonizam označava klinički sindrom koji uključuje tremor u mirovanju,
rigiditet, bradikineziju, fleksorni stav, gubitak posturalnih refleksa i freezing fenomen,
a nastaje zbog poremećaja strukture ili funkcije motoričkih puteva bazalnih ganglija.
Iako je najčešći uzrok parkinsonizma Parkinsonova bolest (PB), cijeli niz drugih
bolesti i patoloških stanja također može biti uzrokom, a zajedničkim imenom nazivaju
se sekundarni parkinsonizam.
Lijekovima inducirani parkinsonizam (LIP) najčešći je oblik sekundarnog
parkinsonizma. Lijekovi koji najčešće induciraju LIP su tipični antipsihotici, međutim
uzrok mogu biti i atipični antipsihotici, gastrointestinalni prokinetički lijekovi, blokatori
kalcijevih kanala, antiepileptici te brojni drugi lijekovi.
Parkinsonizam uzrokovan cerebrovaskularnom bolešću (VP, vaskularni
parkinsonizam) drugi je najčešći oblik sekundarnog parkinsonizma, s heterogenom
kliničkom slikom, patofiziologijom i promjenama na MR-u.
Brojni virusi se povezuju s razvojem parkinsonizma. Tradicionalno virus
influence, a danas i HIV, Epstein-Barr virus, Cytomegalovirus te mnogi drugi DNA i
RNA virusi.
Različiti toksini također su poznati po sposobnosti indukcije parkinsonizma, a
kao najčešći navode se ugljikov monoksid, mangan, MPTP, metilni alkohol i cijanid.
Zatajenje jetre i bubrega, bolesti štitnjače i paratireoidnih žlijezda mogu se
prezentirati kliničkom slikom parkinsonizma te izazvati diferencijalno-dijagnostičke
dvojbe prema PB.
Budući da je na temelju kliničke slike teško razlikovati sekundarni
parkinsonizam od PB, u praksi dolazi do zabune i bolesnicima se nepotrebno
propisuju antiparkinsonici.Stoga je kod bolesnika s parkinsonizmom nužna detaljna
anamneza, klinički pregled, laboratorijska i neuroradiološka obrada kako bi se
izbjegle dijagnostičke i terapijske zabune. |
| Abstract (english) | Parkinsonism indicates a clinical syndrome involving tremor at rest, rigidity,
bradykinesia, flexed posture, loss of postural reflexes and the freezing phenomenon,
caused by the disorder of the structure or function of motor pathways of the basal
ganglia. Although the most common cause of parkinsonism is Parkinson disease
(PD), a number of other diseases and pathological conditions can also be the cause.
These states are jointly called secondary parkinsonism.
Drug-induced parkinsonism (DIP) is the most common form of secondary
parkinsonism. Drugs that usually induce DIP are typical antipsychotics. However,
atypical antipsychotics, gastrointestinal prokinetic drugs, calcium channel blockers,
antiepileptic drugs as well as many other medicaments may also be the cause.
Parkinsonism caused by cerebrovascular disease (vascular parkinsonism) is
the second most common form of secondary parkinsonism, with heterogeneous
clinical features, pathophysiology and changes in the MRI.
Many viruses are associated with the development of parkinsonism.
Traditionally, influenza virus, but recently HIV, Epstein-Barr virus, Cytomegalovirus,
and many other DNA and RNA viruses have been known to cause parkinsonism.
Various toxins are also known for their ability to induce parkinsonism, and the
most common are carbon monoxide, manganese, MPTP, methyl alcohol and
cyanide.
Liver and kidney failure as well as thyroid and parathyroid glands diseases
may present with a clinical picture of parkinsonism and cause a differential diagnostic
dilemma to the PD.
Since it is difficult to distinguish secondary parkinsonism from PB based only
on clinical symptoms, there is confusion in practice and antiparkinsonic drugs are
unnecessarily prescribed to patients. To avoid diagnostic and therapeutic mistakes,
detailed medical history and further diagnostic procedures are necessary. |
