The Patient with Parkinson’s Disease

  • Michael S. Ackerman


A 62-year-old man with a 6-year history of Parkinson’s disease, treated with Sinemet 25/250 mg b.i.d. and Amantadine 100 mg. b.i.d., was brought to the ER by Emergency Services personnel. The patient’s family had become alarmed when he did not answer the telephone that morning. They came to his home and found him on the floor, confused and unable to rise. It was estimated that the patient had been disabled for a period of 18–24 hours. On physical exam, the patient was a thin cachetic man, somewhat disoriented, displaying diffuse tremor, pinrolling movements, and stiff facial expresion. Blood pressure, supine, was recorded at 140/80, heart rate 90/min. Upon sitting, blood pressure was 90/60 and heart rate 116/min. The patient was also noted to have a marked deformity of the right hip which was extremely painful on attempted rotation. X-ray of the right hip revealed a fracture of the femur.

Laboratory data was remarkable for a hematocrit of 47%, and BUN/ creat. of 41/1.3. Chest x-ray within normal limits.

He was scheduled for open reduction and internal fixation of the right hip as soon as possible.


Caudate Nucleus Parkinsonian Patient Drug Holiday Anesthetic Consideration Olivopontocerebellar Atrophy 
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  1. 1.
    Adams RD, Victor M: Principles of Neurology New York: McGraw-Hill 1985;874–97.Google Scholar
  2. 2.
    Ngai SH: Parkinsonism, levodopa, and anesthesia. Anesthesiology 1972; 37(3):344–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Hornykiewicz O: Dopamine (3-hydroxytyramine) and function. Pharmacol Rev 1966; 18:925–64.PubMedGoogle Scholar
  4. 4.
    Carlsson A, Lindquist M, Magnusson T, et al: On the presence of 3 hydroxytyramine in brain. Science 1958; 127:471.PubMedCrossRefGoogle Scholar
  5. 5.
    Cote L, Crutcher MD: Motor functions of the basal ganglia and diseases of transmitter metabolism, in Kandel ER, Schwartz JH (eds): Principles of Neural Science, Elsevier New York: Elsevier, 1985; 523–34.Google Scholar
  6. 6.
    Erlinger H, Hornykiewicz O: Verteilung von Noradrenalin und Dopamin (3-Hydroxytyramine) im Gehirn des Menschen und ihr Verhalten bei Erkrankungen des extrapyridaren Systems. Klin Wochenschr 1960; 38:1236–39.CrossRefGoogle Scholar
  7. 7.
    Sudarsky, L: Management of Parkinson’s Disease: 1987. Resident Staff Phys 1987; 33(3):29–37.Google Scholar
  8. 8.
    Rivera V, Keichian A, Oliver R: Persistent parkinsonism following neuroleptanalgesia. Anesthesiology 1975; 28(5):635–37.CrossRefGoogle Scholar
  9. 9.
    Hoehn MM, Yahr, MD: Parkinsonism: onset, progression and mortality. 1967; Neurology 17:427.Google Scholar
  10. 10.
    Cotzias GC, Van Woert MH, Schiffer LM: Aromatic amino acids and modification of Parkinsonism. N Engl J Med 1967; 276:374–79.PubMedCrossRefGoogle Scholar
  11. 11.
    Weiner W, Koller WC, Perliks S, et al: Drug holiday and the management of Parkinson’s disease. Neurology 1980; 30:1257–61.PubMedGoogle Scholar
  12. 12.
    Markham CH: The on-off side effect of L-dopa, in McDowell F, Barbeare A (ed): Advances in Neurology, Vol. 5 Second Canadian-American Conference on Parkinson’s disease. New York: Raven Press 1974;287–395.Google Scholar
  13. 13.
    Pycock CJ, Marsden CD: Central dopaminergic receptor supersensitivity and its relevance to Parkinson’s disease. J Neurol Science 1977; 31:113–31.CrossRefGoogle Scholar
  14. 14.
    Mayeux R, Stern Y, Mulvey K, et al: Reappraisal of temporary Levodopa withdrawal (“drug holiday”) in Parkinson’s disease. N Engl J Med 313: 724–28.Google Scholar
  15. 15.
    Gildenberg PL: The present role of stereotactic surgery in the management of Parkinson’s disease, Advances in Neurology 1984;40,447–52.PubMedGoogle Scholar
  16. 16.
    Gildenberg PL: The present role of stereotactic surgery in the management of Parkinson’s disease, in Hassler RG, Christ JF (eds): Parkinson-Specific Motor and Mental Disorders. Advances in Neurology, Vol. 40. New York: Raven Press 1984; 447–52.Google Scholar
  17. 17.
    Freed WJ: Functional brain tissue transplantation: reversal of lesion-induced rotation by intraventricular substantia nigra and adrenal medulla grafts. Biol. Psychiatry 1983; 18:1205–67.PubMedGoogle Scholar
  18. 18.
    Freed WJ, Cannon-Spoor HE, Wyatt RJ: Embryonic brain grafts in an animal model of Parkinson’s disease; Criteria for human application. Appl Neurophysiol 1984; 47:16–22.PubMedGoogle Scholar
  19. 19.
    Backlund EO, Granberg PO, Hanberger B, et al: Transplantation of adrenal medullary tissue to striatum in Parkinsonism. First clinical trials. J Neurosurg 1985;62:169–73.Google Scholar
  20. 20.
    Madrazo I, Drucker-Colin R, Diaz V, et al: Open microsurgical autograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson’s disease. N Engl J Med 1987; 316:831–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Drucker-Colin R, Madrazo I, Shkurovich M, et al: Open microsurgical autograft of patients with Parkinson’s disease. Schmitt Neurological Sciences Symposium. June 30-July 3, 1987, Rochester, NY.Google Scholar
  22. 22.
    Gildenberg PL: Surgical therapy of movement disorders, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill 1985; 2507–16.Google Scholar
  23. 23.
    Agid Y, Javoy-Agid F: Peptides and Parkinson’s disease. Trends Neurosci 1985; 7:30–35.CrossRefGoogle Scholar
  24. 24.
    Iacono R, Sandyk, R: Adrenal medullary tissue transplantation in Parkinson’s disease. J Neurosug 1988; 68:158.Google Scholar
  25. 25.
    Cullen BF: Anesthesia for patients with Neurologic Disease. ASA Refresher Courses in Anesthesiology 1983; 11:59.CrossRefGoogle Scholar
  26. 26.
    Aita JF: Why patients with Parkinson’s disease fall. JAMA 1982; 247(4): 515–16.PubMedCrossRefGoogle Scholar
  27. 27.
    Wiklund RA, Ngai S: Rigidity and pulmonary edema after Innovar in a patient on levodopa therapy: report of a case. Anesthesiology 1971; 35(5):545–47.PubMedCrossRefGoogle Scholar
  28. 28.
    Ngai SH, Wiklund RA: Levodopa and surgical anesthesia. Neurology 1972; 22:38–42.Google Scholar
  29. 29.
    Hetherington A, Rosenblatt R: Ketamine and paralysis agitans. Anesthesiology 1980; 52(6):527.PubMedCrossRefGoogle Scholar
  30. 30.
    Glisson SN, EL-Etr AA, Bloor BC: The effects of ketamine upon norepinephrine and dopamine levels in rabbit brain parts. Naunyn Schmiedebergs Arch Pharmacol 1976; 295:149–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Gravlee G: Succinylcholine-induced hyperkalemia in a patient with Parkinson’s disease. Anesth Analg 1980; 59(6): 444–46.PubMedCrossRefGoogle Scholar
  32. 32.
    Cooperman LH: Succinylcholine induced hyperkalemia in neuromuscular disease. JAMA 1970; 213:1867–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Azar I: The response of patients with neuromuscular disorders to muscle relaxants: a review. Anesthesiology 1984; 61:175–87.CrossRefGoogle Scholar

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© Birkhäuser Boston Inc. 1989

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  • Michael S. Ackerman

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