Parkinson's Disease

Parkinson’s disease is a brain disorder that is diagnosed in an estimated 60,000 Americans each year. It occurs when nerve cells, or neurons, in certain parts of the brain die or become impaired and can no longer produce dopamine, the chemical that enables the body to coordinate muscles and movement. Symptoms begin to appear when approximately 80 percent of the cells that produce dopamine are damaged.

More than 1 million people with the disease typically show signs of tremors in the hands, arms, legs, jaw and face, as well slowness of movement, stiffness and problems with balance. Both men and women can be affected by Parkinson’s disease, which also crosses all social, ethnic, economic and geographic boundaries.

Although a small number of patients may be diagnosed under the age of 50, most cases of Parkinson’s disease are identified in people over 65. Blood tests and X-rays cannot be used to diagnose the disease. Rather, blood tests and brain scans, such as magnetic resonance imaging, may be done to rule out other conditions with similar symptoms. The diagnosis may then be confirmed after a thorough examination. There is no cure for Parkinson’s disease, but symptoms can be managed through medications, surgery or a combination of both.

One of the more commonly prescribed medications for Parkinson’s disease is levodopa. This medicine can reduce symptoms of slowness, stiffness and tremor. Levodopa works in the brain where it is converted into dopamine. It is always taken in conjunction with an enzyme inhibitor called carbidopa because blood enzymes would break down most of the levodopa before it could reach the brain.

Substitutes for levodopa, called dopamine agonists, have been developed that do not have to be taken with an enzyme inhibitor. However, these medications tend to cause other side effects. Medications that do not stimulate dopamine production also can be taken to manage symptoms of Parkinson’s disease. Medications should be managed under close physician supervision because each person reacts differently to different drugs.

Deep brain stimulation offers a surgical alternative to medications to treat symptoms of Parkinson’s disease. This procedure involves surgically implanting a battery-operated medical device called a neurostimulator. Similar to a heart pacemaker, it delivers electrical stimulation to specific areas of the brain that control movement and blocks abnormal nerve signals that cause symptoms. The neurostimulator is about the size of stopwatch and usually is implanted under the skin near the collarbone. It is attached by an extension wire passed under the skin of the shoulder, neck and head to an electrode, or lead, which is implanted into the brain through a small opening in the skull.

The deep brain stimulation system provides continuous symptom control and can be adjusted as needed. It does not damage healthy brain tissue and can be reversed if necessary. Medications may still be required, but at reduced levels for most patients.

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The Trouble with Triple A

An aneurysm is a bulge or enlargement in the wall of an artery. Arteries are blood vessels responsible for carrying oxygen-rich blood from the heart to other organs of the body. An aneurysm occurs when the arterial wall weakens.

Most aneurysms happen in the aorta. The aorta is the main artery that carries blood away from your heart to the abdomen, pelvis and legs.

An abdominal aortic aneurysm (AAA) refers to the swelling or bulging of the arterial walls that is in your abdomen. AAAs do not always cause problems but a ruptured aneurysm can cause internal bleeding or even death when left untreated.

What Are the Types of Abdominal Aortic Aneurysms?

AAAs are classified according to their size and the rate at which they are growing. These two factors give physicians an idea how the aneurysm affects the health of the patient afflicted with this condition.

Small AAA (3 cm to 4.4 cm across) – these are slow-growing aneurysms that have a much lower risk of rupture. Regular ultrasound scans are recommended to monitor their growth.
Medium AAA (4.5 cm to 5.4 cm) – these types of aneurysm require ultrasound scans every three months to check if they are getting bigger.
Large AAA (5.5 cm or larger) – these fast-growing AAAs are much more likely to rupture that can lead to life-threatening complications. These types of AAAs need to be treated with surgery especially if they are causing symptoms or leaking blood.

What Are the Most Common Causes of Abdominal Aortic Aneurysms?

The exact cause of AAAs remain unknown. However, the following factors may increase your risk of developing this medical condition:

Smoking – directly damages the arterial walls, making them more susceptible to bulging. Smoking also increases your risk of hypertension.
Atherosclerosis – occurs when plaque builds up inside the arteries. Overtime, the plaque hardens, limiting the supply of oxygen-rich blood to the organs and to the rest of the body.
Hypertension – high blood pressure can also weaken the walls of your aorta. This can cause an aneurysm to form.
Vascular inflammation (vasculitis) – serious inflammation in the aorta and other arteries that can occasionally cause AAAs.
Male sex – AAAs are more common in men and among white people than among black people.
Infection or injury
Genetic factors

Can You Feel an Abdominal Aortic Aneurysm?

Abdominal aortic aneurysm do not often show any obvious symptoms unless they rupture. They are usually discovered during screening or tests. If an individual does have symptoms, they can include the following:

Throbbing or deep pain in the stomach like a heartbeat
Pain spreading from your abdomen or back to the pelvis, buttocks, groin or legs
A stomach pain that does not go away
Clammy or sweaty skin
Dizziness
Nausea and vomiting
Increased heart rate
Fainting or shock

Screening for Abdominal Aortic Aneurysm

AAAs that have not ruptured are picked up or diagnosed during ultrasounds or when your physician feels your stomach and finds the following during an examination:

A lump (mass) in the abdomen
Pulsating sensation in the abdomen
Stiff or rigid abdomen

The following tests may be conducted if your doctor suspects that you may have an abdominal aortic aneurysm:

Abdominal ultrasound
Chest X-ray
Computerized tomography (CT) scan of the abdomen to confirm the size of the aneurysm
CT angiogram (CTA) to help with surgical planning

What Are the Risk Factors for Abdominal Aortic Aneurysm?

If you answer yes to one or a combination of the following descriptions below, then you have a higher chance of developing AAAs:

Are you male?
Are you obese or overweight?
Are you over the age of 60?
Do you have a family history of heart disease or a history of stroke?
Do you have high blood pressure and between 35 and 60 years old?
Do you have high cholesterol or fatty buildup in the blood vessels or atherosclerosis?
Do you have an unhealthy and sedentary lifestyle?
Have you had trauma to your abdomen or other damage to your midsection?
Do you smoke or have previously smoked?
Do you have chronic obstructive pulmonary disease?

How Can an Abdominal Aortic Aneurysm Be Treated?

Treatments depend on its size and exact location. If you are bleeding because of a ruptured AAA, you will need surgery right away. If the aneurysm is small and there are no symptoms, surgery is rarely done. Instead, your physician may choose to closely monitor your condition through ultrasound tests every six months.

Surgery is usually done when the aneurysm is medium-sized or is bigger than 2 inches or 5 centimeters across or is growing quickly to prevent complications from developing. The outcome is often good if the surgery is done before the aneurysm ruptures.

The two types of surgery are:

Open repair – the more invasive form of surgery that is used for aneurysms that are very large or have already ruptured. This procedure involves making a large cut in the abdomen to replace the damaged areas of the aorta with a graft made of man-made material. This type of surgery has a longer recovery time.

Endovascular stent grafting – is a less invasive form of surgery that can be done without making a large cut in the abdomen, making recovery time faster compared to an open repair surgery. It uses a graft to stabilize the weakened walls of the aorta. This safer approach is applicable to those with existing medical conditions or are an older adult.

How to Reduce the Risk of Developing Abdominal Aortic Aneurysm?

There are several ways to prevent AAAs or help stop it from getting bigger. You doctor might also prescribe medicines if you have a condition that raises your risk for AAAs like high blood pressure, cholesterol or diabetes. These heart-healthy habits include

Eating
Exercising
Maintaining a healthy weight
Quitting smoking
Cutting down on alcohol consumption
Reducing stress

It is a medical emergency when an abdominal aortic ruptures. If you or someone you know has any of the symptoms mentioned in this article, seek medical attention or immediately call 911.

Sources:
Centers for Disease Control and Prevention
National Heart, Lung, and Blood Institute
MedlinePlus
National Health Service UK
Healthline