381.2 🩺 國考版

381.2.1 高頻考點

381.2.1.1 Atypical Parkinsonism Categories

  • Synucleinopathies: MSA
  • Tauopathies: PSP, CBD

381.2.1.2 MSA Subtypes

  • MSA-P (parkinsonian)
  • MSA-C (cerebellar)
  • Both have severe autonomic failure

381.2.1.3 MSA Hallmarks

  • Severe autonomic (orthostatic, urinary)
  • Inspiratory stridor (life-threatening)
  • RBD
  • Poor levodopa
  • Pyramidal signs

381.2.1.4 MSA Imaging

  • Hot cross bun sign (pons, T2)
  • Putaminal atrophy + rim hyperintensity
  • Cerebellar atrophy

381.2.1.5 MIBG Scintigraphy

  • Preserved in MSA
  • Decreased in PD/DLB

381.2.1.6 PSP Hallmarks

  • Vertical supranuclear gaze palsy (downgaze)
  • Early falls (within 1 year)
  • Axial rigidity > limb
  • Frontal cognitive
  • Poor levodopa

381.2.1.7 PSP Imaging

  • Hummingbird sign (midbrain atrophy)
  • Mickey Mouse sign
  • Midbrain : pons area ratio reduced

381.2.1.8 PSP Variants

  • Richardson (classic)
  • PSP-P (parkinsonism)
  • PSP-PGF (gait freezing)
  • PSP-CBS
  • PSP-SL

381.2.1.9 CBD Hallmarks

  • Asymmetric parkinsonism
  • Alien limb
  • Cortical sensory loss
  • Apraxia
  • Myoclonus, dystonia

381.2.1.10 CBD vs CBS

  • CBD pathological
  • CBS clinical (can be due to multiple pathologies)

381.2.1.11 Treatment

  • No disease-modifying for any
  • Supportive
  • Levodopa trial (limited response)

381.2.2 Distinguishing

Feature PD MSA PSP CBD
Tremor (rest) + – – –
Asymmetric + – – + (often)
Falls early – + ++ +
Autonomic + (late) ++ – –
Vertical gaze – – ++ +
Levodopa response ++ – – –
Cerebellar – + (MSA-C) – –
Cortical signs – – – ++