ICS-Movement Disorders

Question 1

Extra-pyramidal lesions

Answer 1

Lesions of the basal ganglia. These cause disorders of starting/stopping and suppressing unwanted movements.

Question 2

Three things that can cause Parkinsonism

Answer 2

1) Neurodegenerative disorders (Parkinson’s disease) 2) Drugs (deplete DA) 3) Genetic (Dopa Responsive Dystonia)

Question 3

What are the characteristic features of Parkinsonism?

Answer 3

1) Bradykinesia 2) Rigidity (cogwheel) 3) Resting tremor 4) Flexed posture of neck, trunk & limbs 5) Loss of postural reflexes (initiating gait)

Question 4

Key clinical features in patients with early Parkinson’s disease?

Answer 4

ASYMMETRIC resting tremor (66%), bradykinesia (100%, more prominent in affected limb), mild rigidity, response to DA replacement therapy. Postural instability and imbalance are rare in early Parkinson’s disease.

Question 5

When do postural changes (Pisa posture) start to manifest in Parkinson’s disease?

Answer 5

More advanced stages

Question 6

What things do you need to look at when a patient presents with a tremor?

Answer 6

Is it resting, postural and/or action tremor.

Question 7

A patient presents to the neurology clinic complaining of difficulty signing checks. Physical exam reveals a postural (when holding hands out) and action tremor (using hands). Rapid hand movements are in tact. What type of tremor is this?

Answer 7

Central tremor

Question 8

Most common causes of tremors in upper extremity

Answer 8

*

Question 9

A patient presents with a slow, resting and postural tremor in the left hand. She had a stroke two days ago in the right side of her midbrain. Physical exam reveals dysmetria on finger to nose test with the left hand. What type of tremor does she have?

Answer 9

This is the Holmes “Rubral” tremor. This is usually caused by a lesion in the midbrain.

Question 10

How does chorea differ from a tremor?

Answer 10

Chorea is involuntary, continuous, unpredictable, jerky…dance-like movements.

Question 11

Syndenham’s chorea

Answer 11

Chorea following post-strep infection that causes autoimmune attacking of the basal ganglia

Question 12

What is the most common cause of chorea? What are other common causes of chorea?

Answer 12

Huntington’s disease, due to progressive degeneration of the caudate nucleus. Other causes include basal ganglia lesions (stroke, tumor), drug induced, metabolic disorders (thyroid), autoimmune and pregnancy.

Question 13

Dystonia

Answer 13

Sustained muscle contractions, twisting, repetitive movements or abnormal postures. More focal in adults than in kids

Question 14

Progression of chorea from slow and small to large and fast

Answer 14

Athetosis -> Chorea -> Ballism

Question 15

Cervical dystonia

Answer 15

Twisty, jerky movements keep pulling the head until the head reaches a certain position.

Question 16

Most common place to see tics?

Answer 16

Head, neck arms.

Question 17

Most common cause of tics? Other causes?

Answer 17

Tourrette’s. Other causes include drugs and Huntington’s.

Question 18

2 types of myoclonus

Answer 18

Lightening fast movement. Positive myoclonus: sudden brief jerk (hiccups). Negative myoclonus: sudden loss of muscle tone (asterixis).

Question 19

Myoclonus after TBI that presents 2-3 months after injury.

Answer 19

Lance-Adams syndrome. This happens as a consequence of anoxia.

Question 20

3 motor deficits that present with cerebellar lesions

Answer 20

Decreased motor control, hypotonia and ataxia/dysmetria

Question 21

Midline cerebellar lesion presentation

Answer 21

Wide based stance & increased truncal sway. Nystagmus and regulation of eye movements

Question 22

Cerebellar dysarthria

Answer 22

Abnormalities in word articulation and prosody (scanning speech with inflections on wrong syllables)