27. Extrapyramidal Disease CPC Flashcards Preview

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Flashcards in 27. Extrapyramidal Disease CPC Deck (51)
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1

how much dopamine production must be lost for pts to develop signs of Parkinsonism?

70-80%

2

what are the components of the basal ganglia?

-striatum (caudate and putamen)
-Globus Pallidus (interna and externa)
-subthalamic nuclei
-substantia nigra

3

what is a good site for DBS in parkinson's disease?

subthalamic nucleus

4

term for: Quick (“dance-like”) movements that are rapid, jerky and irregular, usually affecting muscles of the face orobuccal cavity and limbs.

chorea

5

Involuntary slow writhing (“worm-like”) movements flowing from one to the next, sometimes associated with chorea

athetosis

6

a twisting movement, usually of the neck or trunk

dystonia

7

includes a throwing or flinging movement, usually of one side, where it is called a hemibalism.

ballismus

8

fleeting purposeless movement, however they tend to be repetitive and stereotyped, as opposed to chorea, which is random.

tics

9

hyperkinesia that can come in different speeds (fast versus slow) and can be exaggerated in different positions or actions.

tremor

10

the opposite of dyskinesia. consists of a slowing of movement. This can manifest as slowed postural corrections to being thrown off balance or decreased facial expressiveness. It can include a type of stiffness, called rigidity, which is different than spasticity since it produces smooth resistance to passive movement. can also affect initiation of movement and patients can “get stuck”.

Bradykinesia

11

Decreased facial expressiveness. Is a bradykinesia of facial muscles

mask facies

12

Increase in resting muscle tone. In parkinsonism it is consistent throughout the range of motion, unlike the “clasp-knife” effect of spasticity. When rigidity and tremor are both present “cogwheeling” results.

rigidity

13

what are some drugs that can cause Parkinson's like symptoms?

levodopa, neuroleptics

14

a flinging movement of one side of the body that would result from a small stroke in the contralateral subthalamic nucleus.

hemibalism

15

most common causes of choreoathetosis?

Genetic (Huntington's)
advanced age
cerebrovascular disease
cerebral palsy

16

what is the genetic pattern of Huntington's?

autosomal dominant, with complete penetrance (50% of offspring)

17

what does genetic anticipation mean?

the number of CAG repeats can go from 36 to 40 in a generation and the patient may be the first person who is symptomatic

18

how many CAG repeats will result in Huntington/s?

40+

19

Clinical triad of huntington's?

chorea, dementia, behavior change (may result in problems with the law)

20

what drug will make Huntington's wlrse?

levodopa (given for Park)

21

what are some drug treatments for Huntington's?

neuroleptics, which block dopamine. (haloperidol, perphenazine)

22

what is the problem with chronic use of neuroleptics?

they can sensitize the system, and over time can have a reverse effect --> tardive dyskinesia

23

what do dopamine-depleting drugs cause, and should we use them to treat Huntington's?

cause severe depression: we shouldn't use them.

24

essential tremor: does it run in families? what is the age of onset?

yes. age of onset is 25-55 yrs.

25

how bad can essential tremor get?

tends to get worse with time: sometimes will get so bad it's hard to function.

26

does essential tremor tend to be unilateral or bilateral?

bilateral.
parkinson's is unilateral

27

what is affected the most with essential tremor?

upper limbs, head, voice.

28

what is something that we wouldn't necessarily recommend but that can help essential tremor?

alcohol

29

what anti-epilepsy drug is NOT effective for essential tremor?

valproate: has tremor as a side effect

30

what beta-blocker can be used for essential tremor?

propanolol