3 - Movement Disorders Flashcards
(98 cards)
1
Q
Function of the basal ganglia?
A
Central processing center
Roles in:
- movement
- cognition
- emotions
- learning
2
Q
Tremors are?
A
Any movement that is:
- involuntary
- rhythmic
- oscillating
can affect 1 or several body parts
3
Q
Tremors types/descriptions?
A
Resting
Postural
Action (intentional tremors)
4
Q
What is an essential tremor?
A
Rhythmic oscillatory movement characterized by its relationship to voluntary motor activity
5
Q
What makes essential tremor better/worse
A
Worse:
- emotional stress (sleep makes it stop)
Better: medications and ETOH
6
Q
What is chorea?
A
Involuntary, arrhythmic, rapid and purposeless movements
7
Q
Other than having a case of “the wiggles” what is affected by chorea?
A
Strength
- hand grip relaxes (milkmaid grasp)
- gait is irregular/unsteady (dancing gait)
- speech is irregular in volume/tempo
8
Q
Hereditary causes of chorea?
A
Huntington’s
Wilson’s disease
Benign hereditary chorea
9
Q
Causes of chorea?
A
Hereditary Syndenham’s chorea Chorea gravidarum Drug toxicity (lithium) Cerebral vascular disorders
10
Q
What is hemiballismus?
A
Large poorly patterned, flailing movements of the proximal muscles of the limbs
Monoballismus: 1 limb
Paraballism: but upper and lower
11
Q
Causes of hemiballismus?
A
Vascular disease in the contralateral subthalamic nucleuas
Whatever that means
12
Q
Treatments for hemiballismus?
A
Dopamine-depleting or blocking agents
Pallidotomy if severe enough
13
Q
What is pallidotomy?
A
A tiny electrical probe is place in the globus pallidus (brain stuff) and heated to 80*C to destroy that tissue
Not in the slides i just thought this was cool
14
Q
What is athetosis?
A
Greek word for restless
Abnormal movements that are slow, sinuous, writhing and involuntary in character
- Flexion, extension, pronation, supination of fingers/hands
15
Q
What is Dystonia?
A
Prolonged athetosis
Sustained muscle contractions
- absent during sleep
- enhanced by voluntary activity
16
Q
Types of dystonia?
A
Focal:
- torticollis
- blepharospasm
- writers cramp
Generalized:
- cerebral palsy
- acute dystonic reactions
17
Q
Psychogenic dystonia?
A
Chick that got the flu shot stumbles and british accent
18
Q
What is tardive dyskinesia?
A
Involuntary movements of face/tongue
19
Q
What medication can cause tardive dyskinesia?
A
Long term tx with antipsychotic drugs
- dopamine receptor blockers
- metoclopramide (reglan)
20
Q
What are myoclonus?
A
Sudden, rapid, twitch like muscle conractions
Seen: Spontaneousor or with sensory stimulation, arousal or initiation of movement
21
Q
How are myoclonus movements classified?
A
- Generalized
- Focal
- Multifocal
- Segmental
22
Q
What is physiologic myoclonus?
A
Nocturnal myoclonus (hypnogogic jerks) - twitching that awaken us from sleep, seen in normal people when waking up of falling asleep
23
Q
Epileptic myoclonus?
A
Movements associated with seizure
24
Q
What are myoclonic jerks (pathologic myoclonus)
A
Movements from:
- epilepsy
- head injury
- stroke
- cardiac arrest
Associated w hypoxemia
25
Causes of reversible myoclonus?
Metabolic disturbances
- renal failure
- electrolyte imbalance
- hypocalcemia
- toxins
- meds
26
What is essential myoclonus?
Benign familial condition
Brief lightening like moments especially sensitive to ETOH
27
What are Tics?
Brief, rapid, recurrent, purposeless movements
28
Motor vs phonic tics?
Motor - muscle groups
Phonic - verbal tics, air moving through nose or mouth
29
Simple vs complex tics?
Simple: 1 muscle group
Complex: multiple muscle groups
- tourettes
- jumping, sniffling, head banging
30
Types of vocal tics?
Coprolalia - profanity
Echolalia - repetition
31
What makes parkinsonian tremors better/worse?
Better: activity
Worse: stress
32
Describe a cerebellar tremor
A slow tremor of the extremities at the end fo a purposeful movement caused by a lesion or damage to the cerebellum
33
Classic presentation of cerebellar tremors?
Lesion is on the same side as the tremor, and it worsens with direct movement
Often accompanied by
- dysarthria
- nystagmus
- gait problems
- postural tremor of head/neck
34
What are psychogenic tremors associated with?
Conversion disorders and other psych stuff
35
Describe orthostatic tremors
A high frequency tremor that is characterized by:
- rhythmic muscle contractions of leg or trunk
- usually after standing
36
What makes orthostatic tremors decrease?
Sitting
Being lifted off ground
Walking
37
When are you likely to see physiologic tremors?
- anxiety
- fatigue
- metabolic disturbances
- drugs
- Toxins
- alcohol consumption
- alcohol withdrawal
- poisoning
38
What is the MC movement disorder?
Essential tremor (benign essential tremor)
39
Causes of essential tremors?
1/2 are gene mutation
1/2 are idiopathic
40
tx for essential tremors?
Propanolol
Gabapentin
Pregabalin
Benzodiazapines
Thalamic stimulation/surgery for sever cases
41
What is acute dystonia?
Sudden onset of sustained muscle contractions frequently causing twisting and repetitive moments or abnormal postures
42
Drugs that cause acute dystonic reactions (big list)
```
Antipsychotic/neuroleptic drugs (dopamine receptor blockers)
- phenothialzines
- haloperidol
- atypical antipsychotics
Pneothiazine anti-emetics (dopamine antagonist)
- promethazine
- prochlorperizine
Cocaine
LSD
TCA
Lithium
Anticonvulsants
```
43
Patterns of drug-induced acute dystonia?
Laryngeal dystonia
Oculogyric crisis
Buccolingual crisis
Opisthotonus
44
Tx for acute dystonia?
```
Stop the offending med
Then:
Diphenhydramine
Baclofen
ICU (airway)
```
45
4 core symptoms of restless leg syndrome
Urge to move legs
Worsening sx at rest
Improvement w activity
Worse at night
46
Causes of restless leg syndrome?
```
Primary: genetic
Secondary:
- meds
- hypoglycemia
- opiate withdrawal
- anemia
- pregnancy
- ferritin deficiency
- renal failure
- peripheral neuropathy
```
47
Tx for restless leg syndrome?
Dopamine agonist
Opiates
Anticonvulsants
Analgesics
48
What is gilles de la tourette syndrome?
Verbal or motor ticks that are chronic and lifelong.
Usually sporadic onset prior to 21yrs old
49
Tx for bla bla bla Tourettes?
```
Education/counseling
Neuroleptics (haloperidol, pimozide)
Clonidine
Phenothiazines
Botulinum toxin A
```
50
What is parkinsonism? Hint, its not parkinsons
Syndrome similar to parkinson’s disease
Combo of:
- tremor
- rigidity
- bradykinesia
- progressive postural instability
- cognitive impairment
51
Causes of parkinsonism?
1. Neuroleptic drug exposure
2. Cerebrovascular dz
3. Methyl-phenyl-tetrahydropyridine (MPTP)
4. Encephalits lethargica (von Economo’s dz)
52
Parkins disase clinically defined as (slide says KNOW THESE in red)
- resting tremor
- cogwheel rigidity
- bradykinesia
- gait impairment
53
Where is the damage with parkinson’s?
Damage in substantia nigra with cell loss in basal ganglia
54
What causes the problems with parkinson’s?
Lack of dopamine.
Dopamine exerts an inhibitory effect on release of GABA
W/out dopamine GABA output increases
55
Parkinson’s symptoms
TRAP
T: tremor (resting)
R: rigidity (muscle stiffness)
A: akinesia/bradykinesia
P: postural instability (gait impairment)
56
Late features of parkinson’s?
```
Orthostatic instability
Motor complications
Dysphagia
Movement abnormalities (whole body)
Dementia (frontal lobe)
Dysautonomia
Greasy skin/seborrhea
```
57
What will a pet scan show for parkinsons? Does this diagnose the disease?
Decreased dopamine activity in basal ganglia
Dx is clinical
58
Tx for parkinson’s?
```
Dopamine replacement
Anticholinergics
Dopamine agonist
Amantadine (augments dopamine)
Neuroprotection (MAO-B, CoQ10)
```
59
How well does medical therapy work for parkinson’s?
Doesnt reverse or cure, we only hope to slow it down
60
Nonmedical options for parkinson’s?
Surgery: thalamotomy/pallidotomoy
Deep brain stimulation
PT: walking techniques
Speech therapy
61
What are the 3 mc causes of death for parkinson’s pts?
Choking
Pneumoina
Falls
Takes up to 20 yrs
62
What is huntington’s?
Gradual onset of involuntary movement changes in behavior and personality, cognitive impairment that takes years to develop
63
Pathophis of huntingtons?
Genetic mutation causes cell death and atrophy in cerebral cortex
Reduces GABA and ACh
Increases dopamine
64
Age of onset of huntington’s?
25-45 yrs
65
Huntington’s S/S?
Dementia
| Chorea
66
Imaging for huntington’s?
CT/MRI: atrophy of:
- cerebral cortex
- caudate nucleus
67
Tx for huntingtons?
```
Haloperidol (dopamine receptor blocker)
Reserpine (deplete dopamine)
SSRI (moodiness)
Benzodiazepines (sleep and anxiety)
Xenazine (dopamine depleting)
```
68
What does xenazine (terabenazine) do for huntingtons pts?
Reversible, centrally acting, dopamine-depleting drug
Reduces chorea burden and is well tolerated
69
Prognosis for huntington’s?
Progressive dementia
10-25 yrs later die from infection
70
What is stiff person syndrome?
Rare progressive muscle rigidity, stiffness and painful spasms triggered by:
- auditory
- sensory
- emotional
71
Sx of stiff person syndrome?
Stiffness of trunk and legs that spreads
Often has paroxysmal painful muscle spasms
72
Signs of stiff person syndrome?
“Tin man” gait
Hyperlordosis that restricts hip and spine movement
73
What must be r/o for a diagnosis or stiff person syndrome?
- Neuromyotonia
- Pyramidal dysfunction
- Extrapyramidal dysfunction
- Structural spinal cord disease
74
Labs for stiff person?
Antibodies against glutamic acid decarboxylase (GAD)
75
Tx for stiff person syndrome?
Tx of tumor
Glucocorticoids
Baclofen
IVIG
76
Describe cerebral palsy
A chronic impairment of
- muscle tone
- strength
- coordination
- movements
Comes from some early brain insult
77
PE for cerebral palsy?
- Hyperreflexia
- microcephaly
- limb length discrepancies
- cataracts
- retinopathy
- congenital heart defects
78
Wilson’s disease is a disorder of?
Copper metabolism
It builds up in the liver, kidneys, cornea and CNS
79
How does wilson’s disease present?
Liver dysfunction
Neurophychiatric symptoms (parkinsonisms and similar stuff)
Kayser-fleischer rings
80
Dx of wilson’s disease?
More copper in urine and blood
Liver biopsy shows increased copper staining
81
Tx for wilson’s disease?
Copper chelation
- D-penicillamine
less toxic option
- trientine and zinc
82
What are pesudoneurologic syndromes?
Pts with neurological symptoms or signs with no identifiable structure or functional etiology w/in the nervous system
Somatization or conversion disorder are common examples
83
Examples of consciously-invented symptoms?
Factitious movement disorder (munchausens)
- no apparent motivators
Malingering
- external incentive
84
Unconsciously produced symptoms?
Somatoform disorders
- somatization disorder
- hypochondriasis
- conversion disorder
85
What is somatization disorder?
Psychological distress manifested as a physical problem.
UNCONSCIOUS
86
What is needed to diagnose somatization disorder?
2 GI symptoms
4 pain symptoms
1 neuro
1 sexual symptom
87
What is hypochondriasis?
Preoccupation with symptoms and misinterpretation of normal function as symptoms
88
What is conversion disorder?
Voluntary motor or sensory function dysfunction that suggest neurologic or other medical disease but cannot be explained
Can involve secondary gain (but isnt obvious)
Unconscious
89
Clues to diagnosis fo pseudoneurologic syndroes
Look at slide 97 if you want. Its a long dumb list
90
HX Features suggesting pseudoseizures
```
High frequency
Emotional trigger
Gradual onset
Pt can recall
Anti epileptic drugs dont work
Usually know someone with seizures
```
91
Clinical clues suggesting pseudoseizures?
```
No postictal
No injuries
Dystonic posturing
Pelvic thrusting
Geotropic eye movement
Closed eyes
Side to side head movement
Prolonged seizure (2-3 min)
Pain terminates seizure
Normal EEG
Normal serum prolactin
```
92
Clinical clues for pseudoparalysis?
```
Non anatomic pattern weakness
Normal reflexes
Doesn’t involve face
Inconsistent
“Give-way” weakness
Drop test
Hoover test
Adductor sign
“Hysterical gaits”
```
93
Pseudosensory syndrome?
Tingling or numbness that is not anatomical and inconsistent
94
Waddell signs
Non-organic causes of back pain
- superficial tenderness
- nonantiomical tenderness
- pain w axial loading
- pain on stimulated rotation
- distracted straight leg raise
- regional sensory change
- regional weakness
- overreaction
95
Warning signs of pseudocoma?
Pt is usually observed when it happens
They slump to avoid injury when falling
Generally looks like a kid pretending to be unconscious
96
Psychogenic movement disorders (list)
Pseudotremor
Psychogenic Parkinsonism
Psychogenic myoclonus
Psychogenic dystonia
97
What is pseudoneuro-opthalmologic syndrome
| ?
Sudden blindness involving complete loss of vision
98
PE techniques for distinguishing true neurologic deficits and conversion disorder
Slide 112 and 113
