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Semester 5 - Neuro > 7 - Motor disorders > Flashcards

7 - Motor disorders Flashcards

1
Q

Name some causes of chorea:

A
  • Huntington’s
  • Sydenham’s
  • Wilson’s disease
  • SLE
  • Thyrotoxicosis
  • Levodopa
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2
Q

What is the role of the cerebellum?

A 
Role in:
- coordination
- precision
- timing
of purposeful movements
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3
Q

What structure separates the cerebellum from the occipital and parietal lobes?

A

Tentorium cerebelli

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4
Q

What structure separates the cerebellum from the pons?

A

4th ventricle

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5
Q

Which part of the cerebellum regulates trunk musculature?

A

Vermis (midline)

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6
Q

Which part of the cerebellum regulates limb musculature?

A

Lateral hemispheres

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7
Q

Are tracts to and from the cerebellum ipsi- or contralateral?

A

Ipsilateral

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8
Q

Name the 3 lobes of the cerebellum:

A

1) Anterior lobe
2) Posterior lobe
3) Flocconodular lobe

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9
Q

What are the symptoms of cerebellar pathology?

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
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10
Q

Name some causes of cerebellar pathology:

A 
Posterior fossa tumour
Alcohol
Sclerosis (MS)
Trauma
Rare causes
Inherited ie Friedreich's ataxia
Epilepsy med ie Carbamazepine/Phenytoin
Stroke
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11
Q

How do midline lesions of the cerebellum often present?

A
  • Truncal ataxia

- Abnormal gait

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12
Q

What is the name given to the collection of nuclei found of both sides of the thalamus, outside and above the limbic system?

A

Basal ganglia

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13
Q

Name the important structures in the basal gsanglia:

A
  • Caudate nucleus
  • Lentiform nucleus (putamen + globus pallidus)
  • Substantia nigra
  • Subthalamic nucleus
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14
Q

Name the 2 structures which form the lentiform nucleus:

A
  • Putamen

- Globus pallidus

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15
Q

At rest, which pathway in the basal ganglia dominates, and what is the outcome?

A

Indirect pathway dominates
= Thalamus is suppressed from sending excitatory impulses to the motor cortex
= Inhibits motor cortex

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16
Q

What is the main excitatory neurotransmitter in the basal ganglia?

A

Glutamate

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17
Q

What is the main inhibitory neurotransmitter in the basal ganglia?

A

GABA

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18
Q

Which pathway in the basal ganglia has an overall stimulatory effect on the motor cortex?

A

Direct pathway

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19
Q

Which pathway in the basal ganglia has an overall inhibitory effect on the motor cortex?

A

Indirect pathway

20
Q

Which structure of the basal ganglia produces dopamine?

A

Substantia nigra pars compacta

21
Q

Dopamine is released from the substantial nigra pars compacta, on what structure in the basal ganglia does it act?

22
Q

Which dopamine receptors in the basal ganglia pathways activate the direct pathway?

A

D1 receptors

23
Q

Which dopamine receptors in the basal ganglia pathways activate the indirect pathway?

A

D2 receptors

24
Q

What is the role of the basal ganglia?

A
  • Facilitates appropriate movements

- Inhibits inappropriate movements

25
Via which structure does the basal ganglia communicate with the cortex?
Thalamus
26
What are the 2 parts of the substantial nigra? Describe their position in relation to each other:
- Substantia nigra pars compacta - Substantia nigra pars reticularis Both in midbrain, pars reticular is a ventral stri, pars compacta lies dorsally
27
What happens in Parkinson's disease to cause bradykinesia?
- Death of dopaminergic neurones in substantiatia nigra pars compacta - Loss of inhibition on putamen in indirect pathway + - Loss of excitation of putamen in direct pathway = Less excitation of motor cortex = Bradykinesia
28
Basal ganglia disorders typically result in what motor signs?
- Abnormal motor control - Altered posture - Altered muscle tone - Dyskinesia
29
Name the cardinal signs of Parkinson's disease:
- Resting tremor - Rigidity - Bradykinesia
30
Resting tremor, rigidity and bradykinesia are the cardinal sign's of Parkinson's disease. Name some other features:
- Hypophonia - Pill-rolling tremor - Cog-wheel rigidity - Lead-pipe rigidity - Micrographia - Reduced facial expression - Dementia - Depression - Anxiety - Mild cognitive impairment - Visual hallucinations - Insomnia - Falls - Shuffling gait - Urinary incontinence - Constipation - Erectile dysfunction - Orthostatic hypotension
31
What is the main treatment of Parkinson's disease?
Carbidopa/Levodopa (also known as Levocarb, or Co-careldopa) | = Dopamine precursor + peripheral DOPA decarboxylase inhibitor
32
What enzyme inhibitor is given with a dopamine precursor to treat Parkinson's disease? Why?
Peripheral DOPA decarboxylase inhibitor = Reduces the conversion of precursor to Dopamine in peripheral tissues = ^^ concentration of dopamine precursor crosses BBB and available to brain
33
What drugs may be given as an adjunct to Carbidopa/Levodopa for Parkinson's disease?
- Dopamine agonist ie Bromocriptine - MAO-B inhibitor ie Selegiline - COMT inhibitor ie Entacapone - Amantadine
34
What type of drug is Bromocriptine?
Dopamine agonist
35
What type of drug is Selegiline?
MAO-B inhibitor
36
What type of drug is Entacapone?
COMT inhibitor
37
What type of drug is Amantadine?
NMDA antagonist = Glutamate receptor antagonist
38
What is the hereditary pattern of Huntington's disease?
Autosomal dominant
39
Huntington's disease is progressive cell loss in which areas of the brain?
- Basal ganglia | - Cortex
40
What is the average age of onset of Huntington's disease?
30-50 yrs
41
What are the typical signs and symptoms of Huntington's disease?
- Chorea - Dystonia - Incoordination - Cognitive decline - Behavioural difficulties - Abnormal gait
42
What are the treatments available for Huntington's disease?
- Antidepresssants - Mood stabilisers - Antipsychotics - Speech and language therapy
43
What role do antipsychotics have in the treatment of Huntington's disease?
- Antipsychotics antagonise D2/3 dopamine receptors, reducing dopamine transmission - Loss of inhibition on putamen in indirect pathway + - Loss of excitation of putamen in direct pathway = Less excitation of motor cortex = Bradykinesia - So can help suppress involuntary movements (and violent outbursts)
44
What is ballismus?
Rare movement disorder causes repetitive but constantly varying large amplitude involuntary movements of proximal parts of limbs
45
What causes ballismus?
Decreased activity of subthalamic nucleus | = Removed inhibition on thalamus
46
What can cause ballismus?
- Stroke - Trauma - Neoplasm

Semester 5 - Neuro (14 decks)

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