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Neurology > Tremor and Hyperkinetic Disorders > Flashcards

Tremor and Hyperkinetic Disorders Flashcards

1
Q

Name 5 types of hyperkinetic movement disorder.

A 
Tremor. 
Tics.
Chorea. 
Myoclonus. 
Dystonia
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2
Q

Define tremor.

A

Rhythmic sinusoidal oscillation of a body part

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3
Q

Define tics.

A

Involuntary stereotyped movements or vocalizations

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4
Q

Define chorea.

A

Brief irregular purposeless movements which flit and flow from one body part to another

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5
Q

Define myoclonus.

A

Brief electric-shock like jerks

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6
Q

Define dystonia.

A

Abnormal posture of the affected body part

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7
Q

Describe tremor.

A

Rhythmic sinusoidal oscillation of a body part, usually due to alternate activation of agonist and antagonist muscles

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8
Q

Outline the 4 ways in which tremor can be classified.

A

Position: at rest, on posture, during movement (kinetic tremor).
Distribution: body part affected.
Frequency: measured in Hertz.
Amplitude: ‘fine’ or ‘coarse.’

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9
Q

What should you ALWAYS ask a patient who presents with a tremor?

A

When they notice the tremor most

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10
Q

Name the 6 main types of tremor.

A
  • Resting
  • Postural
  • Kinetic
  • Head
  • Jaw
  • Palatal
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11
Q

Name the 3 causes of a resting tremor.

A
  • Parkinson’s disease.
  • Drug-induced parkinsonism.
  • Psychogenic tremor
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12
Q

Name the 3 causes of a postural tremor.

A
  • Essential tremor.
  • Enhanced physiological tremor.
  • Tremor associated with neuropathy.
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13
Q

Name the 2 causes of a kinetic tremor.

A
  • Cerebellar disease (demyelination, haemorrhage, degenerative, toxic).
  • Wilson’s disease.
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14
Q

Name the 2 causes of a head tremor.

A
  • Dystonia.

* Cerebellar disease.

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15
Q

Name the 2 causes of a jaw tremor.

A
  • Dystonia.

* Parkinson’s disease.

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16
Q

Outline the key things which must be discussed when taking a history from a patient with a tremor.

A
  • Age at onset
  • Body part(s) affected
  • Any precipitating factors at onset?
  • Drug / toxin exposure
  • Exacerbating and relieving factors
  • Associated neurological symptoms
  • Associated systemic symptoms
  • Family history
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17
Q

What are the important features which should be included in the examination of a patient with a tremor?

A
  • Examine at rest, on posture and during movement.
  • Ask patient to write something and copy a spiral.
  • Complete physical and neurological examination.
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18
Q

What tests looks at cerebellar function?

A

Get pt to touch their nose, then touch your finger

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19
Q

Tremor due to stress is usually symmetrical

A

TRUE

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20
Q

An asymmetrical tremor suggests a problem with the brain

A

TRUE

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21
Q

What investigations should be done in a patient who presents with a tremor?

A
  • Guided by presentation.
  • TFT’s.
  • Copper and coeruloplasmin in young patients, <45.
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22
Q

Describe the treatment for a patient with a tremor.

A

Usually symptomatic, if at all.

in selected cases, deep brain stimulation

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23
Q

What is a tremor associated with dystonia?

A

A tremor in a body part that is not dynamic, but there is dystonia elsewhere

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24
Q

A dystonic tremor can occur at…….

A

Rest, in sustained postures and in voluntary movement

Focal and task specific

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25
Q

Describe an essential tremor.

A
  • Abnormal tremor in bilateral upper limbs, with absence of neurological signs elsewhere
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26
Q

Essential tremors are _________

A

BILATERAL

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27
Q

What is the duration of an essential tremor like?

A

Long

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28
Q

An essential tremor is not what?

A

A diagnosis, but a syndrome of many different types of tremor – dystonia predominates

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29
Q

What medications can be used to treat a dystonic tremor/

A

1st Line: Propanolol + Primidone

Also: atenolol, gabapentin, sotalol, alpraxolam, topiramate, clonazepam, nadolol, nimodipine

30
Q

What type of drug in Primidone?

A

An anticonvulsant

31
Q

What can be used in the treatment of a severe dystonic tremor?

A

Deep brain stimulation

32
Q

What is dystonia?

A

A disorder of movement, specifically of involuntary sustained muscle contraction, which leads to twisting and repetitive movement or abnormal posturing

33
Q

Give 2 examples of dystonia.

A
  • Writers cramp

* Torticollis

34
Q

There are 3 main physiological abnormalities that have been found in patients with dystonia. What are these?

A
  • Loss or reduction in reciprocal inhibition
  • Alterations in brain plasticity
  • Alterations in sensory function
35
Q

What is the main treatment for dystonia?

A
  1. Botox

2. Deep brain stimulation

36
Q

What is the definition of chorea?

A

Brief irregular purposeless movements that flit and flow from one body part to another. Patients appear constantly restless or fidgety. Often generalized, but it may be confined to one region (e.g. face)

37
Q

In some cases, it can be difficult to distinguish between chorea and . . .

A

Myoclonus (short and not flying around) or tics (suppressible

38
Q

Chorea is a _______

A

Symptom

39
Q

What is the main cause of inherited chorea?

A

Huntington’s disease

40
Q

What is the major autoimmune cause of chorea?

A

SLE

41
Q

Suggest a cause of paroxysmal chorea.

A

Parkinson’s disease

42
Q

Outline the important features to cover when taking a history from a patient with chorea.

A
  • Age of onset
  • Acute or gradual
  • Drug exposure
  • Family history
  • Psychiatric/behavioural disturbances
  • Systemic symptoms
43
Q

What should be covered when examining a patient with chorea?

A
  • Examine at rest, with arms out and while walking
  • Note distribution of chorea
  • Other neurological signs
  • Systemic signs
44
Q

What investigations should be carried out in a patient who presents with chorea?

A
  • Brain imaging
  • Blood tests
  • Antibodies
45
Q

What is given for symptomatic treatment of chorea?

A

Terabenazine or dopamine receptor blocking drugs

46
Q

What is Huntington’s disease?

A

An autosomal dominant inherited neurodegenerative disorder characterized by progressive behavioural disturbance, dementia, and movement disorder, usually chorea

47
Q

What is the inheritance pattern of Huntington’s disease?

A

Autosomal dominant

48
Q

Who gets Huntington’s disease?

A
  • 4-8 per 100,000.
  • Affects males and females equally.
  • Some communities have high prevalence rates (Moray Forth in Scotland + Venezuela).
  • Some communities have low rates (Japanese + African Americans).
49
Q

When does Huntington’s usually onset?

A

4th decade, although it is variable

50
Q

Describe the onset of Huntington’s disease.

A

Psychiatric, cognitive or behavioural disturbances, neurological signs or mixed.

  • EYE MOVEMENT ABNORMALITIES
51
Q

Describe the genetics of Huntington’s disease.

A

CAG triplet-repeat expansion on chromosome 4

52
Q

Tics can be either motor or vocal

A

TRUE

53
Q

Tics can be either motor or complex

A

TRUE

54
Q

When do primary tic disorders start and what is the cause?

A

Childhood

Idiopathic

55
Q

When do secondary tic disorders start?

A

Adulthood

56
Q

What should you always ask when taking a history from a patient with tics?

A

Associated psychopathology e.g OCD, ADHD, anxiety, self harm

57
Q

What should always be noted on examination of a patient with tics?

A

Are the tics suppressible?

58
Q

What is the inheritance of Tourettes like?

A

Autosomal dominant inheritance is seen in some families, but no genes have been identified yet

59
Q

What is the diagnostic criteria for Tourettes syndrome?

A
  • Multiple motor tics + one or more vocal tics
  • Tics must occur many times a day
  • Age of onset <18
  • Exclusion of obvious secondary causes
60
Q

What is the treatment for Tourettes syndrome?

A

Symptomatic – clonidine + tetrabenazine for tics.
+
Associated psychopathology (inc CBT).

61
Q

What is the definition of myoclonus?

A

Brief electric shock-like jerks.

  • Hiccups or hypnic jerks (when falling asleep) are common and normal forms of myoclonus
62
Q

What is myoclonus caused by?

A

Brief activation of a group of muscles, leading to a jerk of the affected body part.

63
Q

What can muscle activation in myoclonus be caused by?

A

The cortex, subcortical structures, spinal cord or nerve root and plexus

64
Q

What is negative myoclonus caused by?

A

A temporary cessation of muscle activity.

Eg: asterixis (liver flap) in pts with liver failure

65
Q

When is the onset of Juvenile Myoclonus Epilepsy?

A

In teenage years

66
Q

What are the 2 features of JME?

A

Myoclonic jerks + generalized seizures.

67
Q

What are the typical precipitants of myoclonic jerks and seizures?

A

Alcohol and sleep deprivation

68
Q

When do symptoms of JME tend to be worse?

A

In the mornings

69
Q

What will an EEG of someone with JME show?

A

Characteristic 3-5Hz polyspike and wave pattern

70
Q

Name 2 drugs which are affective in the treatment of JME?

A

Sodium valproate + Levetiracetam

71
Q

What drug can aggravate JME and thus should never be given?

A

Carbamazepine

72
Q

Longterm, what is the treatment for JME?

A

AED

Neurology (42 decks)

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