Neuro Cases 2 Flashcards
Tremor is what?
involuntary, rhythmic, oscillatory movement of a body part and the most common movement disorder in primary care practices
Resting tremor:
1) when does it occur
2) when is it enhanced?
3) when is it diminished?
occurs in body part that is relaxed and completely supported against gravity
enhanced by mental stress or movement of another body part (so moving foot makes resting hand tremor worse)
diminished by voluntary movement of that part
Action tremor?
Postural tremor –> maintaining a position against gravity (raising arm and it starts moving)
Isometric tremor –> isometric muscle contraction against a rigid stationary object (making a fist)
kinetic –> voluntary movement which includes an intention tremor (target-directed movement –> reaching for a pen makes it worse the closer you get)
Everybody has what kind of tremor?
what can cause these to increase?
what happens for diagnosing?
what is this called?
asymptomatic physiologic tremor –> it’s at low amplitude, high frequency at rest and during activity
anxiety, caffeine, stress, meds, fatigue.
if the tremor is increased by these triggers, then no further testing needed.
enhanced physiologic
Essential tremor:
1) what is it the most common?
2) what kind of tremor is it usually?
3) where is it seen?
4) is it a single hand, both hands?
5) how do you get it and does it get worse?
6) what makes it worse? make it easier?
MOST COMMON PATHOLOGICAL TREMOR
95% of people have kinetic rather than postural
most common in hands and wrists, but also head and voice!
bilateral usually –> inhibits daily activities
can be inherited, progresses with age.
caffeine and fatigue. alcohol.
Parkinsonism?
1) what is it?
2) what causes it?
3) most common form?
clinical syndrome characterized by tremor!
various meds cause Parkinsonism by blocking or depleting DOPAMINE
idiopathic Parkinson’s disease (PD)
Parkinson’s disease
what do most present with?
classic Parkinson tremor is what?
hallmark signs?
chronic neurodegenerative disease
resting tremor is the presenting feature that gets better with action
at rest –> pill-rolling motion of the fingers.
bradykinesia –> difficulty rising from a seated position, reduced arm swing while walking, micrographia (handwriting is super small)
Cerebellar tremor?
Classic –> low-frequency, slow-intension or postural tremor.
caused by MS with cerebellar plaques, strokes, or brainstem tumors
Psychogenic tremor?
1) what are some features?
2) what makes it better or worse?
3) what is it more seen in?
abrupt onset, spontaneous remission, changing tremor characteristics (location and frequency)
increase with attention (from other people) and extinction with distraction (distracting the patient)
more seen in allied health professions and litigation.
HPI for tremor?
1) fam hx?
2) gradual onset?
3) abrupt?
family history of neurologic disease or tremor –> genetic component –> common for essential tremors
older patient and gradual onset –> Parkinsons or essential
sudden onset –> psychogenic from medication, toxins, or brain tumor.
why would someone be worried about Parkinson’s?
it’s a neurodegenerative disorder and we can delay it but there is no cure –> they get dementia.
Parkinson Disease?
1) what do they have? what about on the first involved side?
2) vocal things?
3) smelling?
4) any QOL stuff?
5) what about autonomics
6) general facial features?
tremor, decreased arm swing on the first involved side
soft voice
decreased smell
sleep problems
autonomic dysfunction –> constipation, sweating, etc)
decreased facial expression (mask like)
Features that separate PD from ET?
3 essentials
what about neurological signs?
tremor.. PD is resting tremor, ET is postural or action tremor.
distribution –> PD is asymmetrical, ET is symmetrical
writing –> PD is micrographia, ET is tremulous
neurological signs ONLY in PD –> bradykinesia, rigidity, loss of postural reflexes
