Abnormal Involuntary Movements Flashcards
(26 cards)
What is chorea?
Involuntary, rapid, jerky movements moving from one part of body to another
Slow, sinuous limb movement
Athetosis
Main cause of chorea
Basal ganglia damage - caudate nucleus
Causes of chorea
Huntington’s disease, Wilson’s disease, ataxic telangiectasia
SLE, anti-phospholipid syndrome
rheumatic fever: Sydenham’s chorea
drugs: oral contraceptive pill, L-dopa, antipsychotics
neuroacanthocytosis
pregnancy: chorea gravidarum
thyrotoxicosis
polycythaemia rubra vera
carbon monoxide poisoning
cerebrovascular disease
Ballistic movements
Involuntary, sudden, jerking movements on contralateral lesion side
Hemiballism
Damage to sub thalamic nucleus
What do ballistic movements affect?
Proximal limb musculature
When do hemiballism symptoms decrease?
Sleep
Treatment for hemiballism
Antidopaminergic - haloperidol
Huntington’s disease
Inherited neurodegenerative condition
Progressive and incurable
Death 20 yrs after initial symptoms
Huntington’s genetics
Autosomal dominant
Trinucleotide repeat disorder
Degeneration of cholinergic and GABAergic neurons in striatum of basal ganglia
Defect in huntington gene on chromosome 4
Features of Huntington’s disease
chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements
after 35 yrs
Oculogyric crisis
Dystonic reaction to certain drugs or conditions
Features of oculogyric crisis
Restlessness, agitation
Involuntary upward deviation of eyes
Causes of oculogyric crisis
Antipsychotics
Metoclopramide
Postencephalitic Parkinson’s disease
Management of oculogyric crisis
Cessation of causative med
Intravenous antimuscarinic - benztropine or procyclidine
Restless legs syndrome
Spontaneous continuous lower limb movements and paraesthesia
Clinical features of RLS
Akathisia - uncontrollable urge to move legs
At night later day
Symptoms worse at rest
Paraesthesia - crawling or throbbing sensation
Periodic limb movements of sleep (PLMS)
Causes of RLS
there is a positive family history in 50% of patients with idiopathic RLS
iron deficiency anaemia
uraemia
diabetes mellitus
pregnancy
Diagnosis of RLS
Bloods - ferritin
Exclude IDA
Management of RLS
simple measures: walking, stretching, massaging affected limbs
treat any iron deficiency
dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)
benzodiazepines
gabapentin
Tics
Intermittent, stereotypical, repetitive involuntary movements
Blinking and shrugging - 15% primary school kids
Treatment - clonidine and atypical antipsychotics
Wilson’s disease
Autosomal recessive disorder
Excessive copper deposition in tissue
Increased copper absorption from small intestine
Decreased hepatic copper excretion
Defect in ATP7B gene on chromosome 13
10-25 yrs symptom onset
Children present with liver disease
Young adults - neurological disease
Features of Wilson’s disease
- Liver - hepatitis, cirrhosis
- Neurological - basal ganglia degeneration - in brain (basal ganglia, putamen and globus pallid us), speech, behaviour and psychiatric problems
- Asterixis, chorea, dementia, Parkinsonism
- Kayser-Fleischer rings - green-brown rings, copper accumulation in Descemet membrane
-Renal tubular acidosis - Fanconi syndrome
-Haemolysis
-Blue nails
