CM: Movement Disorders Flashcards Preview

Block 9 - Neuro > CM: Movement Disorders > Flashcards

Flashcards in CM: Movement Disorders Deck (27):
1

What is parkinsonism?

clinical syndrome w several components: bradykinesia, tremors at rest, rigidity, stooped posture, shuffling gait, postural instability

2

What is bradykinesia/akinesia?

slowness of movement, absence or paucity of spontaneous movement and/or decreased amplitude

3

What is a tremor?

rhythmic oscillation of any body part, amplitude varies but frequency predictable

4

What are the different kinds of tremors?

essential, rest, dystonic, task-specific

5

What is Parkinson Disease?

neurodegenerative disorder characterized by paucity or slowness of movements and rest tremor
also has flexed posture, freezing, asymmetrical onset

6

How can Parkinson dz be diagnosed?

bradykinesia and 1 of the following: rigidity, rest tremor, postural instability (appears later)
exclude other etiologies

7

What are non-motor symptoms of Parkinson's dz?

REM behavior disorder, cognitive disorders, autonomic dysfunction, GI and GU symptoms, sexual dysfunction, sensory symptoms (restless leg), fatigue

8

What is the pathogenesis of Parkinson's dz?

less inhibition of SN --> more inhibition of thalamus --> less activation of cortex

9

When is levodopa used as treatment for Parkinson's?

initiated when symptoms are "disabling"
complications = side effects, motor fluctuations, dyskinesia

10

When are DOPA agonists used as treatment for Parkinson's?

early onset therapy, less effective long term, more side effects in older patients (sudden somnolence, hallucinations, edema, compulsive behaviors)

11

What are the features of surgical management of PD?

motor symptoms not optimally controlled: on-off fluctuations, significant dyskinesias
no evidence of cognitive decline
includes deep brain stimulation of STN or GPi

12

What are the features of DBS in PD?

doesn't cure
bilateral needed for gait
smooths out on-off fluctuations, improves tremor, rigidity, dyskinesia
akinesia and postural instability responds least
programming requires frequent diligent follow up
decreases meds, doesn't eliminate them

13

How can essential tremor be recognized?

progressive action tremor: postural + kinetic
bilateral: may involve head, voice, limbs
absence of other progressive neurological signs
may be mitigated by alcohol
torpedoes = swelling of proximal purkinje cells in cerebellum

14

What is dystonia?

abnormal muscle contraction causing sustained posture, co-contraction of agonist-antagonists
interrupts and is induced by limb movement
may cause repetitive tremor-like contractions

15

What are the different types of dystonia?

focal or generalized
idiopathic = primary cervical dystonia
drug induced = acute dystonia, tardive dystonia
genetic = primary torsion, dopa-responsive, Wilson's dz
blepharospasm = eye closure

16

What is chorea?

non-rhythmyic, abrupt, unsustained
writhing, flowing, dance-like
random, unpredictable timing
focal or generalized

17

What is ballism/hemiballism?

proximal, large amplitude, hemibody movements from lesion of contralateral STN/basal ganglia

18

What is dyskinesia?

abnormal, involuntary, hyperkinetic movements
nonspecific

19

What is stereotypy?

repetitive, usually continuous movements
fragments of normal movements
autism, rett disorder, mental retardation

20

How can tardive dyskinesia be recognized?

persistent abnormal involuntary movements
face, mouth, lip sterotypies (chewing movements, tongue protrusion)
choreiform movements of limbs
pelvic thrusting, dystonia

21

How can Wilson's dz be recognized?

high serum and urine copper, low ceruloplasmin
neurological: tremor, drooling, dystonia, parkinsonian syndrome, cognitive impairment, dementia, psychosis
giant panda sign in midbrain

22

How can Sydenham dz be diagnosed?

usually after group A beta hemolytic strep
chorea (hemi, of distal extremities), hypotonia, tics, behavioral abnormalities
elevated anti-streptolysin O, DNA-ase B titers

23

What is the clinical triad of Huntington's?

chorea and other movement abnormalities, cognitive (dementia, executive dysfunction), psychiatric (personality changes, depression, disinhibition, OC, addiction)

24

What is myoclonus?

non-rhythmyic, abrupt, unsustained, rapid jerk-like
random unpredictable timing

25

What is a tic?

recognizable pattern, unpredictable timing
urge --> tic --> transient relief --> urge --> tic...

26

How can Tourette's syndrome be diagnosed?

multiple motor and phonic tics
occur many times a day for at least 1 yr
onset before 21, no other explanation

27

What is the pathophysiology of Huntingtons?

AD
CAG repeats >40
>60 = juvenile form