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Neurology finals > Dyskinesias > Flashcards

Dyskinesias Flashcards

1
Q

What is a dyskinesia?

A

Involuntary abnormal movement

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2
Q

What are dyskinesia’s characterised by?

A

Frequency
Amplitude
Exacerbating factors - stress and fatigue

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3
Q

Describe rest tremor

A

Abolished on voluntary movement

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4
Q

Give a cause for rest tremor

A

Parkinsonism

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5
Q

Describe intention tremor

A

Irregular, large amplitude, worse at the end of purposeful acts

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6
Q

Give some causes of intention tremor

A

Cerebellar damage - MS, stroke

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7
Q

Describe postural tremor

A

Absent at rest, present on maintained posture (arms outstretched) and may persist (but is not worse) on movement

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8
Q

Give some causes of postural tremor

A

Benign essential tremor
Thyrotoxicosis
Beta- agonists

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9
Q

Describe re-emergent tremor

A

Postural tremor developing after a delay of 10 seconds

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10
Q

What are the causes of re-emergent tremor

A

Parkinson’s disease

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11
Q

Describe chorea

A

Non-rhythmic jerky, purposeless movements flitting from one place to another

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12
Q

Give some examples of choreas

A

Grimacing
Raising the shoulders
Flexing/extending the fingers

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13
Q

Give some causes of chorea

A

Huntington’s disease

Sydenham’s chorea

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14
Q

Which drug worsens chorea

A

Levodopa

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15
Q

What is Sydenham’s chorea

A

Rare complication of group A streptococcal infection

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16
Q

Describe hemiballismus

A

Large amplitude flinging hemichorea affecting proximal muscles contralateral to a vascular lesion of the subthalamic nucleus

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17
Q

What is the typical patient with hemiballismus

A

Elderly

Diabetic

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18
Q

What is the prognosis of hemiballismus

A

Recovers spontaneously over a few months

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19
Q

Describe athetosis

A

Slow, sinuous, confluent, purposeless movements (especially digits, hand, tongue and face)
Often difficult to distinguish from chorea

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20
Q

What causes athetosis

A

Cerebral palsy

21
Q

What is psuedoathetosis caused by?

A

Severe proprioceptive loss

22
Q

What are tics?

A

Brief, repeated, stereotyped movements often difficult to distinguish from chorea

23
Q

What types of tics occur in tourettes syndrome?

A

Motor and vocal

24
Q

What might haloperidol cause if given to people for tics?

A

Tardive dyskinesia

25
Q

Which drugs are considered for severe tics

A

Clonidine or clonazepam

26
Q

Describe myoclonus

A

Sudden involuntary focal or general jerks arising from the cord, brainstem or cerebral cortex

27
Q

Which conditions is myoclonus seen in

A 
Metabolic 
Neurodegenerative (lysosomal storage enzyme defects)
CJD
Myoclonic epilepsies (infantile spasms)
Benign essential myoclonus
Asterixis (metabolic flap)
28
Q

Describe benign essential myoclonus

A

Childhood onset with frequent generalised myoclonus without progression
Often autosomal dominant

29
Q

Which drugs might benign essential myoclonus respond to?

A

Valproate
Clonazepam
Piracetam

30
Q

Describe the genetic inheritance pattern of benign essential myoclonus

A

Autosomal dominant

31
Q

Describe asterixis

A

Jerking of outstretched hands
Worse when wrists extended (loss of extensor tone as there is incoordination between flexors and extensors - negative myoclonus)

32
Q

What causes asterixis

A 
Liver or kidney failure
Hyponatraemia
Hypercapnia
Gabapentin 
Thalamic stroke if unilateral
33
Q

What are tardive syndromes?

A

Delayed onset yet potentially irreversible symptoms occurring after chronic exposure to dopamine antagonists

34
Q

Describe tardive dyskinesia

A

Orobuccolingual
Truncal
Choreiform

35
Q

Describe tardive dystonia

A

Sustained, stereotyped muscle spasms of twisting, turning character

36
Q

Describe tardive akathisia

A

Sense of restlessness or unease +/- repetitive, purposeless movements

37
Q

How do you treat tardive dyskinesia

A

Gradually withdraw neuroleptics and wait 3-6 months

Tetrabenazine may help

38
Q

Which antipsychotics are less likely to cause tardive syndromes

A

Quetiapine, olanzapine and clozapine - Atypical antipsychotics

39
Q

Describe dystonia

A

Prolonged muscle contractions causing abnormal posture or repetitive movements

40
Q

Describe idiopathic generalized dystonia

A

Childhood onset dystonia often starting in one leg with ipsilateral progression over 5-10yrs

41
Q

What inheritance pattern is idiopathic generalized dystonia

A

Autosomal dominant (DYT1 deletion)

42
Q

What must you exclude in idiopathic generalized dystonia

A

Wilsons disease

Dopa responsive dystonia

43
Q

What drugs may be used to treat idiopathic generalized dystonia

A

Anticholinergics
Muscle relaxants
Deep brain stimulation

44
Q

Describe focal dystonia

A

Confined to one part of the body
Idiopathic and rarely generalise
Worsened by stress
Patients might develop a geste antagoniste to try to resist the dystonic posturing

45
Q

Give some examples of focal dystonias

A

Spasmodic torticollis - where head is pulled to one side of the body
Writers cramp
Blepharospasm - involuntary contraction of orbicularis oris

46
Q

How are focal dystonia’s treated?

A

Injection into the overactive muscles

47
Q

What is acute dystonia

A

Torticollis (head drawn up)
Oculogyric crisis (eyes drawn up)
Trismus (oromandibular spasm)

48
Q

What causes an acute dystonia?

A

Staring neuroleptics and some anti-emetics (metoclopramide and Cyclizine)

49
Q

How do you treat acute dystonic reactions

A

A dose of anticholinergic

Neurology finals (32 decks)

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