Lecture 3: Mvmnt Disorders Flashcards Preview

Neurology > Lecture 3: Mvmnt Disorders > Flashcards

Flashcards in Lecture 3: Mvmnt Disorders Deck (23):

Benign Essential Tremor

-postural tremor of hands, head or both
-fam Hx
-gets better with alcohol
- no other abnormal findings
-tx: propanolol or primidone


Parkinsonism: essentials of dx

any combo of tremor, rigidity, BRADYKINESIA, progressive postural instability


Most common variety of Parkinsonism

Idiopathic Parkinson Dz: begins btwn 45-65 y/o


Other causes of Parkinsonism

-rarely family basis
-postencephalic parkinsonism= rare
-toxin exposure (C disulfide, manganese dust, CO poisoning)
-MPTP use
-Reversible parkinsonism: use of neuroleptic drugs


Idiopathic Parkinson Dz etiology

dopamine depletion due to degeneration of dopaminergic nigrostriatal system leads to an intolerance of Dopa and Ach


Risk factors for Idiopathic Parkinson

Age, fam hx, male sex, ongoing herbicide/pesticide exposure, significant prior head trauma


Parkinson Clinical Findings:

-tremor: usually one limb or one side of body for many yrs before becoming more generalized; decreases with voluntary mvmnts
-bradykinesia: most disabling of sx's: ***decrease arm swinging


Park: Clinical Dx

-immobile face w/ widened palpebral fissures; infrequent blinking; fixity of facial expression
-blepharoclonus and tremor at mouth/lips
-repetitive tapping at bridge of nose prides sustained blinking = Myerson sign


Other Park findings:

gait: shuffling of feet, slow to turn, no swinging of arms
-impairment of fine rapid alternating mvmnts and micrographia
-NO muscle weakness, alteration in reflexes or plantar response


Park Tx:

Amatadine: mild sx's, help with side effects of l-dopa
Anticholinergic agents: better balance with dopa levels
L-dopa: improves all major features of parkinsonism; long term use increase side effects
Dopamine Agonist: directly act on dopa receptors and help with SE of Ldopa
Selective MOIs: rasagiline: inhibit breakdown of Dopa
COMT inhibs: reduce metab of Ldopa, decrease SE due to increase levels of Ldopa = entacapone
Atypical antipsychs
Brain stimulation


Ldopa side effects

Occurs wit=h prolonged use
-dyskinesia, restlessness, confusion, and other behavioral changes
-"on/off" phenomenon: abrupt transient fluctions in severity throughout day with marked bradykinesia


Huntington Dz main features:

***Chorea and dementia and family hx
Other findings: onset 30-50, fatal in 15-20 yrs; very debilitating; CT: atrophy
-NO cure


Idiopathic Torsion Dystonia

dystonic mvmnts and postures; NORMAL birth and development: no other neurological signs


Dystonic mvmnts in Idiopathic Torsion Dystonia

-mvmnts of head and neck: torticollis, blepharospasm, facial grimacing, forced open/closing of mouth


DDX Idiopathic Torsion

-birth trauma, kinecterus, prenatal anoxia all cause dystonia, but all have abnormal early development


Guilles de la Tourette Syndrome : features

-multiple motor tics or phonic tics
-sx's begin before 21 y/o
-tics occur frequently for 1 ye
-tics vary in #, frequency and nature over time


Features of tics

-motor tics: initial manifestation (80%), involve face, head and shoulders
-phonic tics: 20%, grunts, barks, hisses, throat clearing, coughs; may be verbal utterances; echolalia or palilalia
-some can be self harming


Essential of dx

Tic like character of abnormal mvmts and absence of neurological signs


Tics Tx

-Alpha adrenergic agonists: clonidine
-typical antipsychs: haloperidol
-atypical antipsychs: risperidone, apripazole



involuntary, continuous, abrupt, rapid, brief, unsustained, irregular mvmnts that flow from randomly from one body part to another
**dance-like mvmnt of feet and hands


Disorders/Drugs that cause Chorea

Disorders: Huntington dz, Wilson's dz

Drugs: Dopaminergics, anti-dopaminergics, anticonvulsants



neurologic syndrome characterized by involuntary, sustained, patterned, and often repetitive muscle contractions of opposing muscle movements or abnormal postures
***longer duration than chorea, twisting of body parts, younger age at onset


Drugs that cause Dystonia

Dopamine blocking agents, neuroleptics, certain nausea meds