Movement Disorders Flashcards
(24 cards)
Which are the most common neurodegenerstive disorders
- Alzheimer’s
- Parkinson
Describe Parkinson’s disease
Progressive neurodegenerative disorder that affects movement.
Nerve cells (neurons) die in the brain in the substantia nigra
Substantia nigra is responsible for producing dopamine which helps control
Control movement and coordination
Develops when 60% of these cells die
Imbalance between direct and indirect pathway within basal ganglia inhibiting motor cortex regions
Neurons go to primary cortex via thalamus and basal ganglia
Symptoms hallmark:
Tremor
Bradykinesia (slow)
Muscle ridge tiny
Gait disturbance (shuffling)
Mood disturbance
• Dopamine Dysregulation Syndrome and Impulsive Control Disorders.
• Cognitive decline.
• Pain.
• Sleep disorders.
• Dysautonomia.
• Orthostatic Hypertension, Genitourinary Dysfunction, Constipation
Thought to be caused by genetic predisposition and enviromental factors , toxins
Progressive disease, no cure but there are some treatments
Atypical Parkinson’s can rapidly evolve, there can be some with non motor symptoms
Eyes closed tests they will feel unbalanced and eyes open on the affected side will show more positive results
Give relative differential diagnosis for a tremors
-Essential tremor
-Dementia with lewy bodies (exposure to -metal causing Parkinson’s)
-Multiple system atrophy.
• Corticobasal Degeneration.
• Progressive Supranuclear Palsy. (Neuro degeneration disorder affect balance and vision. Fear of falling backwards)
• Basal Ganglia Calcification.
• Other Neurodegenerative Disorders.
What is atypical parkinsonian disorders
Rapidly evolving Parkinson with other signs of neurological dysfunction
Multiple system atrophy
More aggressive
What are hyperkinetic disorder
Group of movement disorders characterised by exciseve or abnormal movements
Tremors (involuntary rhythmic movements of hands, arms, head) if ascending and descending don’t work together this can cause a tremors
Dystonia (muscles contract uncontrollably)
Chorea (jerky dance ike movement. Face, hands, legs)
Myoclonus (sudden, brief jerks or twitches)
Tic disorders (rapid, respective o events or vocalisations. Tourette’s)
What is a tremor caused by
Damage to tracts and ascending/descending system balance can cause a tremor ur
In parks in on, Corticospinal tract causes motor dysfunction due to damage to basal ganglion which leads to this
You can get physiological tumours due to increased stress levels . Fatigue, alcohol, drugs and metabolic distrbances can also cause this
List different types of tremors
Rest (Parkinson’s)
Action
Postural (essential tremors )
Kinetic (essential tremors )
Intention (cerebellar tremous)
Task specific
Isometric
Describe essential tremours
Involuntary, rhymic shaking. Mc affect hands
Occurs when doing voluntary movements like holing a cup or writing
Progressive, doesn’t involve other symptoms like bradykinesia
Family history
Bilateral
Mc
Upper limb action (postural when body is held against gravity or kinetic where moving body part is affected)
Symmetric more prominent dominant side
• 50% familial with autosomal dominant inheritance.
• 50-70% symptoms improve with alcohol consumption.
• Tremor likely progressive.
• Most treatments (for all tremors) are pharmacological
Cerebellar issue
List specific tremours
tremors:
• Neuropathic tremor. Nerve damage like peripheral neuropathy or CNS m seen in limbs and can have numbness tingling or weakness. Mainly during rest)
• Dystonic tremor (muscles contract uncontrollably leading to abnormal postures. simultaneous contraction of agonist and antagonist muscles Mc 26. Caused by a lesion in the basal ganglia. Normally involves the same muscle groups. Initially normally focal. Hyperkinetic)
• Psychogenic tremor Rest or movement. Neck, hands, jaw.
• Cerebellar tremor.(coordination and fine motor control issues, Multipel sclerosis,stroke, cerebralar disorders. Low frequency which worsens when fine motor)
• Holmes tremor. (RARE, midbrain, resting tremour turn into an intention tremours. Motor issues)
• Palatal tremor.(vibration or tremours of roof of mouth. Brainstem . Affect ear)
• Tardive tremor. (Drugs, hands face and atre jerky at rest. Lip smacking)
• Orthostatic tremor.(standing, associated with Parkinson’s. Legs high frequency shaking when still)
• Psychogenic tremor (stress, anxiety, trauma, different frequency)
Describe dystonia
Dystonic tremor (muscles contract uncontrollably leading to abnormal postures.
simultaneous contraction of agonist and antagonist muscles Mc 26.
Pain and discomfit
Onset sudden or gradual. Severity depends on person
Caused by a lesion in the basal ganglia. Normally involves the same muscle groups. Initially normally focal. Hyperkinetic)
Mc is cervical dystonia (Lean to one side
Inherited genetic disorder
Unknown etiology
Describe chorea
Chorea.
• Brief, semidirected, irregular movements, usually distal.
Flowing motion anf uncontrollable
• Not repetitive or rhythmic and appear to flow from one muscle to
another.
• Pathophysiology – Disturbance in modulation of the basal ganglia’s
thalamocortical motor pathways.
• Most notable for its link to Huntington’s disease (HD). Huntington’s
Chorea.
Stroke, brain injury can cause
• Other than HD, there are other specific forms of chorea
Involuntary movement (JERKY DANCING)
DIFFICULTY FINE MOTOR CONTROL
Speech difficulty
Facial movement
Emotional and cognitive change
Dopamine blockigndrugs can help
Describe huntingtons disease
.
• Hereditary, progressive neurodegenerative disorder.
Mutation causing production of abnormal protein Huntington
• Most common cause of chorea.
• Classic HD – Chorea, neurobehavioural changes and gradual
dementia.
• Onset usually 40-50yrs. Can occur throughout adulthood.
• Early onset normally characteristic of increased severity and more
rapid progression
What is myoclonus
Brief, shock-like involuntary movements.
• Caused by contractions (positive myoclonus) or inhibitions (negative
myoclonus- asterixis).
• Myoclonus – Sudden, abrupt, brief, involuntary, jerklike contraction of
a muscle or muscle group.
• Asterixis – Sudden inhibition of voluntary muscular contraction with
lapses in sustained posture
.
• Physiologic – Physiologic Sleep Myoclonus.
• Pathologic – multifocal and nonprogressive.
• Essential, if presumed pathologic, to refer
Can be caused by Parkinson’s, Huntingtons, epilepsy , cerebral opalsy, stroke or braininjur t
List cortical and subcortical gait disorders
Gait
• Cortical Gait Disorders.
• Frontal Gait. (Damage to frontal lobe. Shuffling gait with small steps and difficulty lifting feat. Freezing gait and stopped)
• Cautious Gait. (Balance issues, muscle weakness, joint problems,s seen with anxiety. Cautious avoiding fast or wide steps. Older adults with Parkinson’s)
• Psychogenic Gait. (Limping, shuffling, freezing)
These gaits are caused by damage to the cortex of the brain often due to strokes, brain injuries, certain neurodegenrtstive diseases
• Subcortical Gait Disordors.
Caused by damage to the subcortical structures of the brain such as the basal ganglia anf the thalamus. Seen in Parkinson’s, huntingtons, multiple system atrophy
• Spastic Gait. (Stiffnes, dragging , crossing legs over. like multiple sclerosis, cerebral palsy, or after a stroke.)
• Ataxic Gait. (Cerebellum dysfunction. Multiple sclerosis, stroke. Wide-base walking)
• Hypokinetic-Rigid Gait (basal ganglia issue. Parkinson’s, hypokinesia. Slow less, ridging, freezing. Minimal arm swing and stopped posture)
• Hyperkinetic Gait. (basal ganglia, such as Huntington’s disease or dystonia.. jerky and involuntary)
• Dystonic Gait (abnormal muscle contracts of legs neck or trunk. Twisting, jerking movements. Abnormal postures , cervical or general dystonia).
Myoclonus gait (toxins, Parkinson’s, epilepsy, dementia, huntingtons, multiple sclerosis. Jerky shuffling gait, infrequent stoping, posytrtual instability, exaggerated, abrupt movements)
give primary signs of parkisnons disease
resting tremour
bradykinesia (slow of voluntary movement)
muscle rigidity
shuffling gate
What is scissor gate
Legs cross over each other
Spactisity
UMNL
Reduced leg step
Difficulty with balance and coordination
Cerebral palsy
MS
Stroke
Parkinson’s
What is ataxic gait
Wide based stance may appear undstead
Difficulty coordination
Swaying
Cerebellar ataxia, MS due to cerebellar id due which helps coordination and balance
What is steppage gait
Lift leg higher than normal and dregs sfoot.
Anterior tibial muscle weakness
Peripheral neuropathy, foot drop, MND, Charcot Marie
What is waddling gait
A side to side sway
Weak hip muscles
Hip joint deformity
Muscle weakness
Muscular dystrophy
What is hemiplegic gait
After stock
One leg drag or stiff, arm held in flexion
Circumspection of other leg
Hemiplegic weakness
What is cerebellar gait
Wide vases unsteady, fall toward one side
Cerebellar disorders, MS, alcohol intoxication
What is shuffling gait
Minimal arm movement, small steps
Parkinson’s
What is a Lewy body
Abnormal climb our deposit of a protein found in brain neurons
Accumulates abnormally
Parkinson’s dieswea as they accumulate in substantia nigra which produces dopamine
Lewy body dementia
Describe gait cycle
Stance phase 60%
Foot is in contact with group
Initial contact is heel strike
Loading response (absorb impact) knee flex
Mistance:body weight on foot. Other leg in swing phase
Terminal stance is heel off
Pre swing is toe off
Swing phase is 40%
Initial swing: leg moves forward, hip and knee flex
Mid swing:knee extends
Terminal seeing: leg prepares to make contact with the ground
Be mindful of stride, stem, cadence (number of steps)
