Movement Disorders Flashcards
What is a Movement disorder?
impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function
what is the major Hypokinetic Movement Disorder?
Parkinson’s Disease (major disorder)
what are examples of Hyperkinetic Movement Disorders?
Huntington’s Disease
Wilson’s Disease
Tourette’s Syndrome
Restless Leg Syndrome
what is parkinsons disease?
synydrome with combo of tremor, rigidity, bradykinesia, and characteristic disturbance of gait and posture
what is the average onset of parkinsons?
mid-late life; mean age is 57 yrs
who does parkinsons affect?
Affects all ethnicities
has equal M/F distribution
occurs 1 per 100 people that are over 65 yrs
4th most common disease in the elderly
what are symptoms of parkinsons caused by?
Decreased movment due to lack of DA in substantia nigra projecting to striatum
what is the pathophysiology of parkinsons?
- Loss of dopaminergic cells in substantia nigra
- Poor regulation of Striatum output
- Decrease in thalamic excitation of motor cortex
- Decreased excitation of corticospinal tracts.
what are the 4 hallmark signs of parkinsons?
Resting Tremor (aka Pill-Rolling)
Rigidity (Lead-Pipe or Cogwheel)
Bradykinesia: slow starting/initiate movement
Festinating: Flexed Posture with shuffling gait
how can you look for differential diagnosis?
must look for tremor disease that arent parkinson’s
Involuntary tremor vs. Intentional tremor
Depression
Wilson’s Disease
Huntington’s Disease
what is huntingtons disease?
genetic neurodegenerative disorder which predominately has behavioral, cognitive, or movement disorders signs
what is the 1st sign of huntingtons disease?
change in personality (impulsive, irritable, irrational)
who does huntingtons disease affect?
50% chance to pass on the disorder
Paternal Descent
30-40 y/o diagnosis
what is the pathophysiology of huntingtons disease?
Mutation on chromosome 4 increasing glutamine production
Over-expression of gene: i.e. excess glutamine, excitotoxicity
Atrophy & neuronal degeneration of cortex causing uncontrolled movements, loss of intellect, and emotional disturbance*
what is a hallmark of huntingtons disease?
caudate atrophy
what type of physical findings are there for adult onset of huntingtons?
Prominent chorea
Bradykinesia
Postural reflex compromise
what are the physical findings for terminal huntingtons pts?
Lack of motor coordination of mouthc. Dysarthria, dysphagia, & respiratory difficulties
what are general mental findings of huntingtons?
Cognitive impairment
Depression
Psychiatric disorders
what causes wilsons disease?
Autosomal recessive trait
excessive copper that somenoes body cant break down
what is the pathophysiology of wilsons disease?
Abnormal copper metabolism
Deposition of copper in tissues
Txable and reversible and repressive
what are signs and symptoms of wilsons disease?
Tremors Dystonia gait: loose Depression Difficulty speaking, swallowing Easy bruising Fatigue Joint pain Loss of appetite, Nausea Skin rash Swelling of arms and legs jaundice
what is Tourette Syndrome?
Dxed when childhood onset tics are multifocal (many tics), motor or vocal, lasting longer than 1 yr and naturally wax and wane
what part of the brain is involved in tourette syndrome?
caudate Nuc
Excessive projections to caudate
Studies show caudate atrophy, enlarged lateral ventricles
what is the incidence of tourette syndrome?
Onset: 2-21 y/o
Male predilection
