Movement disorders Flashcards Preview

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Flashcards in Movement disorders Deck (52):
1

What can cause movement disorders?

-age-environment toxins
-genetic disorders
-medication
-metabolic
-parkinson's dz-stroke

2

Ex of genetic disorders?

-Huntington dz-wilson dz

3

Types of movement disorders?

-ataxia
-dystonia
-tics
-tremor
-myoclonus
-chorea
-athetosis

4

What is trunkal ataxia?

-cannot stand on own-normal strength in arms and legs

5

What are tics?

-involuntary muscle contractions
-has a strong urge/sensation --> relieved by contraction

6

Tic categorized?

-simple-complex

7

Ex of tics?

-blinking
-clearing of throat
-facial twitching
-grunting
-shrugging
-sighing

8

Tic compressed?

-can but feels uncomfortable

9

Tremor?

-hyperkinetic disorder
-fast or slow
-symmetric/non-symmetric

10

Categorization of tremor?

-rest-essential/intension

11

Rest tremor?

-basal ganglia

12

Intention tremor?

-cerebellar

13

What is important to ask about tremors?

-start with one hand or both?

14

What is dystonia?

-long lasting muscle contraction
-sometimes painful

15

What is myoclonus?

-sudden, brief muscle contraction
-can be confused w/tic

16

Does rest tremor get go away?

-no, it gets better when doing something

17

What is chorea?

-may look like fidgeting
-involves distal extremities
-"irregular timed, non repetitive, complex motor movements, random, abrupt"

18

What is athetosis?

-involves distal extremities

19

Similarities of chorea and athetosis?

-restlessness
-exaggerated gestures
-may look like fidgeting
-dance like gait

20

What dz is chorea and athetosis related to?

Hunnington dz

21

Essential tremor:
age
time
what is it

age: 40-60yo
time: progressive
what is it: kinetic and postural (occurs w/ voluntary maintenance; shakes when doing something but no tremor at rest)

22

Essential tremor- neurological findings?

-bilateral
-improves w/ walking
-tone and reflexes are normal
-gait and balances are normal

23

Essential tremor - difference from Parkinson?

-no bradykinesis
-no rigidity
-no masked face

24

Essential tremor - worse/better?

worse: stress
better: drinking

25

Essential tremor - tx?

betablockers

26

Parkinson - patho?

lacking dopaminergic cells of the basal ganglia (substantia nigra)

27

Parkinson - RF?

age

28

Parkinson - timeline?

early: movement probs (tremor)
later: behavior, mental
progressive dz

29

Parkinson - non movement PE?

sleep distrubances
progressive supranuclear palsy
depression
fatigue
constipation
*does not improve w/ tx

30

Parkinson - PE?

-bradykinesis
-tremor at rest
-rigidity
-postural instability
-mask like face
-shuffling gate

31

Parkinson - tremor?

resting tremor
"pill rolling"
+/- vocal cords

32

Parkinson - rigidity?

stiff, resistance like PASSIVE muscle movements
"lead pipe rigidity" - bending a lead pipe
"cogwheeling" - ratchet feeling

33

Parkinson - bradykinesis?

not able to get out chair/walking (cannot initiate first step)
not able to write (fine motor skills goes downhill)

34

Parkinson - postural instability?

not able to walk/sit
arms not swinging as walking

35

Parkinson - labs?

nothing - clinical dx
r/o: CT/MRI/CSF: NORMAL

36

Parkinson - tx?

dopamine (dopamine agonist)
- levodopa
surgery

37

Tourette's syndrome - sx?

-vocal/motor tics
-usually childhood
-linked w/ personality and physical
-many times a day
-best to see in corner of eye b/c they can suppress it (though it's uncomfortable)

38

Tourette's syndrome - timeline?

age 5: simple motor tics (blinking)
age 7: complex (snorts, shrugs)
age 14: violent head shake, vocals involved
age 17: subtle head shake, abdominal tense

39

Tourette's syndrome - sx mental?

obsessive
compulsive behaviors
-rage attack

40

Transient tics?

-in childhood and goes away on its own

41

Huntington's dz - timeline?

early behavioral changes (irritability, depression, apathy)
usually not until 30-40yo (but can be juvenile - 21yo)
subtle motor changes (restlessness, coordination probs, gait abnormalities)

42

Huntington dz - RF?

autosomal dominant
*be careful for suicide in pts and FH

43

Huntington dz - dx?

gene probe

44

Huntington dz - tx?

symptomatic - life expectancy 15-20 yrs after diagnosis

45

Restless leg syndrome - sx?

pt is restless when legs are at rest - esp at night
"paresthesias"
"dysesthesias"
leg kicks while sleeping
NORMAL neurologic examination

46

Restless leg syndrome - labs?

CBC - check iron
if anemic, tx anemia RLS might go away

47

Restless leg syndrome - dx?

1) urge to move legs
2) rge worse at night
3) legs >>> arms
4) sx, walk, sx again

48

Restless leg syndrome - tx?

lifestyle changes: avoid caffeine, exercise, hot baths
no med tx

49

Tardive dyskinesia - RF?

too much dopminergic antagonist properties
long term/HD anitpyschotics
schizophrenic/bipolar pts
elderly pts on potent meds

50

Tardive dyskinesia - sx?

smacking of lips
pursing of lips
rapid eye blinking
athetosis of fingers/toes

51

Tardive dyskinesia - tx?

remove drug

52

Tardive dyskinesia - prevention?

start of low and go slow/short (dopamine antagonist)