Flashcards in Movement disorders Deck (42):
disorder of BG. often called extrapyramidal disorder bc don't affect pyramidal system aka corticospinal tract
structures involved in motor ctrl and planning + emotion, cognition, eye mvt. putamen, globes plaids, caudate nucleus, sub thalamic nucleus, substantial nigra. doesn't directly proj to periphery, instead has reciprocal cxn to cortex via thalamus.
main site of dopamine production of 3/4 dopamine pathways in brain (nigrostriatal, mesolimbic, mesocortical)
caudate + putamen
putamen + globus pallidus
decr o or slowed mvt
abn, extra mvt.
most common mvt disorder. rhythmic mvt due to alternating contractions btw agonist and antagonist M
chorea and athetosis
chorea- irreg, asym, random, continuous. athetosis- snake like slow twisting - more in distal M.
violent, involuntary flailing of extremities - extreme form of chorea
random, repetitive, rapid, purposeless mvt at random interval. involve motor or vocal (grunting, sniffing). semi voluntary bc can be temporality suppressed with great effort unlike other mvt D.
rapi, brief, unctrl jerks
sustaiend, abn posture caused by simultaneous activation of both agonist and antagonist M
subjective sense of inner restlessness in which pt feels compelled to move continuously
slow start. then fast. then prob stopping.
idiopathic parkinson's gait
small steps and doesn't lift feet. festinating gait
parkinson's dx criteria
tremor (unilateral at onset, wose at rest, disappear with mvt)
rigidity (cogwheel rigidity)
postural instbaility (lose postural reflexes)
shuffling gait with decr arm sling. festinating gait or freezing epic. but can ride bike.
other sx: depression, apathy, masked facial expression, anosmia, dysphagia/ dysarthria, urinary dusfunc/ constipation, autonomic dysfunc, sleep disruotion, REM sleep. micrographic (small handwriting) is often 1st syndrome
vanishes in sleep
idiopathic destruction of dopamine making neurons in substantial nigra of midbrain. sx start with >80% drop making neurons are destroyed
intracytoplasmic inclusion composed of alpha synuclein. pathological hallmark of PD.
mostly clinical. ioflupane iodine-123 injection or DaTscan- contract agent use with SPECT for detecting dopamine transporters DaT in suspected parkinsonian syndromes
progressive supranuclear palsy
reptilian state. tauopathy,no tx. look up. midbrain atrophy. MRI-penguin sign
Parkinson's disease DD
1) medication induced parkinsonism- high potency typical antipsychotics and antiemetics
2) parkinson -plus syndrome
3) essential tremor
4) progressive supranuclear palsy
parkinson plus syndrome
div into multi system atrophy, cerebellar type and multi system atrophy parkinsonian type.
clues: lack of response to parkinson meds, wide based gait, eye mv abn, symmetrical onset of sx, rapid onset of disability- w/in 5y of sx onset, early onset dementia, early onset falling, prominent autonomic dysfunction
action tremble, often bilateral, w/ head tremor or voice tremor, often familiar, improve with alf, lack of bradykinesia rigidity, gait ab. more common
alcohol alleviates it. tx with propranolol/ inderal. primidone, non selective beta blocker.
progressive supranuclear palsy
parkinsonian sx marked by vertical gaze palsies, with downward gaze. spectacular falls, alter mood/ behavior, depression, apthy, progressive dementia.
dopamine agonist therapy SE
impulse control disorders like pathological gambling or hyper sexuality
combo of carbidopa/levadopa. carbidopa prevent conversion of levodopa to dopamine by dopa decarboxylase - preventing emesis "sin emesis). carbodipa doesn't cross BBB, so levodopa can be converted to dopa in CNS.
SE: paranoia and hallucination.
if SE, lower dose. if low dose doesn't tx sx then raise dose + add antipsychotic- quetiapine/seroquel or chlozaril
if get hypotension, add fludrocortisone
deep brain stimulation in PD targets_
subthalamic nucleus. bc lesions there cause hemiballism- wild, flinging mvt of CL extremities. this tx is for ppl with on-off response to med. dyskinesia and tremors are responsive this this therapy
1) dopamine agonist: requip/ropinirole and mirapex/pramipexole. CI in elderly due to psychiatric sc. as progress tx with carbadopa-levadopa- most effective but cause dev of dyskinesia
honey moon period- initial tx element sx for many years
snippet can be combined with COMT inhibitors to prolong.
multiple system atrophy MSA
show hot cross buns sign. orthostatic hypotension
dementia, psychosis, choreiform mvt -irregular, rapid, uncontrolled, involuntary. mvt flow randomly from one part of body to another.
caudate nucleaus atrophy --> enlarged ventricles
auto DOm CAG repeat.
show anticipation- early generation affected earlier than previous
give haloperidol to improve chorea
why always get pregnancy test.
result from childhood infection with group A beta -hemolytic streptococci and occur in pt with rheumatic fever
auto R --> cu accumulate in liver, brain, eyes. primary liver disease in late childhood-early adolescent as acute hepatitis/ cirrhosis.
classic presentation- wing flapping tremor. hepatolenticular degeneration. midbrain- face of the giant panda sign. present with irritability, personality change, enlarge liver, coarse tremor in arms. mvt are slow and dysarthria. kayser fletcher ring around cornea bc deposit copper in descent's membrane.
labs- low serum cerloplasmin, incr urinary coper, incr LFT
wilson's disease tx
1) lo cu diet
2) zinc salts block cu absorption
3) penicillamine and trientine incr excretion of cu in urine
4) in severe disease liver transplantation is indicated
botox as tx
for spastic torticollis- painful spasm of neck M that force head to rotate and tilt, imaging normal. blepherospasm- forceful eyelid closure
restless leg syndrome
1) starts during inactivity
2) relief with mvt
3) worsening in evening
1st line tx- dopamine agonist- roperinole.
precede more serious illness like PD. can be SE of SSRI. should test for Fe def.
tx acid reflux. SE: sudden twisting of neck, protruded tongue, N, migraine.
tx SE with diphenhydramine
akathisia. tx with propranolol/inderal.
if dev fever and rigidity use dopamine agonist like dromocriptine. or dantrolene- Ca ch blocker
the finger. n touter's D.
tourette's disorder tx
alpha adrenergic agnoist has best risk/benefit ratio.
most commonly used med- guanfacine/ tenet or clonidine. also use anti psych.