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Flashcards in Movement disorders Deck (42):
1

movement disorder

disorder of BG. often called extrapyramidal disorder bc don't affect pyramidal system aka corticospinal tract

2

BG

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)

3

striatum

caudate + putamen

4

lenticular nuc

putamen + globus pallidus

5

hypokinetic disorder

decr o or slowed mvt

6

hyperkinetic disorder

abn, extra mvt.

7

tremor

most common mvt disorder. rhythmic mvt due to alternating contractions btw agonist and antagonist M

8

chorea and athetosis

chorea- irreg, asym, random, continuous. athetosis- snake like slow twisting - more in distal M.

9

ballism

violent, involuntary flailing of extremities - extreme form of chorea

10

tics

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.

11

myoclonus

rapi, brief, unctrl jerks

12

dystonia

sustaiend, abn posture caused by simultaneous activation of both agonist and antagonist M

13

akathisia

subjective sense of inner restlessness in which pt feels compelled to move continuously

14

festinating gait

slow start. then fast. then prob stopping.

15

idiopathic parkinson's gait

small steps and doesn't lift feet. festinating gait

16

parkinson's dx criteria

TRAP
tremor (unilateral at onset, wose at rest, disappear with mvt)
rigidity (cogwheel rigidity)
akinesia/bradykinesia,
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

17

resting tremor

vanishes in sleep

18

parkinson's path

idiopathic destruction of dopamine making neurons in substantial nigra of midbrain. sx start with >80% drop making neurons are destroyed

19

lewy body

intracytoplasmic inclusion composed of alpha synuclein. pathological hallmark of PD.

20

PD dx

mostly clinical. ioflupane iodine-123 injection or DaTscan- contract agent use with SPECT for detecting dopamine transporters DaT in suspected parkinsonian syndromes

21

progressive supranuclear palsy

reptilian state. tauopathy,no tx. look up. midbrain atrophy. MRI-penguin sign

22

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

23

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

24

essential tremor

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.

25

progressive supranuclear palsy

parkinsonian sx marked by vertical gaze palsies, with downward gaze. spectacular falls, alter mood/ behavior, depression, apthy, progressive dementia.

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dopamine agonist therapy SE

impulse control disorders like pathological gambling or hyper sexuality

27

sinemet

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

28

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

29

PD tx

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.
MAO inhibitor

30

multiple system atrophy MSA

show hot cross buns sign. orthostatic hypotension

31

huntington's disease

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

32

chorea gravidarum

why always get pregnancy test.

33

sydenham's chorea

result from childhood infection with group A beta -hemolytic streptococci and occur in pt with rheumatic fever

34

wilson's disease

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

35

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
give lactulose

36

botox as tx

for spastic torticollis- painful spasm of neck M that force head to rotate and tilt, imaging normal. blepherospasm- forceful eyelid closure

37

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.

38

reglan/metoclopramide

tx acid reflux. SE: sudden twisting of neck, protruded tongue, N, migraine.
tx SE with diphenhydramine

39

haloperidol SE

akathisia. tx with propranolol/inderal.
if dev fever and rigidity use dopamine agonist like dromocriptine. or dantrolene- Ca ch blocker

40

copropraxia

the finger. n touter's D.

41

tourette's disorder tx

alpha adrenergic agnoist has best risk/benefit ratio.
most commonly used med- guanfacine/ tenet or clonidine. also use anti psych.

42

tourrette's disoder dx criteria

1) both multiple motor and at least 1 vocal tic
2) tics occur many times a day, nearly daily or intermittently throughout a period of >1y. never more than 3mo tic free
3) onset bf 18 and not due to other cause
4) PANDAS is neuropsychiatric D manifest by ticks and OCD