Movement Disorders Flashcards by Samii Ross

movement disorders are primarily concerned with what part of the brain?

basal ganglia (however do concern other parts of the brain too)

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main pathophysiology of parkinsons?

dopaminergic neuron loss in the pars compacta region of the substantia nigra causing pigment loss and formation of lewy bodies

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what is the main aim of parkinsons medication at a cellular level?

aim to increase dopamine conc or stimulate dopamine receptors directly

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most common age range for parkinsons patients?

60s-70s

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motor features of parkinsons only appear when most of the neurons in the substantia nigra are lost T or F

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give examples of UMN features; where is the problem?

pyramidal weakness
spasticity
corticospinal tract

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problems with the basal ganglia will cause what problems?

hyperkinetic - dystonia, tics, myoclonus, chorea

hypokinetic- rigidity, bradykinesia

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is parkinsons a hyper or hypokinetic disorder?

hypokinetic

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what is parkinsonism?

symptoms compatible with extrapyramidal problems that is not caused by parkinsons disease (can be caused by medication)

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ataxia is a result of a problem in which part of the brain?

cerebellum

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basal ganglia are made up of __ matter

grey

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how do the basal ganglia control movement?

via a positive/negative feedback loop through the thalamus and cerebral cortex

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where is dopamine made?

in the midbrain by dopaminergic neurons

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what structures are the neurohistological hallmark of PD?

lewy bodies

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most anterior component of the basal ganglia?

caudate nucleus

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what 2 structures make up the lentiform nucleus component of the basal ganglia, where are they located?

putamen
globus pallidus
posterolateral to the thalamus

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what is the most lateral component of the lentiform nucleus?

putamen

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motor symptoms of parkinsons?

tremor
bradykinesia
rigidity
postural instability

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non-motor symptoms of parkinsons?

sleep disorders
hallucinations
GI dysfunction
depression
dementia
anosmia

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bradykinesia is…

slow movement

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how could you differentiate a postural tremor from a resting tremor?

the patient is fine at rest but when you ask them to hold their arms out or do a movement they have a tremor

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those with postural tremor usually have a/an ___ tremor

action

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intention tremor is a hallmark of disease in what part of the brain?

cerebellar disease

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how would you test for an intention tremor

patient touches their nose and touches your finger while you move it to different targets

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postural tremor is often __lateral

resting tremor in PD is usually __lateral

uni

how would you test for rigidity?

muscle tone

rigidity affects both sides equally in parkinsons T or F

F, usually worse on 1 side

2 main subtypes of PD

tremor dominant | non tremor dominant (more gait/postural focused)

what sleep problems can be present in those with PD?

restlessness | REM sleep disorder - acting out dreams

pre-emptive symptoms of PD

``` sleep disorders constipation hyposmia depression fatigue ```

what is required for a diagnosis of parkinsonism

bradykinesia plus: resting tremor rigidity postural instability

describe a parkinsonian gait

shuffling, short-stepped gait with flexed and stiff trunk and legs

late onset symptoms of parkinsons? if a patient presented with these what would be the case?

dementia hallucinations early onset bulbar problems eye movement disorder cant be parkinsons, is most likely lewy body dementia

what does a DATSCAN do?

looks at the dopamine transporter

a PMH of what should prompt you to consider other diagnoses?

repeated strokes repeated head injury early dementia

risk factors for parkinsons

advancing age (+++) positive FH (early age at diagnosis suggests genetics) male environmental eg rural living, B blocker use genetics

what genetic mutation can cause PD?

point mutation in alpha-synuclein (protein in the brain)

Tx for tremor

anti-cholinergic agents

Tx for PD

dopamine agonists for motor symptoms decarboxylase inhibitors eg levodopa anticholinergics for tremor

side effects of dopamine agonists

euphoria hallucinations hypersexuality

examples of hyperkinetic disorders

tremor tics chorea myoclonus dustonia

what is a tremor

rhythmic sinusoidal oscillation of a body part

what are tics?

involuntary stereotyped movements of vocalisations | can be suppressible

brief irregular purposeless movements which flit and flow from 1 body part to the other is described as...

chorea

brief electric shock like jerks are referred to as...

myoclonus (jerk before bed is a physiological example)

abnormal posture of an affected body part can be described as...

dystonia

primary movement disorders tend to be progressive T ro F

a heredo-degenerative movement disorder has what kind of onset?

late onset, progressive | usually as part of a degenerative process

a psychogenic movement disorder has what kind of presentation?

diverse presentation coupled with unusual physical features | psychological disturbance

cause of a tremor?

alternate activation of agonist and antagonist muscles

how is a tremor classified? how should you explore it in a history?

``` position - is it at rest? movement? distribution- where is the tremor frequency amplitude- how much it moves age at onset drug exposure ```

when do you get a tremor in PD

at rest

how is tremor investigated?

TFTs | copper and coeruloplasmin test in young patients

most common movement disorder?

essential tremor

bilateral action tremor of hands and forearms wth absence of other signs, positive FH that has lasted for a while could suggest....

essential tremor

what neurological movement problem can partially be stopped by the patient?

TICS

what conditions present with tics?

tourettes | huntingtons disease

inheritance for tourettes?

Tx of tourettes

clonidine | CBT

a patient with chorea looks...

restless and fidgety

huntingtons inheritance?

myoclonus can present in what systemic conditions?

liver and renal failure | drug intoxication

what gene has the mutation in young onset primary dystonia

DYT1

is dystonia AD or AR?

Tx of primary onset dystonias

levodopa

patients with chorea will be relaxed when they sleep T or F

a shin tremor is a classic symptom of...

parkinson's disease

a head tremor (yes-no) is a classic symptom of...

essential tremor

when will a cerebellar tremor occur?

after a movement

this tremor increases in times of stress and disappears when distracted; it's common in people with psychiatric disorders

functional tremor

what is an extensor plantar response?

babinski sign is positive | toes fan out

treatable causes of myasthaenia

anaemia | hypothyroidism

how does the presentation of vascular parkinsonism differ from PD?

no rest tremor tends to affect the lower limb poor levodopa response

what tremor does drug induced parkinson present with if any?

coarse postural tremor

cause of drug induced parkinsons?

dopamine antagonists