Flashcards in Movement Disorders Deck (72)
What is akathisia?
State of restlessness (can't sit still)
What is ataxia?
Inability to coordinate movements of the trunk or limbs
What is athetosis?
Involuntary writhing limb movements
What is ballism?
Flailing, ballistic, involuntary movements in a limb
What is chorea?
Quick involuntary, dance-like movements
What are dyskinesias?
Involuntary movements, chorea-like or tic-like
What is dystonia?
Abnormal muscle tone with sustained posture
What is myoclonus?
Involuntary spasmodic jerky movements
What are tics?
Habitual, semi-voluntary, spasmodi, quick, brief movements
What PE to do for a movement disorder
Motor (rest, posture and kinetic movements, rapid alternating movements)
Station/stance and pull-testing
Types of Parkinsonisms
Idiopathic Parkinson's Disease
Normal pressure hydrocephalus
Progressive supranuclear palsy
Multiple system atrophy
Dementia with lewy bodies
Disease course of Idiopathic Parkinson's
Symptom free honeymoon about 3 yrs after diagnosis
Motor complications at about 5-7 yrs
Onset to death about 20 years
Pathophysiology of Parkinsons
Degeneration of DA neurons in substantia nigra pars compacta
Cardinal features of Idiopathic Parkinson's
Rest tremor of Idiopathic Parkinson's
4-7 Hz and can be pill rolling (slow and at rest)
Rigidity of Idiopathic Parkinson's
Sustained resistance through passive range of motion
Lead pipe or cog wheeling
Muscle stretch receptors are normal
Akinesia-bradykinesia of Idiopathic Parkinson's
Masked facies, loss of manual dexterity, getting out of chairs, loss of spontaneous animation, loss of associated movements
Postural instability of Idiopathic Parkinson's
Stooping and retropulsion
Falls with turning (center of gravity)
*should be the last of the 4 to be seen in PD
Rating scales for Idiopathic Parkinson's
-Unified Parkinson's Disease Rating scale (UPDRS):
I is mentation, mood and behavior
II is activities of daily living
III is motor exam
IV is complications of therapy
-Modifies Hoehn and Yahr staging (stages 0-5)
Find the offending drug (anti-nausea, anti-psychotic basically anything anti-dopamines)
Absence of rest tremor
Spasticity and hyperreflexia
Normal Pressure Hydrocephalus
APRAXIA OF GAIT
(wet, wacky and wobbly)
Corticobasal degeneration Parkinsonism
Unilateral limb rigidity
Dystonia or myclonus
Progressive supranuclear palsy related Parkinsonism
SUPRANUCLEAR GAZE PALSY (vertical gaze, down > up gaze)
Slowed saccades, axial rigidity, absence of tremor, spastic-ataxic dysarthria, poor L-dope response
Multi system atrophy Parkinsonsim
Falls, axial dystonia, respiratory stridor, akinesia, absence of rest tremor, dysmetria
Prominent autonomic features!!!
Poor l-dope response
Dementia with lewy bodies
Cognitive disorder: prominent dream enactment behavior, mild autonomic sxs
When to do MRI of the brain
Gait disorder and falling
Multisystem atrophy on MRI
Hot cross bun sign
Progressive supranuclear palsy on MRI
Hummingbird sign due to midbrain atrophy