Movement Disorders, Cohen I Flashcards Preview

Year 2 neuro exam 2 > Movement Disorders, Cohen I > Flashcards

Flashcards in Movement Disorders, Cohen I Deck (59)
Loading flashcards...
1

Parkinsons

tremors
weakness
stooped posture
festinating gait!!!!

2

4 cardinal features PD

resting tremor 4-7 Hz
bradykinesia
dysequilibrium
rigidity

should have 3/4 to Dx

3

physiologic tremor

normal tremor usually hands and fingers
excacerbated by fatigue, stress, drugs and age
faster freq than pathological tremors

4

pathologic tremor

disturbs normal functioning

5

Bradykinesia in PD

slow
look like statues
masked facies
dec blinking
hard to swallow-- drooling!!
walk or speak briefly with greater speed when under stress

6

what is kinesis paradoxica

in PD patient stressed and can for brief time walk/run
overcome slowness

7

Dysequilibrium in PD

not steady on feet, fall backwards, try to catch up with falling
lack of arm swinging!!

8

dangerous physical sign of PD

lack of arm swinging, lack of balance

9

cogwheeling

PD

10

early Sx of PD (not 4 cardinal)

insomina
loss of sense of smell
impotence, incontinence, hypotension
depression
cramps and pains in back and shoulders
small scribly handwriting
loss of power of voice, monotone

11

pathology PD

loss of cells in substantia nigra-- other areas too
loss of dopamanergic neurons in striatum

12

Lewy Bodies

alpha synuclein
eosinophilic in neurons

13

What is synuclein

protein that helps facilitate movement of synaptic vesicles to end of axon

14

Genes assoc with PD

PARK 1 -11

15

rare familial cases PD

young age

16

peak age incidence PD

55-59
range 40-70

17

M vs F PD

M>F

18

Best Tx for PD

L dopa
dopamine does not cross BBB so give L dopa
can combine with carbidopa

19

most common drug for PD
side effects

sinemet which is L dopa and carbidopa
can cause nausea, hypotension and nightmares if advanced too quickly
dyskinesias
psychosis

20

What are the dopaminergic drugs used in PD and benefits?

Mirapex and Requip which bind to D2 R
less wearing off effect and less dyskinesias so good to use in younger patients

21

prominent side effect of Dopamine agonists

psychosis
visual hallucinations

22

What drug is give to increase dopamine release in PD

amantadine
anticholinergic
loses effectiveness in 6 mo

23

What drugs prolong benefits of L dopa

inhibitors of monoamine oxidase and COMT

24

Psych problems in PD

dementia (later onset)
depression
psychosis

25

why careful with antipsychotics in PD

some are antidopaminergic so use the atypical ones that are not

26

survival of PD patients

50% die in 15 years

27

Surgery for PD

cuts or strong stimulation in globus pallidus
deep brain stimulation of subthalmic nuclei

28

Signs of drug induced Parkinsonism

no resting tremor
bradykinesia and dysequilibrium

29

what drugs today can cause parkinsonism

phenothiazines for nausea, reflux
metocloparmide
promethazine
weeks needed to recover once stop drug

30

Signs Progressive Supranuclear Palsy

no tremor
severe dysequlibrium
FALLS!! and CHOKING
loss of speech and moderate dementia
progressive loss EOMI!!!!! vertical then horizontal
extension of neck and confused look on face
blink alot!!