Movement Disorders, Cohen I Flashcards Preview

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

Flashcards in Movement Disorders, Cohen I Deck (59):
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!!

31

fearful expression on patient

progressive supranuclear palsy

32

PSP misdiagnosed as

PD

33

deaths from PSP

aspiration pneumonia or from fall

34

pathology PSP

degeneration of entire brainstem
especially midbrain

35

25% PSP patients respond to what drugs used in PD

l dopa carbidopa

36

most common movement disorder seen in practive

essential tremor

37

essential tremors

mostly arms, sometimes head
fast
evident in childhood or in 20s

38

what cause essential tremors

disease in thalamus probably

39

Dx essential tremor

Hx and lack of other evidence of disease
FMH+++!!
cannot touch to opposing fingers or nose

40

what must you rule out to Dx essential tremor

hyperthyroidism
medication effect
cerebellar disease
parkinsonism features

41

Tx for essential tremors

weights on wrists, heavier utensils
propanolol and primidone

42

Tx for severe essential tremor

surgery via deep brain stimulation

43

Tics

rapid movements
sniffing, grunting, blinking, clearing throat, protruding chin, wrinkling face, shrugging shoulders
usually in children and fades away

44

Tourettes

both motor and vocal tics
start before age 21
does not fade away
many patients also have OCD

45

pathology tourettes

maybe dopamine disorder

46

Tx tourettes

haloperidol or other D2 blockers
newer antipsychotics and sometimes clonidine

47

Chorea

irregular and variable movement
smooth and continous
writhing

48

Syndenham chorea

untreated group A strep infection

49

Huntington

inherited
chromosome 4
CAG repeats
chorea, tremors, clumsiness, dementia, psych agitaiton depression and psychosis

50

age onset HD

40s 50s

51

area affected in HD

basal ganglia

52

HD Dx

known +FMH
testing done AFTER counseling!

53

Tx HD

dopaminergic blockers or chorea that are also antipsychotics to help agitation
Tetrabenazine!

54

side effects of dopaminergic blockers used in HD

sedation, hypotension and tardive dyskinesia when used chronically

55

Prognosis HD

rapid downhill course
die in institutions from suicide infections or falls

56

Restless Leg syndrome

cannot stop moving legs
Dx middle aged and elderly
less common in children
painful disturbing creepy crawly sensation
interferes with onset sleep
maybe autosomal recessive

57

MRI restless leg syndrome

reductions total iron esp in substantia nigra
reduced dopaminergic activity in brainstem and basal ganglia
reduced activity tyrosine hydroxylase

58

Tx Restless leg syndrome

dopaminergic drugs like pramipexole and l dopa carbidopa
iron!!
benzos and gabapentin

59

when are medications taken for those with restless leg syndrome

at least 30 minutes before onset of sleep or all time in those with continuous restless leg syndrome