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Movement Disorders & Parkinsons Flashcards

(50 cards)

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1
Q

Name the parts of the brain involved in voluntary movement

A
  • pyramidal tracts
  • basal ganglia
  • cerebellum
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2
Q

What is the word used to describe too little movement?

A

Hypokinetic

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3
Q

What is the word used to describe too much movement?

A

Hyperkinetic

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4
Q

State three important factors to include in a history of suspected movement disorder

A

Birth
Family History
Drug and toxin history

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5
Q

What does the pneumonic TRAP stand for?

A

Tremor
Rigidity
Akinesia/bradykinesia
Postural disturbances

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6
Q

Describe rigidity

A

Increased muscle tone that is felt on passive movement, resistance is felt throughout full range of movement

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7
Q

What is the difference between rigidity and spasticity?

A

No increase with higher mobilising speed, which distinguishes rigidity from spasticity owing to UMN lesions

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8
Q

What is the name for the combination of rigidity and tremor?

A

Cog wheel felt at the wrist

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9
Q

What maneuver can be used to test for rigidity?

A

Froment’s - rigidity increases in examined body segment by voluntary movement of other body parts

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10
Q

What is akinesia?

A

Loss of movement

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11
Q

What is bradykinesia?

A

Slowed movement

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12
Q

State the features of hyperkinetic disorders

A 
Tremor 
Dystonia 
Chorea 
Ballism 
Myoclonus 
Tics
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13
Q

Define camptoconia

A

Extreme anterior truncal flexion

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14
Q

Define festination

A

Lots of small steps, change of centre of gravity

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15
Q

What is the test for postural instability?

A

Pull test

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16
Q

What is a tremor?

A

Rhythmic sinusoidal oscillation of a body part

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17
Q

Name four types of tremor

A
  • rest
  • postural (when arms outstretched)
  • kinetic
  • cerebellar (when you approach a target)
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18
Q

Describe dystonia

A

Sustained, intermittent muscle contractions causing abnormal repetitive movements, postures or both

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19
Q

What makes a dystonia worse?

A

Voluntary action

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20
Q

Describe chorea

A

Irregular purposeless movement that flit and flaws from one body part to another - restless and fidgety

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21
Q

What causes chorea?

Study These Flashcards
A 
Basal ganglia lesions
APLS 
Huntington's 
Neuroacanthocytosis 
Oral contraception
22
Q

Name a variant of chorea

Study These Flashcards
A

Ballism - involves proximal joints resulting in large amplitude flinging movements with a hemi-body distribution

23
Q

What causes ballism?

Study These Flashcards
A

Contralateral lesion invloving striatum or subthalamic nucleus

24
Q

Describe myoclonus

Study These Flashcards
A

Brief electric shock like jerks, hiccups and hypnic jerks

25
Give an example of negative myoclonus
Asterixis in liver flap
26
What are tics?
Un-voluntary repetitive stereotyped movements or vocalisations - suppressible by the patient for a short period of time
27
Describe motor and vocal tics
Motor - eye blinking, jerks, complex sequence | Vocal - sniffing, grunting, snorting, phrases
28
What disease often has a onset of persistent multiple motor and vocal tics?
Gilles de la Tourette Syndrome
29
Describe the most common type of tremor
Essential tremor - seen when hands are outstretched, runs in families autosomal dominant slow progression made worse by alcohol
30
What can cause a tremor?
- Wilson's disease - Physiological tremor - Hepatic encephalopathy - Titubation (oscillation of the head in anteroposterior/verticle position)
31
What are the non-motor clinical features of Parkinson's disease?
``` Sleep disorders Hallucinations GI dysfunction Depression Cognitive impairment Anosmia ```
32
What causes parkinsons disease?
Loss of dopaminergic neurons from the pars compacta region of substantia nigra
33
What percentage of neurons need to be lost to give parkinsons symptoms?
60%
34
What staging can be used in Parkinson's?
Braak - early non-motor symptoms, areas subsequently affected as disease progresses through motor and non-motor phases
35
State the three sub-types of parkinson's disease
- tremor dominant (relative absence of other motor symptoms) - non-tremor dominant (akinetic rigid syndrome, postural instability) - mixed
36
Which subtype has the slower progression rate?
Tremor dominant
37
What are the stages of Parkinson's disease?
Prodromal phase Early Stage Unstable Advanced and palliative
38
Describe the prodromal phase of Parkinson's
Up to 20 years, constipation, psychiatric problems, hyposomia, EDS, RBS
39
How is Parkinson's diagnosed?
- Bradykinesia and one or more - resting tremor, rigidity, postural instability - Presence of parkinsonism with no alternative diagnosis and dopamine responsiveness
40
What form of imaging can be useful in Parkinson's?
DatSCAN - radioiodine solution will result in a period shaped
41
State the factors that increase your risk of Parkinson's
Pesticides, head injury, rural living, beta blockers, agriculture, well water drinking
42
State the factors that decrease your risk of Parkinson's
Tobacco, coffee, NSAIDs, CCB, Alcohol
43
What are motor flucutations?
Alterations between periods of good motor symptom control and reduced control
44
What are non-motor flucutations?
Alterations between periods of good and bad non-motor symptoms control
45
What is dyskinesisa?
Involuntary choreiform or dystonic movements which occur most frequently when levodopa concentrations are at their maximum
46
Describe the pathophysiology of Parkinson's
- Lewy body formation in the cells that remain due to accumulation of aggregations - Reactive gliosis, immune pathways can move in blood to outside of the brain
47
What drugs are used in the treatment of Parkinson's?
``` Levodopa + beserazide = madopar Dopamine agonist - ropinirole MAO-B inhibitors - selegiline COM inhibitors - entacapone Muscarinic ACh receptor antagonist ```
48
What drug treats the tremor?
Anticholinergic agents
49
What drug has the greatest symptomatic benefit?
Levodopa
50
Name the surgical treatment available for Parkinsons
Deep brain stimulation - targets the subthalamic nucleus and globus pallidus

Neurology (29 decks)

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