Neurology: Movement Disorders Flashcards Preview

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Flashcards in Neurology: Movement Disorders Deck (30):
0

What is dystonia?

Sustained muscle contraction, rapid or repetitive, focal or generalized.

1

When do most movement disorders disappear during the course of the disease?

During sleep

2

Where does Idiopathic Torsion Dystonia present with symptoms initially?

Begins with inversion of the foot.

Eventually the whole body is involved and results in distortion of the body.

3

What is the mental status of patients with Idiopathic Torsion Dystonia?

Normal mental status

4

How is Idiopathic Torsion Dystonia diagnosed and treated?

H&P diagnosis.

Treat with movement and relaxation meds:
-diazepam, baclofen, carbamazepine

5

What 4 common causes of Torticollis?

1. Hyperthyroidism
2. Ocular Imbalance
3. Cervical Spine disease
4. SCM hypertrophy

6

What is the best treatment for torticollis?

Botulinum toxin
-most torticollis is a tight muscle etiology

-with all the other causes the treatment is to fix the underlying condition

7

What is a blepharospasm and how is it treated?

Contraction of the orbicularis oculi muscles leading to increased blinking and facial grimacing.

Treat with Botulinum Toxin

8

What type of genetic characteristic does Essential Tremor exhibit?

Anticipation

9

What areas of the body are most effected by an Essential Tremor?

Head and larynx (voicebox)

-tremors are exacerbated by stress

10

What are 6 treatments for an Essential Tremor?

1. Alcohol
2. Beta Blockers: propranolol
3. Barbiturates: primidone
4. BZ: diazepam
5. Carbonic Anhydrase Inhibitors: topiramate
6. Surgery: pacemakers

11

What is one side effect common with topirimate?

Kidney Stones

12

What is Tardive Dyskinesia and what are the most common presenting symptoms?

A medication induced persistent, permanent, and repetitive series of involuntary movements.

Patients present commonly with lower facial muscle movements: chewing, tongue darting, as well as other body regions: piano playing, marching in place

13

What medication is associated with causing Tardive Dyskinesia?

Typical Antipsychotics: haloperidol

14

What is the treatment for Tardive Dyskinesia?

Remove the cause

Meds: reserpine or Tetrabenazine

15

What 3 meds commonly cause drug-induced parkinsonism?

Haloperidol (antipsychotics)
Alpha methyl dopa
Metoclopramide

Treatment involves removing the drug

16

What is acute Akathisia?

Feeling of restlessness and an inability to sit still.

17

What is neuroleptic Malignant Syndrome?

Autonomic dysfunction, fever, rigidity, akinesia, and altered mental status resulting from use of antipsychotics.

18

What are two systemic conditions involved with Neuroleptic Malignant Syndrome and what can they lead to?

1. Acidosis: caused by accumulation of CO2 from constant muscle contraction, can lead to anything from hyperventilation to coma.

2. Myoglobinuria: can clog the kidney and lead to kidney failure

19

Name two drugs that can treat Neuroleptic Malignant Syndrome.

1. Bromocriptine: DA agonist allows muscles to relax
2. Dantrolene: acts on sarcoplasmic reticulum and ryanodine receptor to relax muscles

20

What causes Sydenham Chorea (St. Vitus Dance)?

Young patients with an immature BBB become infected with Strep. pyogenes which progresses to rheumatic fever. The Abs made against the strep cross the BBB and target the Subthalamus and caudate nuclei.

Patients present with standard chorea symptoms: dance-like movements, darting tongue, facial grimacing

21

What are 4 treatments for Sydenham Chorea?

1. Sedatives
2. Phenothiazines (phenothiazine, tetrabenazine), haloperidol
3. Valproic Acid
4. IV IgG to shut down immune system

22

What brain structure most notably atrophies in Huntington Chorea?

Caudate Nucleus

23

What 3 medications can be used to treat HD?

1. Haloperidol
2. phenothiazine
3. Tetrabenazine

24

What causes Hemiballism?

Some kind of contralateral subthalamic lesion: vascular, hemorrhage, tumor, iatrogenic

Can be bilateral.

25

What are 3 drugs used to treat Hemiballism?

1. Haloperidol
2. Tetrabenazine
3. Phenothiazine
(same as the choreas)

26

What condition makes treating Tics in children difficult?

Attention Deficit Disorder

27

What is required to diagnose Gilles de la Tourette Syndrome?

1. Multiple Tics
2. Vocalizations

(these patients also have sexual impulses)

28

What is the biochemical cause of Tourette Syndrome?

Anti-DNAase B antibodies
-hereditary

Some have dysregulation of DA or an absence of the protein Dynorphin.

29

What are some medications used to treat Tourette Syndrome?

-clonidine
-haloperidol
-pimozide (treats tics)
-naltrexone
-marinol (marijuana pill)