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Clinical Conditions II > Parkinson's > Flashcards

Parkinson's Flashcards

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1
Q

Extrapyramidal Disorders

A 
affect the regulation of movement:
– initiation of movement
– speed of movement
– control or quality of the movement
– tremor
– whether movement is voluntary or not
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2
Q

Abnormal Movements

A

Tremor, Chorea, Athetosis, Dystonia, Balismus, Myoclonus and Tics

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3
Q

Types of Tremors

A
  • Physiological: normal (6-12)
  • Intention: during activity, cerebellar injury
  • Resting: associated with PD (4-6)
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4
Q

Chorea

A

– Involuntary rapid, irregular muscle jerks
– Associated with lesions of the caudate or putamen
– When strong, facial and tongue movements are also observed
– Voluntary movements can be distorted.

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5
Q

Unilateral Chorea

A

Hemiballismus

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6
Q

Dystonia & Athetosis

A

– Slow, purposeless, writhing movements (athetosis)
– Dystonia refers to those movements which are more like or turn into postures
– Not present during sleep; affected by stress and intention
– Associated with perinatal anoxia, CP, Huntington’s & drug side effect (inherited or acquired)

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7
Q

Myoclonus

A
  • Sudden, violent muscle jerks

- Can be spontaneous or brought on by sensory stimulation, arousal, or as part of a voluntary movement

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8
Q

Physiologic Myoclonus

A

nocturnal myoclonus & hiccups

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9
Q

Essential Myoclonus

A

isolated abnormality

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10
Q

Epileptic Myoclonus

A

manifestation of epilepsy

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11
Q

Symptomatic Myoclonus

A

Associated many neuro-degenerative and metabolic disorders (from cerebral cortex – brainstem –spinal cord)

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12
Q

Tics

A

– Sudden, recurrent, coordinated abnormal movements or verbalizations
• Occurs repeatedly and can be suppressed voluntarily for short periods
• Worsen with stress
• Diminished during voluntary movements or mental concentration, and disappear during sleep

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13
Q

Transient simple tics

A

common in children; usually go away within a year

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14
Q

Chronic simple tics

A

begin in childhood; benign but don’t go away

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15
Q

Tourette’s Syndrome

A

Chronic multiple motor and vocal tics

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16
Q

Involuntary Verbal Tics in Tourettes Syndrome

A

– Typical to include grunts, barks, hisses, or coughing.
– Coprolalia: vulgar or obscene utterances
– Echolalia: parroting of another’s speech
– Parilalia: repeating the same word over and over

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17
Q

Involuntary Motor Tics in Tourette’s Syndrome

A

– Blinking, grimacing, sniffing
• hopping, jumping, obscene gestures may develop
– Echopraxia: imitation of another’s movements
– Self mutilation (40-50%): biting nails, picking nose, pulling hair

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18
Q

Lesions of Basal Ganglia

A

• Decomposes behavior into isolated motor acts
• Decomposes intended motor acts into movements of inappropriate amplitudes
– Too little or too much amplitude

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19
Q

Idiopathic Parkinsonism

A

– Progressive, neurodegenerative disease

• Deficits due to loss of dopamine 2° degeneration of dopaminergic neurons in substantia nigra pars compacta

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20
Q

Two Major “Forms” of Parkinsonism

A

Tremor dominant and Akinetic

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21
Q

PIGD (Akinetic) Type Parkinsonism

A

more postural instability, gait difficulty -associated with a worse prognosis

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22
Q

Later Onset is more likely to cause

A

PIGD type

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23
Q

Risk Factors of Parkinson Disease

A

• Genetic, behavioral, and environmental factors are being examined

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24
Q

Genetic Risk Factors for Parkinson’s

A

– 5-10% with familial pattern of inheritance
– Role of alpha-synuclein protein due to change in
the gene SNCA (Lewy bodies)

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25
Environmental Risk Factors for Parkinson's
– Chemical toxins Higher Risk: Rural Living Lower Risk: Cigarette smoking, alcohol use, caffeine, physical activity, regular ibuprofen use, calcium channel blockers
26
Pathology of Parkinsonism
Widespread distribution of Lewy Bodies in the lower brainstem
27
Long Prodromal Phase: Early non-motor signs (NMS) prior to Dx
– Olfaction involvement (hyposmia) – Constipation – REM sleep behavior disorder
28
Cardinal Features of Sporadic PD
* Tremor – resting “pill rolling” * Rigidity – cogwheel or lead pipe * Bradykinesia – slow movement * Postural instability
29
Supportive Criteria of Parkinson's
* Unilateral onset with persistent asymmetry * Progressive * Response to dopamine therapy * Olfactory dysfunction
30
Exclusion Criteria of Parkinson's
* Lack of benefit from dopamine * Current or recent use of dopaminergic blockers * Documentation of alternative cause: (Hydrocephalus, encephalitis, trauma, toxins, vascular disorder) * Physical exam
31
Physical Exam findings that exclude a pt from Parkinson's dx
– Cerebellar signs (ataxia, dysmetria) – Early dementia – Supranuclear gaze palsy – PD limited to the LE’s for more than 3 yrs. • Likely Lower Body Parkinsonism – Less responsive to L-dopa and higher incidence of HTN – Cortical signs (aphasia, apraxia, astereo-agnosia)
32
Diseases that may look like Parkinson Disease
* Progressive supranuclear palsy: progressive and fatal * Multiple system atrophy: progressive and fatal * Lewy body disease
33
Progressive supranuclear palsy
– Idiopathic, degenerative, primarily affecting subcortical grey matter (dentate nucleus, pons, midbrain, BG) – Failure of voluntary vertical gaze – Postural instability – Neck often assumes an extended posture – Psuedopulbar palsy – facial weakness, dysarthria, dysphagia, increased jaw and gag reflexes – Dementia - forgetfulness, slowed thought, changes in mood and personality
34
How is Progressive supranuclear palsy distinguished from PD?
early falls, problems of downward gaze, extended neck posture, tremor uncommon in PSP and PD drugs are less effective in PSP
35
Multiple system atrophy
– Wide-spread neuro degeneration – MSA-P – neuronal loss in striatum and GP • Bradykinesia; rigidity – MSA-C – cerebellar degeneration – Shy-Dragersyndrome: autonomic involvement • Postural hypotension, anhidrosis, disturbance of sphincter control and impotence
36
How is Multiple system atrophy distinguished from PD?
symmetric presentation and multi-system involvement
37
Lewy body disease
– Form of dementia – Cognitive changes lead to dementia and usually precede or occur shortly after the appearance of PD-like deficits – Cognitive function may fluctuate markedly within a 24 hour period – Postural hypotension and syncope
38
How is Lewy Body disease distinguished from PD?
early cognitive involvement, symmetric deficits, and less likely to see tremor
39
PD Voluntary Movement
• Akinesia – No movement or – Delay in initiation • Bradykinesia – Slow movement • Hypokinesia – Low amplitude movement
40
Involuntary Movement PD
• Tremor – Pill Rolling – Resting 4-6 times/sec • Rigidity – Different than spasticity
41
PD Walking
* Flexed posture * Anterior displaced CM * Short, shuffling steps * Loss of associated movement * Festinating gait
42
Standing Balance; Static - PD
Postural predisposition to loss of balance
43
Dynamic Standing Balance- PD
– Impairments in preparatory postural adjustments | – Loss of righting and protective responses
44
Mental Status in PD
* Decline in cognitive function (usually significant declines occur later in the disease process) * Visual disturbances (hallucinations) * Depression
45
Precursor of Dopamine
L-dopa | 3-5 year max benefit
46
What is the goal of taking medication with PD?
restoring balance between Ach & Dopamine
47
What can brain stimulation help with?
- dyskinesias | - may reduce rigidity
48
Huntington’s Disease (chorea)
* A progressive degenerative (of striatum) disorder * A hereditary disorder which manifests itself in early to mid adult life * Each child of an affected parent has a 50% chance of inheriting the gene that causes HD * Progressive and fatal: average lifespan is 15 years after clinical onset
49
Clinical Findings of HD
* Chorea: starts as restlessness, can’t suppress blinks, but progresses to choreiform movements * Motor impersistence (drop objects, cant hold tongue out, minor car accidents) * Dystonia * Dementia and emotional disturbances * With OCD and chorea, weight loss is a significant problem in HD
50
Atypical or Westphal variant form and subtypes of HD
– Can show rigidity, akinesia (like PD) | – Juvenile form (before age 20) is rare but can show rigidity, akinesia along with other neurobehavioral symptoms
51
Dementia and emotional disturbances in HD
– Earliest changes consist of irritability, moodiness, and antisocial behavior – Later – OCD, impairment of attention and executive function with eventual psychosis, consistent with frontostriatal pathology – Depression (potentially many years) – Personality issues
52
Hemiballismus
* Sudden (acute) onset of flinging – choreic movements (implicating proximal muscle involvement) * Typically thought to be due to a lesion of the subthalamic nucleus in the basal ganglia (usually as a result of a CVA)
53
Tardive Dyskinesia
* Choreo-athetoid movements of the face, mouth, jaw and tongue * Grimacing, pursing the mouth, writhing movements of the tongue, and “fish-gaping” * Associated with prolonged use of psychotropic drugs
54
Role of Cerebellum in Movement
* Balance and Eye Movements * Skilled Voluntary Movement * Locomotion * Muscle Tone (hypotonia is common with damage)
55
Typical signs and symptoms of damage to the cerebellum
* Incoordination * Delays in movement initiation and termination * Hypotonia * Intention tremor * Dysequilibrium and vertigo
56
Ataxia (Incoordination)
• Loss of ability to control and coordinate movements
57
Ataxia is often associated with
– Delays in initiation – Dysmetria: errors in the range of movement (Hypometria or hypermetria) – Dysdiadochokinesia (Errors in rate and regularity of movement)
58
Etiologies of Damage to Cerebellum
* Toxins * Genetic Diseases (Friedreich’s Ataxia) * System Degeneration (Olivopontocerebellar atrophy) * Structural Diseases (Tumors) * Demyelinating Disease (MS)
59
Friedreich’s Ataxia
* One of the most common hereditary disorders of the nervous system * Disrupts normal assembly of amino acids into proteins * Progressive degeneration of – Dorsal root ganglia, large myelinated axons of peripheral sensory nerves, Corticospinal tracts, Dentate nuclei
60
Friedreich’s Ataxia average age of onset
13 years
61
Friedreich’s Ataxia Sxs
* Ataxia begins in lower limbs (gait ataxia) but progresses up * Nystagmus and dysarthria * Impairment of sensation; later LE weakness (UMN and LMN) * Scoliosis
62
Olivopontocerebellar Atrophy
Combined degeneration of the cerebellum, pons, and | inferior olives
63
Olivopontocerebellar Atrophy Sxs
• Progressive ataxia with a later onset than Friedreich’s ataxia • Gait is usually affected first with resultant decreased movement speed and balance deficits • Dysarthria, muscle spasms, weakness and autonomic disorders are also common: Urinary incontinence; orthostatic hypotension
64
B1 (thiamine) deficiency
Wernicke-Korsakoff | oculomotor abnormalities; mental status; ataxia of stance and gait

Clinical Conditions II (11 decks)

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