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Neurology-Week 4 & 5 > 2. Movement Disorders > Flashcards

2. Movement Disorders Flashcards

1
Q

“Extrapyramidal” means what?

A

SUBCORTICAL control of movement (outside of the Corticospinal/Corticobulbar tracts)

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2
Q

Examples of structures in the Extrapyramidal system

A

Basal Ganglia (composed of striatum and globus pallidus)
Substantia nigra
Subthalamic nucleus
Red nucleus
Brain Stem (Reticular formation/Cerebellum)

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3
Q

Blood supply to the Basal Ganglia is MOSTLY through what artery

A

Lenticulostriate arteries (tiny branches of MCA)

  • BG is supplied by many branches of “Internal Carotid Artery”.
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4
Q

In the Basal Ganglia, the (direct/indirect) pathway stimulates the Motor Cortex via the thalamus

A

Direct

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5
Q

In the Basal Ganglia, the (direct/indirect) pathway inhibits the Motor Cortex

A

Indirect

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6
Q

_________ is the excitatory NT, and ______ is the inhibitory NT for the basal ganglia circuitry.

A

Glutamate

GABA

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7
Q

The Direct Pathway results in overall (increased/decreased) motor activity.

A

Increased

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8
Q

Pattern of info for the DIRECT Pathway

A

Cortex–> Striatum–> GPi–> Thalamus–> Cortex

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9
Q

The Indirect Pathway results in overall (increased/decreased) motor activity

A

Decreased

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10
Q

Pathway of info for the Indirect Pathway

A

Cortex–> Striatum–> GPe–> Subthalamic Nucleus–> GPi–> Thalamus –> Cortex

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11
Q

Output from the Striatum (Caudate and Putamen) is always inhibitory/excitatory for both direct & indirect pathways

A

inhibitory (GABA)

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12
Q

The Substantia Nigra (pars COMPACTA) produces _______ to excite direct pathway and inhibit indirect pathway.

A

Dopamine

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13
Q

(D1/D2) receptor is an INHIBITORY receptor. Binding of dopamine inhibits (direct/indirect) pathway

A

D2; indirect

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14
Q

(D1/D2) receptor is an EXCITATORY receptor. Binding of dopamine excites (direct/indirect) pathway

A

D1; direct

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15
Q

Dopamine binding of D1 and D2 receptors all result in (facilitating/inhibiting) movement

A

facilitating

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16
Q

There are ____________ neurons in the Striatum whose axons DON’T LEAVE the striatum and synapse in both the GPe and GPi; they work to INHIBIT the direct pathway and EXCITE the Indirect pathway

  • Opposite effect to DOPAMINE
A

Cholinergic

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17
Q

Movement Disorder; Depigmentation of neurons in Substantia Nigra Pars Compacta; histologically can see a-synuclein deposits in cells causing LEWY BODIES

  • No dopamine –> decreased direct pathway and decreased inhibition of indirect pathway –> limited motion
A

Parkinson’s Disease

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18
Q

Slowness of movement; most characteristic feature of Parkinson’s

A

Bradykinesia

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19
Q

Stiffness and resistance to movement of a body part; primary symptoms of Parkinson’s

A

Rigidity

  • Cogwheel rigidity most common
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20
Q

Cardinal Motor & Non-motor features of Parkinson’s Disease

A 
Motor:
Bradykinesia
Rigidity
Tremor
Postural Instability/Abnormal Gait

Non-Motor:
Expressionless Face
Dementia
Anosmia

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21
Q

Know these HYPERKINETIC movements

A
  1. Chorea (irregular, random movement: Dr. Felix doing hula hoops)
  2. Athetosis (Continuous writhing movement: like typing)
  3. Ballismus (sudden, vigorous, forceful movements: bullet-like)
  4. Dystonia (TWISTING movements and abnormal postures)
  5. Myoclonus (Sudden, brief, shock-like movements: jerk)
  6. Tremor (rhythmical and regular movements)
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22
Q

______ tremor occurs with voluntary contraction of the muscle (2 types)

  1. ______ tremor occurs during purposeful movements and disappears during rest.
  2. ______ tremor occurs with upright posture and resolves with rest/lying down.
A

Action

  1. Intention
  2. Postural
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23
Q

________ is coarse tremor that is worse at the END of purposeful movements; caused by cerebellar lesion/disease

_______ occurs at REST and is improved with purposeful movement. Tremor associated with PD!

_______ is tremor that worsens during times of emotional stress, metabolic alterations and intoxications

A

Cerebellar Tremor

Resting Tremor

Physiologic Tremor

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24
Q

Disease characterized by both types of ACTION tremors (intention & postural) of arms and head.

  • Nodding, voice changes, dysphagia and difficulty with fine motor tasks; WORSE with emotional stress and BETTER with ALCOHOL (wow!)
A

Essential Tremor

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25
Q

Essential tremors are…

  1. tremors of (action/rest)
  2. (symmetric/asymmetric) at onset
  3. (high/low) frequency
  4. (commonly/rarely) involve the head and voice
A

Action
Symmetric
High
Commonly

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26
Q

Parkinson’s tremors are…

  1. tremors of (action/rest)
  2. (symmetric/asymmetric) at onset
  3. (high/slow) frequency
  4. (commonly/rarely) involve the head and voice
A

Rest
Asymmetric
Slow (3Hx) –> “pill rolling”
Rarely

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27
Q

Lentiform/Lenticular nucleus is composed of

A

Putamen

Globus Pallidus

28
Q

_____ is the major input site of BG.

_____ is the major output nucleus of BG.

_____ is the second major output nucleus of BG.

A

Striatum

GPi

Substantia Nigra (pars reticulata)

29
Q

How is Lewy Body Dementia different from Parkinson’s Disease?

A

In Lewy body dementia, dementia appears FIRST and then is followed by PD-like motor features.

In PD, core motor features appear first and BEFORE dementia.

30
Q

Tx for essential tremor

A
  1. Beta-blockers (PROPRANOLOL)

2. Mysoline (barbitruate)

31
Q

Hyperkinetic movements characterized by TWISTING movements and abnormal postures

A

Dystonia (2 types)

  • Generalized
  • Focal
32
Q

Focal dystonia affect a single group of muscles and has 4 types.

  1. ______ dystonia involves the neck.
  2. ______ repetitive, involuntary squeezing of the eye muscles
  3. ______ dystonia cramping of finger/hand
  4. ______ dysphonia involves larynx; presents with hypophonia (soft speech)
A
  1. Cervical
  2. Blepharospasm
  3. Focal Hand
  4. Spasmodic
33
Q

Tx for focal dystonia

A

Botox

34
Q

Irregular, random movement: Dr. Felix doing hula hoops

A

Chorea

35
Q

What conditions commonly produce Chorea

A

Huntington’s
Anti-Parkinson’s meds
Antipsychotics

Post-Streptococcal
Lupus
Gravidarum (aka. hyperemesis/severe vomiting)

36
Q

Choreiform movements caused by anti-parkinson’s med are called

A

L-dopa induced dyskinesia

37
Q

Choreiform movements caused by antipsychotics are called

A

Tardive Dyskinesia

38
Q

Movement Disorder; FATAL AD condition; CAG trinucleotide expansion that accumulate over generations resulting in earlier and earlier appearances (“anticipation”); neuronal intranuclear inclusions of mutant huntingtin protein; causes behavioral changes, chorea and dementia;

A

Huntington’s Chorea

  • aka. Huntington’s Disease
39
Q

Huntington’s Chorea results in atrophy of _____ and dilation of _______.

A

Caudate Nucleus; Lateral Ventricles

40
Q

Rapid Involuntary movements; usually patients can temporarily suppress, but eventually overwhelming anxiety and inner tension can only be relieved with allowing; can include obscene GESTURES or WORDS

A

Tics

41
Q

Tic disorders are often seen as part of a triad of

A

ADHD
OCD
Tics

42
Q

A tic disorder defined by multiple MOTOR tics + at least ONE VOCAL tic many times a day for more than a year; onset is BEFORE 18; tx only if the child is bothered by them

A

Tourette’s Syndrome

43
Q

A movement disorder that affects ONE SIDE (CONTRALATERAL lesion) of the body; involves large-amplitude involuntary jerking, irregular movements

A

Hemiballismus

44
Q

Hemiballismus is due to a lesion in which part of the brain?

A

Subthalamic Nucleus

45
Q

A lesion in the LEFT Subthalamic Nucleus causes _______ hemiballismus

A

RIGHT

  • CONTRALATERAL lesion
46
Q

Movement disorders caused by exposure to medications that block dopamine are known collectively as

A

Extrapyramidal symptoms

47
Q

Movement disorder caused by CHRONIC exposure to medications that block DOPAMINE within the CNS

A

Tardive Dyskinesia

48
Q

Describe the movements of TD

A

Choreiform affecting the lips, mouth, and tongue (continuous sucking/chewing movements)

  • facial involvement
49
Q

What are the common medications that cause TD?

A
  1. Antipsychotics (haloperidol, fluphenazine, pimozide)

2. Antiemetics (Metoclopramide, prochlorperazine)

50
Q

Parkinson’s is due to a problem in which part of the brain?

A

Substantia Nigra Pars Compacta (depigmentation of neurons producing DOPAMINE)

51
Q

Huntington’s is due to a problem in which part of the brain?

A

Caudate Nuclei (leads to dilatation of lateral ventricles)

52
Q

_____ cerebellar peduncle connects to midbrain
_____ cerebellar peduncle connects to pons
_____ cerebellar peduncle connects to medulla

A

Superior
Middle
Inferior

53
Q

_____ cerebellar peduncle connects to midbrain
_____ cerebellar peduncle connects to pons
_____ cerebellar peduncle connects to medulla

A

Superior
Middle
Inferior

54
Q

Unlike the cerebrum, which works on a CONTRALATERAL basis, the cerebellum works _____ so cerebellar lesions cause _____ symptoms

A

ipsilaterally; ipsilateral

55
Q

What section of cerebellum is responsible for proximal limb and truncal/core homonculus?

A

Vermis

56
Q

What section of cerebellum is responsible for distal limb homonculus?

A

Intermediate zone/cerebellar hemisphere

57
Q
  1. Superior Cerebellar Peduncle is supplied by _______
  2. Middle Cerebellar Peduncle is supplied by ________
  3. Inferior Cerebellar Peduncle is supplied by ________
A
  1. Superior cerebellar artery (branch of basilar artery)
  2. AICA (branch of basilar artery)
  3. PICA (branch of vertebral artery)
58
Q

Unsteady gait that is irregular and uncoordinated

A

Ataxia

59
Q

________ ataxia are caused by lesions that interrupt the sensory input; compensated with visual input.

________ ataxia are caused by lesions in cerebellum; doesn’t compensate with visual input.

________ ataxia is a combination of both above.

A

Sensory
Motor
Spinocerebellar

60
Q

Inherited atxia; AR condition caused by GAA trinucleotide repeats on the Frataxin (FXN) gene on chromosome 9; leads to frataxin (iron-binding protein) deficiency and iron accumulation in mitochondria

A

Friedreich’s Ataxia

61
Q

Inherited ataxia associated with progressive ataxia, cardiomyopathy, pes cavus (foot deformity), scoliosis, blindness/deafness

A

Friedreich’s Ataxia

62
Q

A disorder of mitochondrial myopathy that causes cerebellar ataxia and TONIC-CLONIC episodes; ragged red fibers on histological findings

A

MELAS

63
Q

A disorder of mitochondrial myopathy that causes cerebellar ataxia and MYOCLONUS epilepsy; ragged red fibers on histological findings

A

MERFF

64
Q

What are some common etiologies of ACQUIRED ataxias?

A

Prion disease (CJD)
Chronic alcohol overuse
Autoimmune Disease

65
Q

What physical exams test for Ataxia?

A
  1. Finger to nose (cerebellar hemisphere)
  2. Heel to toe (cerebellar vermis)
  3. Romberg Sign (+ means sensory ataxia)

Neurology-Week 4 & 5 (14 decks)

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