21. Movement disorder/tremor Flashcards
causes tremor?
Parkinsonism
Benign essential tremor
Cerebellar disease
Liver failure
CO2 retention
Salbutamol tremor
Lithium and lithium toxicity
Thyrotoxicosis
Drug Withdrawal/opiates/alcohol
features parkinsonism tremor
resting tremor
pill rolling
features cerebellar tremor
intention tremor
past pointing
features benign essential tremor
postural tremor (worse if arms outstretched)
management besnign essential tremor
propranolol is first-line
primidone is sometimes used
causes of cerebellar syndrome
neoplastic: cerebellar haemangioma
stroke
alcohol
multiple sclerosis
coeliac
hypothyroidism
drugs: phenytoin, lead poisoning
paraneoplastic e.g. secondary to lung cancer
Friedreich’s ataxia, ataxic telangiectasia
what is asterixis? causes?
flapping tremor
- encephalopathy
- CO2 retention
what drugs cause tremor
beta agonist eg salbutamol
lithium - fine tremor
lithium toxicity - coarse tremor
what is chorea? cauases?
uncontrollable purposeless fitting movements
- Huntington’s chorea
- Wilson’s disease (see parkinsonism chapter)
- Sydenham’s chorea (rheumatic fever)
genetics huntingtons
autosomal dominant
more than 38 repeats of the CAG trinucleotide in the gene encoding the huntingtin protein.
triad for huntingtons
Dominant inheritance
Choreoathetosis
Dementia
imaging huntingtons interpretation
loss of striatal volume and increased size of the frontal horns of the lateral ventricles.
(MRI shows atrophy of the caudate nucleus and putamen)
what drug is used to manage chorea in huntingtons
tetrabenazine
chorea in a child - first differential?
rheumatic fever - sydenham’s chorea
what is rheumatic fever
Rheumatic fever develops following an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection.
This cross-reactivity is a Type II hypersensitivity reaction and is termed molecular mimicry.
diagnostic criteria rheumatic fever
evidence of recent strep infection plus:
2 major criteria
1 major with 2 minor criteria
Major criteria
- erythema marginatum
- Sydenham’s chorea: this is often a late feature
- polyarthritis
- carditis and valvulitis (eg, pancarditis)
- subcutaneous nodules
Minor criteria
- raised ESR or CRP
- pyrexia
- arthralgia (not if arthritis a major criteria)
- prolonged PR interval
management rheumatic fever
antibiotics: oral penicillin V
anti-inflammatories: NSAIDs are first-line
treatment of any complications that develop e.g. heart failure
what is myoclonus? differentials?
Sudden brief involuntary twitching or jerking of a muscle or group of muscles
Myoclonic seizures
Juvenile myoclonic epilepsy
creutzfeldt-Jakob disease
features CJD
dementia (rapid onset)
myoclonus
MRI CJD
hyperintense signals in the basal ganglia and thalamus
causes CJD
Sporadic 85% of cases - cause unknown
Variant CJD - mad cow disease
what is dystonia? causes?
Dystonias describe a prolonged, often painful, muscle contraction.
dystonia= abnormal posturing due to agonist and antagonist co-contraction
usually an acute dystonic reaction eg antipsychotics or metoclopramide - treat with procyclidine
Writer’s cramp is the most common form of occupational focal dystonia.
what movement problems can you get in wilsons disease
Parksinonsom, Asterixis, Chorea
