27. Extrapyramidal Disease CPC Flashcards
how much dopamine production must be lost for pts to develop signs of Parkinsonism?
70-80%
what are the components of the basal ganglia?
- striatum (caudate and putamen)
- Globus Pallidus (interna and externa)
- subthalamic nuclei
- substantia nigra
what is a good site for DBS in parkinson’s disease?
subthalamic nucleus
term for: Quick (“dance-like”) movements that are rapid, jerky and irregular, usually affecting muscles of the face orobuccal cavity and limbs.
chorea
Involuntary slow writhing (“worm-like”) movements flowing from one to the next, sometimes associated with chorea
athetosis
a twisting movement, usually of the neck or trunk
dystonia
includes a throwing or flinging movement, usually of one side, where it is called a hemibalism.
ballismus
fleeting purposeless movement, however they tend to be repetitive and stereotyped, as opposed to chorea, which is random.
tics
hyperkinesia that can come in different speeds (fast versus slow) and can be exaggerated in different positions or actions.
tremor
the opposite of dyskinesia. consists of a slowing of movement. This can manifest as slowed postural corrections to being thrown off balance or decreased facial expressiveness. It can include a type of stiffness, called rigidity, which is different than spasticity since it produces smooth resistance to passive movement. can also affect initiation of movement and patients can “get stuck”.
Bradykinesia
Decreased facial expressiveness. Is a bradykinesia of facial muscles
mask facies
Increase in resting muscle tone. In parkinsonism it is consistent throughout the range of motion, unlike the “clasp-knife” effect of spasticity. When rigidity and tremor are both present “cogwheeling” results.
rigidity
what are some drugs that can cause Parkinson’s like symptoms?
levodopa, neuroleptics
a flinging movement of one side of the body that would result from a small stroke in the contralateral subthalamic nucleus.
hemibalism
most common causes of choreoathetosis?
Genetic (Huntington’s)
advanced age
cerebrovascular disease
cerebral palsy
what is the genetic pattern of Huntington’s?
autosomal dominant, with complete penetrance (50% of offspring)
what does genetic anticipation mean?
the number of CAG repeats can go from 36 to 40 in a generation and the patient may be the first person who is symptomatic
how many CAG repeats will result in Huntington/s?
40+
Clinical triad of huntington’s?
chorea, dementia, behavior change (may result in problems with the law)
what drug will make Huntington’s wlrse?
levodopa (given for Park)