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Junior - Neuro 2 > 3 - Movement Disorders > Flashcards

3 - Movement Disorders Flashcards

1
Q

Function of the basal ganglia?

A

Central processing center

Roles in:

  • movement
  • cognition
  • emotions
  • learning
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2
Q

Tremors are?

A

Any movement that is:

  • involuntary
  • rhythmic
  • oscillating

can affect 1 or several body parts

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3
Q

Tremors types/descriptions?

A

Resting

Postural

Action (intentional tremors)

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4
Q

What is an essential tremor?

A

Rhythmic oscillatory movement characterized by its relationship to voluntary motor activity

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5
Q

What makes essential tremor better/worse

A

Worse:
- emotional stress (sleep makes it stop)

Better: medications and ETOH

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6
Q

What is chorea?

A

Involuntary, arrhythmic, rapid and purposeless movements

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7
Q

Other than having a case of “the wiggles” what is affected by chorea?

A

Strength

  • hand grip relaxes (milkmaid grasp)
  • gait is irregular/unsteady (dancing gait)
  • speech is irregular in volume/tempo
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8
Q

Hereditary causes of chorea?

A

Huntington’s

Wilson’s disease

Benign hereditary chorea

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9
Q

Causes of chorea?

A 
Hereditary
Syndenham’s chorea
Chorea gravidarum
Drug toxicity (lithium)
Cerebral vascular disorders
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10
Q

What is hemiballismus?

A

Large poorly patterned, flailing movements of the proximal muscles of the limbs

Monoballismus: 1 limb
Paraballism: but upper and lower

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11
Q

Causes of hemiballismus?

A

Vascular disease in the contralateral subthalamic nucleuas

Whatever that means

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12
Q

Treatments for hemiballismus?

A

Dopamine-depleting or blocking agents

Pallidotomy if severe enough

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13
Q

What is pallidotomy?

A

A tiny electrical probe is place in the globus pallidus (brain stuff) and heated to 80*C to destroy that tissue

Not in the slides i just thought this was cool

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14
Q

What is athetosis?

A

Greek word for restless

Abnormal movements that are slow, sinuous, writhing and involuntary in character

  • Flexion, extension, pronation, supination of fingers/hands
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15
Q

What is Dystonia?

A

Prolonged athetosis

Sustained muscle contractions

  • absent during sleep
  • enhanced by voluntary activity
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16
Q

Types of dystonia?

A

Focal:

  • torticollis
  • blepharospasm
  • writers cramp

Generalized:

  • cerebral palsy
  • acute dystonic reactions
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17
Q

Psychogenic dystonia?

A

Chick that got the flu shot stumbles and british accent

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18
Q

What is tardive dyskinesia?

A

Involuntary movements of face/tongue

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19
Q

What medication can cause tardive dyskinesia?

A

Long term tx with antipsychotic drugs

  • dopamine receptor blockers
  • metoclopramide (reglan)
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20
Q

What are myoclonus?

A

Sudden, rapid, twitch like muscle conractions

Seen: Spontaneousor or with sensory stimulation, arousal or initiation of movement

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21
Q

How are myoclonus movements classified?

A
  1. Generalized
  2. Focal
  3. Multifocal
  4. Segmental
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22
Q

What is physiologic myoclonus?

A 
Nocturnal myoclonus (hypnogogic jerks)
- twitching that awaken us from sleep, seen in normal people when waking up of falling asleep
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23
Q

Epileptic myoclonus?

A

Movements associated with seizure

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24
Q

What are myoclonic jerks (pathologic myoclonus)

A

Movements from:

  • epilepsy
  • head injury
  • stroke
  • cardiac arrest

Associated w hypoxemia

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25
Q

Causes of reversible myoclonus?

A

Metabolic disturbances

  • renal failure
  • electrolyte imbalance
  • hypocalcemia
  • toxins
  • meds
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26
Q

What is essential myoclonus?

A

Benign familial condition

Brief lightening like moments especially sensitive to ETOH

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27
Q

What are Tics?

A

Brief, rapid, recurrent, purposeless movements

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28
Q

Motor vs phonic tics?

A

Motor - muscle groups

Phonic - verbal tics, air moving through nose or mouth

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29
Q

Simple vs complex tics?

A

Simple: 1 muscle group

Complex: multiple muscle groups

  • tourettes
  • jumping, sniffling, head banging
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30
Q

Types of vocal tics?

A

Coprolalia - profanity

Echolalia - repetition

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31
Q

What makes parkinsonian tremors better/worse?

A

Better: activity

Worse: stress

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32
Q

Describe a cerebellar tremor

A

A slow tremor of the extremities at the end fo a purposeful movement caused by a lesion or damage to the cerebellum

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33
Q

Classic presentation of cerebellar tremors?

A

Lesion is on the same side as the tremor, and it worsens with direct movement

Often accompanied by

  • dysarthria
  • nystagmus
  • gait problems
  • postural tremor of head/neck
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34
Q

What are psychogenic tremors associated with?

A

Conversion disorders and other psych stuff

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35
Q

Describe orthostatic tremors

A

A high frequency tremor that is characterized by:

  • rhythmic muscle contractions of leg or trunk
  • usually after standing
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36
Q

What makes orthostatic tremors decrease?

A

Sitting
Being lifted off ground
Walking

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37
Q

When are you likely to see physiologic tremors?

A
  • anxiety
  • fatigue
  • metabolic disturbances
  • drugs
  • Toxins
  • alcohol consumption
  • alcohol withdrawal
  • poisoning
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38
Q

What is the MC movement disorder?

A

Essential tremor (benign essential tremor)

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39
Q

Causes of essential tremors?

A

1/2 are gene mutation

1/2 are idiopathic

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40
Q

tx for essential tremors?

A

Propanolol
Gabapentin
Pregabalin
Benzodiazapines

Thalamic stimulation/surgery for sever cases

41
Q

What is acute dystonia?

A

Sudden onset of sustained muscle contractions frequently causing twisting and repetitive moments or abnormal postures

42
Q

Drugs that cause acute dystonic reactions (big list)

A 
Antipsychotic/neuroleptic drugs (dopamine receptor blockers)
- phenothialzines
- haloperidol
- atypical antipsychotics 
Pneothiazine anti-emetics (dopamine antagonist)
- promethazine
- prochlorperizine
Cocaine
LSD
TCA
Lithium 
Anticonvulsants
43
Q

Patterns of drug-induced acute dystonia?

A

Laryngeal dystonia
Oculogyric crisis
Buccolingual crisis
Opisthotonus

44
Q

Tx for acute dystonia?

A 
Stop the offending med
Then: 
Diphenhydramine
Baclofen
ICU (airway)
45
Q

4 core symptoms of restless leg syndrome

A

Urge to move legs

Worsening sx at rest

Improvement w activity

Worse at night

46
Q

Causes of restless leg syndrome?

A 
Primary: genetic
Secondary: 
- meds
- hypoglycemia
- opiate withdrawal
- anemia
- pregnancy
- ferritin deficiency
- renal failure 
- peripheral neuropathy
47
Q

Tx for restless leg syndrome?

A

Dopamine agonist
Opiates
Anticonvulsants
Analgesics

48
Q

What is gilles de la tourette syndrome?

A

Verbal or motor ticks that are chronic and lifelong.

Usually sporadic onset prior to 21yrs old

49
Q

Tx for bla bla bla Tourettes?

A 
Education/counseling
Neuroleptics (haloperidol, pimozide)
Clonidine
Phenothiazines 
Botulinum toxin A
50
Q

What is parkinsonism? Hint, its not parkinsons

A

Syndrome similar to parkinson’s disease

Combo of:

  • tremor
  • rigidity
  • bradykinesia
  • progressive postural instability
  • cognitive impairment
51
Q

Causes of parkinsonism?

A
  1. Neuroleptic drug exposure
  2. Cerebrovascular dz
  3. Methyl-phenyl-tetrahydropyridine (MPTP)
  4. Encephalits lethargica (von Economo’s dz)
52
Q

Parkins disase clinically defined as (slide says KNOW THESE in red)

A
  • resting tremor
  • cogwheel rigidity
  • bradykinesia
  • gait impairment
53
Q

Where is the damage with parkinson’s?

A

Damage in substantia nigra with cell loss in basal ganglia

54
Q

What causes the problems with parkinson’s?

A

Lack of dopamine.

Dopamine exerts an inhibitory effect on release of GABA

W/out dopamine GABA output increases

55
Q

Parkinson’s symptoms

TRAP

A

T: tremor (resting)
R: rigidity (muscle stiffness)
A: akinesia/bradykinesia
P: postural instability (gait impairment)

56
Q

Late features of parkinson’s?

A 
Orthostatic instability
Motor complications
Dysphagia
Movement abnormalities (whole body)
Dementia (frontal lobe)
Dysautonomia 
Greasy skin/seborrhea
57
Q

What will a pet scan show for parkinsons? Does this diagnose the disease?

A

Decreased dopamine activity in basal ganglia

Dx is clinical

58
Q

Tx for parkinson’s?

A 
Dopamine replacement
Anticholinergics
Dopamine agonist
Amantadine (augments dopamine)
Neuroprotection (MAO-B, CoQ10)
59
Q

How well does medical therapy work for parkinson’s?

A

Doesnt reverse or cure, we only hope to slow it down

60
Q

Nonmedical options for parkinson’s?

A

Surgery: thalamotomy/pallidotomoy

Deep brain stimulation

PT: walking techniques

Speech therapy

61
Q

What are the 3 mc causes of death for parkinson’s pts?

A

Choking
Pneumoina
Falls

Takes up to 20 yrs

62
Q

What is huntington’s?

A

Gradual onset of involuntary movement changes in behavior and personality, cognitive impairment that takes years to develop

63
Q

Pathophis of huntingtons?

A

Genetic mutation causes cell death and atrophy in cerebral cortex

Reduces GABA and ACh
Increases dopamine

64
Q

Age of onset of huntington’s?

A

25-45 yrs

65
Q

Huntington’s S/S?

A

Dementia

Chorea

66
Q

Imaging for huntington’s?

A

CT/MRI: atrophy of:

  • cerebral cortex
  • caudate nucleus
67
Q

Tx for huntingtons?

A 
Haloperidol (dopamine receptor blocker)
Reserpine (deplete dopamine)
SSRI (moodiness)
Benzodiazepines (sleep and anxiety)
Xenazine (dopamine depleting)
68
Q

What does xenazine (terabenazine) do for huntingtons pts?

A

Reversible, centrally acting, dopamine-depleting drug

Reduces chorea burden and is well tolerated

69
Q

Prognosis for huntington’s?

A

Progressive dementia

10-25 yrs later die from infection

70
Q

What is stiff person syndrome?

A

Rare progressive muscle rigidity, stiffness and painful spasms triggered by:

  • auditory
  • sensory
  • emotional
71
Q

Sx of stiff person syndrome?

A

Stiffness of trunk and legs that spreads

Often has paroxysmal painful muscle spasms

72
Q

Signs of stiff person syndrome?

A

“Tin man” gait

Hyperlordosis that restricts hip and spine movement

73
Q

What must be r/o for a diagnosis or stiff person syndrome?

A
  • Neuromyotonia
  • Pyramidal dysfunction
  • Extrapyramidal dysfunction
  • Structural spinal cord disease
74
Q

Labs for stiff person?

A

Antibodies against glutamic acid decarboxylase (GAD)

75
Q

Tx for stiff person syndrome?

A

Tx of tumor
Glucocorticoids
Baclofen
IVIG

76
Q

Describe cerebral palsy

A

A chronic impairment of

  • muscle tone
  • strength
  • coordination
  • movements

Comes from some early brain insult

77
Q

PE for cerebral palsy?

A
  • Hyperreflexia
  • microcephaly
  • limb length discrepancies
  • cataracts
  • retinopathy
  • congenital heart defects
78
Q

Wilson’s disease is a disorder of?

A

Copper metabolism

It builds up in the liver, kidneys, cornea and CNS

79
Q

How does wilson’s disease present?

A

Liver dysfunction

Neurophychiatric symptoms (parkinsonisms and similar stuff)

Kayser-fleischer rings

80
Q

Dx of wilson’s disease?

A

More copper in urine and blood

Liver biopsy shows increased copper staining

81
Q

Tx for wilson’s disease?

A

Copper chelation
- D-penicillamine

less toxic option
- trientine and zinc

82
Q

What are pesudoneurologic syndromes?

A

Pts with neurological symptoms or signs with no identifiable structure or functional etiology w/in the nervous system

Somatization or conversion disorder are common examples

83
Q

Examples of consciously-invented symptoms?

A

Factitious movement disorder (munchausens)
- no apparent motivators
Malingering
- external incentive

84
Q

Unconsciously produced symptoms?

A

Somatoform disorders

  • somatization disorder
  • hypochondriasis
  • conversion disorder
85
Q

What is somatization disorder?

A

Psychological distress manifested as a physical problem.

UNCONSCIOUS

86
Q

What is needed to diagnose somatization disorder?

A

2 GI symptoms
4 pain symptoms
1 neuro
1 sexual symptom

87
Q

What is hypochondriasis?

A

Preoccupation with symptoms and misinterpretation of normal function as symptoms

88
Q

What is conversion disorder?

A

Voluntary motor or sensory function dysfunction that suggest neurologic or other medical disease but cannot be explained

Can involve secondary gain (but isnt obvious)

Unconscious

89
Q

Clues to diagnosis fo pseudoneurologic syndroes

A

Look at slide 97 if you want. Its a long dumb list

90
Q

HX Features suggesting pseudoseizures

A 
High frequency
Emotional trigger
Gradual onset
Pt can recall
Anti epileptic drugs dont work
Usually know someone with seizures
91
Q

Clinical clues suggesting pseudoseizures?

A 
No postictal
No injuries 
Dystonic posturing
Pelvic thrusting
Geotropic eye movement 
Closed eyes 
Side to side head movement 
Prolonged seizure (2-3 min)
Pain terminates seizure
Normal EEG
Normal serum prolactin
92
Q

Clinical clues for pseudoparalysis?

A 
Non anatomic pattern weakness
Normal reflexes
Doesn’t involve face
Inconsistent
“Give-way” weakness
Drop test
Hoover test
Adductor sign
“Hysterical gaits”
93
Q

Pseudosensory syndrome?

A

Tingling or numbness that is not anatomical and inconsistent

94
Q

Waddell signs

A

Non-organic causes of back pain

  • superficial tenderness
  • nonantiomical tenderness
  • pain w axial loading
  • pain on stimulated rotation
  • distracted straight leg raise
  • regional sensory change
  • regional weakness
  • overreaction
95
Q

Warning signs of pseudocoma?

A

Pt is usually observed when it happens

They slump to avoid injury when falling

Generally looks like a kid pretending to be unconscious

96
Q

Psychogenic movement disorders (list)

A

Pseudotremor
Psychogenic Parkinsonism
Psychogenic myoclonus
Psychogenic dystonia

97
Q

What is pseudoneuro-opthalmologic syndrome

?

A

Sudden blindness involving complete loss of vision

98
Q

PE techniques for distinguishing true neurologic deficits and conversion disorder

A

Slide 112 and 113

Junior - Neuro 2 (4 decks)

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