46,49,59,61 Flashcards
essential tremor affects which body parts
both hands and forearms and less commonly the head and voice
begins in one upper extremity and soon compromises the other.
age of onset in essential tremor
bimodal- 20s or 60s
unimodal- 50s
tremor frequency decreases with age
which drugs can exacerbate essential tremor
valproic acid
lithium
differential for essential tremor
Parkinson’s disease and dystonic tremor.
first line medical management for essential tremors depending on age
young- propranolol
old- primidone
surgical management for essential tremors
stereotactic thalamotomy and thalamic stimulation
target: ventralis intermedius nucleus of the thalamus.
posture. Involuntary sustained twisting is referred to as
dystonia
drugs that can cause dystonia
dopamine blocking drugs (neuroleptic/antipsychotics)
antiemetics (prochlorperazine or metoclopramide)
Focal dystonia commonly affects which muscles?
cervical muscles –> twisting of head to side (torticollis)
other types of focal dystonia
blepharospasm (an involuntary closure of the eyelids),
dystonic writer’s cramp,
spasmodic dysphonia,
oromandibular dystonia.
Young patients with focal dystonia should be
screened for
Wilson’s disease.
diagnosing focal dystonia
clinical
treatment for mild dystonia
nothing
treatment for severe dystonia
*botox- lasts up to 3-6 mo
anitcholinergics, benzos
type of gait in cerebellar dysfunction
wide based gait
cardinal features of cerebellar dysfunction
disturbances in motor control,
muscle tone regulation,
coordination of skilled movements.
can speech be affected in cerebellar dysfunction?
yes- speech slurred- cerebellar dysarthria
arterial supply of cerebellum and which main arteries they come from
PICA- vertebral artery
AICA- basilar
SCA- basilar
The distal portions of PICA bifurcate into a medial trunk that supplies the _____ and a lateral trunk that supplies the ______
medial: vermis and the adjacent cerebellar hemisphere
lateral: cortical surface of the tonsil and cerebellar hemisphere.
AICA supplies the
lateral tegmentum of the lower two-thirds of the pons
ventrolateral cerebellum.
The _____ arises from AICA to supply the facial and auditory nerves.
internal auditory artery
SCA supplies the .
superolateral cerebellar hemispheres,
superior cerebellar peduncle,
the dentate nucleus,
part of middle cerebellar peduncle
cerebellar infarction (caused by thrombosis or embolus) presents with what?
severe vertigo, nausea, vomiting, and ataxia.
Loss of balance and difficulty maintaining posture, standing, and walking
what can happen with bilateral or large cerebellar infarcts?
edematous cerebellum may compress the aqueduct of Sylvius or the fourth ventricle
–> obstructive hydrocephalus,
or may compress the brainstem–> decreased alertness.
With a cerebellar pressure cone, there is downward displacement of the cerebellar tonsils through the foramen magnum, resulting in
neck stiffness, cardiac and respiratory rhythm disturbances, apnea, and death.
With upward transtentorial herniation, there is upward displacement of the superior aspect of the cerebellar
hemisphere through the edge of the _____ resulting in ____
tentorial incisura
midbrain compression
Clinical manifestations of upward cerebellar herniation include
lethargy, coma, paralysis of upward gaze, midposition and unreactive pupils, and abnormal extensor posturing.
management of cerebellar infarcts
ICU, stroke unit
Emergency surgery (e.g., ventriculostomy or posterior fossa decompression or both)
most common dominantly inherited ataxia
in the world is ____
SCA 3 (Machado-Joseph disease)
SCA stands for
spinocerebellar ataxia
SCA 3 clinical features
progressive ataxia along with abnormalities of eye
movements, speech, and swallowing.
Onset-30s or 40s
supranuclear ophthalmoparesis.
Facial myokymia (resembling fasciculations)
SCA-1 presentation
begins with gait ataxia, and over time patients develop severe dysarthria and dysphagia.
Ophthalmoparesis, spasticity, and choreoathetosis
most patients with SCA 1 become wheelchair bound within ___ years
15
SCA 6 presentation
milder, slow course
mild sensory loss
SCA 7 is associated with
retinal degeneration.
SCA 10 is common in what population and has what manifestation
Mexican families
seizures
SCA 12 is associated with
prominent early tremor of the arms and head
SCA 17 presentation (onset, features)
midlife
cognitive decline and basal ganglia signs
