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Semester 5 - Neuro > 7 - Motor disorders > Flashcards

7 - Motor disorders Flashcards

1
Q

Name some causes of chorea:

A
  • Huntington’s
  • Sydenham’s
  • Wilson’s disease
  • SLE
  • Thyrotoxicosis
  • Levodopa
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2
Q

What is the role of the cerebellum?

A 
Role in:
- coordination
- precision
- timing
of purposeful movements
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3
Q

What structure separates the cerebellum from the occipital and parietal lobes?

A

Tentorium cerebelli

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4
Q

What structure separates the cerebellum from the pons?

A

4th ventricle

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5
Q

Which part of the cerebellum regulates trunk musculature?

A

Vermis (midline)

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6
Q

Which part of the cerebellum regulates limb musculature?

A

Lateral hemispheres

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7
Q

Are tracts to and from the cerebellum ipsi- or contralateral?

A

Ipsilateral

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8
Q

Name the 3 lobes of the cerebellum:

A

1) Anterior lobe
2) Posterior lobe
3) Flocconodular lobe

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9
Q

What are the symptoms of cerebellar pathology?

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
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10
Q

Name some causes of cerebellar pathology:

A 
Posterior fossa tumour
Alcohol
Sclerosis (MS)
Trauma
Rare causes
Inherited ie Friedreich's ataxia
Epilepsy med ie Carbamazepine/Phenytoin
Stroke
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11
Q

How do midline lesions of the cerebellum often present?

A
  • Truncal ataxia

- Abnormal gait

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12
Q

What is the name given to the collection of nuclei found of both sides of the thalamus, outside and above the limbic system?

A

Basal ganglia

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13
Q

Name the important structures in the basal gsanglia:

A
  • Caudate nucleus
  • Lentiform nucleus (putamen + globus pallidus)
  • Substantia nigra
  • Subthalamic nucleus
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14
Q

Name the 2 structures which form the lentiform nucleus:

A
  • Putamen

- Globus pallidus

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15
Q

At rest, which pathway in the basal ganglia dominates, and what is the outcome?

A

Indirect pathway dominates
= Thalamus is suppressed from sending excitatory impulses to the motor cortex
= Inhibits motor cortex

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16
Q

What is the main excitatory neurotransmitter in the basal ganglia?

A

Glutamate

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17
Q

What is the main inhibitory neurotransmitter in the basal ganglia?

A

GABA

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18
Q

Which pathway in the basal ganglia has an overall stimulatory effect on the motor cortex?

A

Direct pathway

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19
Q

Which pathway in the basal ganglia has an overall inhibitory effect on the motor cortex?

A

Indirect pathway

20
Q

Which structure of the basal ganglia produces dopamine?

A

Substantia nigra pars compacta

21
Q

Dopamine is released from the substantial nigra pars compacta, on what structure in the basal ganglia does it act?

A

Putamen

22
Q

Which dopamine receptors in the basal ganglia pathways activate the direct pathway?

A

D1 receptors

23
Q

Which dopamine receptors in the basal ganglia pathways activate the indirect pathway?

A

D2 receptors

24
Q

What is the role of the basal ganglia?

A
  • Facilitates appropriate movements

- Inhibits inappropriate movements

25
Q

Via which structure does the basal ganglia communicate with the cortex?

A

Thalamus

26
Q

What are the 2 parts of the substantial nigra? Describe their position in relation to each other:

A
  • Substantia nigra pars compacta
  • Substantia nigra pars reticularis
    Both in midbrain, pars reticular is a ventral stri, pars compacta lies dorsally
27
Q

What happens in Parkinson’s disease to cause bradykinesia?

A
  • Death of dopaminergic neurones in substantiatia nigra pars compacta
  • Loss of inhibition on putamen in indirect pathway
    +
  • Loss of excitation of putamen in direct pathway
    = Less excitation of motor cortex = Bradykinesia
28
Q

Basal ganglia disorders typically result in what motor signs?

A
  • Abnormal motor control
  • Altered posture
  • Altered muscle tone
  • Dyskinesia
29
Q

Name the cardinal signs of Parkinson’s disease:

A
  • Resting tremor
  • Rigidity
  • Bradykinesia
30
Q

Resting tremor, rigidity and bradykinesia are the cardinal sign’s of Parkinson’s disease. Name some other features:

A
  • Hypophonia
  • Pill-rolling tremor
  • Cog-wheel rigidity
  • Lead-pipe rigidity
  • Micrographia
  • Reduced facial expression
  • Dementia
  • Depression
  • Anxiety
  • Mild cognitive impairment
  • Visual hallucinations
  • Insomnia
  • Falls
  • Shuffling gait
  • Urinary incontinence
  • Constipation
  • Erectile dysfunction
  • Orthostatic hypotension
31
Q

What is the main treatment of Parkinson’s disease?

A

Carbidopa/Levodopa (also known as Levocarb, or Co-careldopa)

= Dopamine precursor + peripheral DOPA decarboxylase inhibitor

32
Q

What enzyme inhibitor is given with a dopamine precursor to treat Parkinson’s disease? Why?

A

Peripheral DOPA decarboxylase inhibitor
= Reduces the conversion of precursor to Dopamine in peripheral tissues
= ^^ concentration of dopamine precursor crosses BBB and available to brain

33
Q

What drugs may be given as an adjunct to Carbidopa/Levodopa for Parkinson’s disease?

A
  • Dopamine agonist ie Bromocriptine
  • MAO-B inhibitor ie Selegiline
  • COMT inhibitor ie Entacapone
  • Amantadine
34
Q

What type of drug is Bromocriptine?

A

Dopamine agonist

35
Q

What type of drug is Selegiline?

A

MAO-B inhibitor

36
Q

What type of drug is Entacapone?

A

COMT inhibitor

37
Q

What type of drug is Amantadine?

A

NMDA antagonist = Glutamate receptor antagonist

38
Q

What is the hereditary pattern of Huntington’s disease?

A

Autosomal dominant

39
Q

Huntington’s disease is progressive cell loss in which areas of the brain?

A
  • Basal ganglia

- Cortex

40
Q

What is the average age of onset of Huntington’s disease?

A

30-50 yrs

41
Q

What are the typical signs and symptoms of Huntington’s disease?

A
  • Chorea
  • Dystonia
  • Incoordination
  • Cognitive decline
  • Behavioural difficulties
  • Abnormal gait
42
Q

What are the treatments available for Huntington’s disease?

A
  • Antidepresssants
  • Mood stabilisers
  • Antipsychotics
  • Speech and language therapy
43
Q

What role do antipsychotics have in the treatment of Huntington’s disease?

A
  • Antipsychotics antagonise D2/3 dopamine receptors, reducing dopamine transmission
  • Loss of inhibition on putamen in indirect pathway
    +
  • Loss of excitation of putamen in direct pathway
    = Less excitation of motor cortex = Bradykinesia
  • So can help suppress involuntary movements (and violent outbursts)
44
Q

What is ballismus?

A

Rare movement disorder causes repetitive but constantly varying large amplitude involuntary movements of proximal parts of limbs

45
Q

What causes ballismus?

A

Decreased activity of subthalamic nucleus

= Removed inhibition on thalamus

46
Q

What can cause ballismus?

A
  • Stroke
  • Trauma
  • Neoplasm

Semester 5 - Neuro (14 decks)

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