Adult Movement Disorders Flashcards
MC Movement D/O
Parkinsons
MC Neurodegenerative D/O
AD #2 Parkinsons
Environmental exposure that put patient at risk for parkinsosn
- herbicide/pesticides
- metals
- well water
- farming, rural
- wood/steel mills
% of dopaminergic neurons lost at symptom onset in parkinsons
60-80%
Lewy Bodies/Neurites:
appearance
- eosinophilic
- intracytoplasmic inclusions
Sleep change assc with Parkinsons
REM Behavior D/O
Autonomic changes assc with parkinsons
constipation urinary frequency sweating drooling orthostatic hypotension
Only parkinsons drug shown to slow progression of disease
MAO-Bi
selegiline, rasageline
Sites for DBS in Parkinsons
- STN (tremor, dyskinesia)
- GPe (dystonia)
- VIM (tremor)
In NPH, what should be done before performing LP?
- MOCA
- number steps over 10 meters
- walking speed
(then determine improvement after LP)
NPH appearance on imaging
- ventricles dilated
- atrophic cortex
PSP Symptoms
- Parkinsonism
- Neck Dystonia
- Pseudobulbar palsy
- Supranuclear ophtalmoplegia
Describe ophthalmoplegia
loss of vertical gaze initially
HD genetic change
AD CAG repeat chromosome 4 with genetic anticipation
Juvenile Onset HD appears as ______
parkinsonism
parkinsonism in kid –> think HD
HD = caudate atrophy
What is the microscopic finding?
-loss of spiny striatal neurons with gliosis
Treatments for HD
- Tetrabenazine (dopa depleting agent)
- Antipsychotics
- SSRIs
ADRs assc with tetrabenazine
- depression (combine with SSRI)
- orthostatic hypotension
MC cause action tremor
benign essential tremor (familial)
What improves benign essential tremor?
alcohol
Contrast PD and BET tremors
- Parkinsons is lower frequency and at rest
- BET is higher frequency and assc with action/ postures
DOC for BET
propranolol
Secondary treatments for BET
- topiramate
- primidone
Drug known to cause parkinsonism
metaclropromide
