Spasticity - strokes - results from UMN damage - tone initially increases and then decreases (clasp-knife) rigidity in corticospinal disorders

- Parkinson's - caused by basal ganglia disorders - continuous throughout attempts to bend the limb - rigidity with a superimposed tremor

Basal Nuclei: Parkinsons And Huntingtons Flashcards by Sarah Heath

Absence of movement

Akinesia

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Decreased amount of movements

Hypokinesia

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Slowed movements

Bradykinesia

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What terms are not used for corticospinal, corticobulbar, LMN, or muscular disorders

Akinesia
Hypokinesia
Bradykinesia

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What are bradykinetic movements caused by

Increases inhibitory basal ganglia outflow to the thalamus

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What do basal nuclei dysfunctions affect

Body movements, eye movements, cognition, and emotional regulation

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What disorder is bradykinesia, hypokinesia, and akinesia seen with

Parkinson’s

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If you have too much dopamine

Psychological disorders

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If you have too little dopamine

Parkinson’s

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Decreases spontaneous movements, without coma, can be seen in

Diffuse lesions of the frontal lobes, subcortical white matter, thalami, or brainstem reticular formation

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Depression and advances schizophrenia

Can also causes marked psychomotor retardation, which in the extreme is called Catatonia
-mimics basal nuclei disorders

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If you give someone too many anti-psychotics, what is the effect

Parkinson’s like symptoms

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Types of rigidity

Spasticity

Cogwheel

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What kind of rigidity is seen in corticospinal disoriders

Spasticity

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Spastic rigidity

Spasticity

strokes
results from UMN damage
tone initially increases and then decreases (clasp-knife) rigidity in corticospinal disorders

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Cogwheel rigidity

Parkinson’s
caused by basal ganglia disorders
continuous throughout attempts to bend the limb
rigidity with a superimposed tremor

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What kind of rigidity is seen in Parkinson’s

Cogwheel

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__________ is a common idiopathic neurodegenerative condition caused by loss of dopaminergic neuron in the substantia nigra pars compacta

Parkinson’s

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What is Parkinson’s caused by

Loss of dopaminergic neurons in the substantia nigra pars compacta

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What is Parkinson’s characterized by

bradykinesia
rigidity
instability
tremor (at rest)

BRIT

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Why is there a tenor at rest with Parkinson’s

Basal nuclei are what allow you to sit still without random movements, this is disrupted

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Age of onset for Parkinson’s

40-70

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How many people affected with Parkinson’s

1% of individuals over 65

Familial tendency and Parkinson’s

There is verbally no familial tendency, except in rare cases of familial Parkinson’s

Pathological cause of Parkinson's

There is a loss of pigmented dopaminergic neurons in the substantia nigra pars compacta, causing the substantia nigra to appear pale to the eye on cross section

Are Lewy bodies pathognomonic for Parkinson's

What is diagnosis of Parkinson's disease is based on what

Almost ONLY on clinical features

Common manifestations of bradykinesia and hypokinesia in Parkinson's disease

- micorgraphia - masked fancies or hypomimia - posture is stooped - postural instability - festinating gait - armswing is dimnishied

What is often the 1st symptom of Parkinson's

Micrographia, writing becomes small

Characteristic decrease in spontaneous blink rate and in facial expression

Marked facies or hypomimia

Festinating gait in Parkinson's

Once they have started, they tend to walk with small shuffling steps

Late symptoms of Parkinson's

- depression and anxiety - Dementia - diffuse Lewy bodies diseas - bradyphrenia (slow response to Qs) - seborrhea (oily skin) and hypersalivation - impaired smell is an earlier symptom

When should a diagnosis other than idiopathic Parkinson's should be suspected

- patient does not respond to levodopa - symmetrical symptoms - absence of resting tremor - rapid progression of symptoms

Shy-Crager syndrome

Parkinson's + orthostatic hypotension

Parkinson's like diseases

Dementia with Lewy bodies

Main mode of treatment for Parkinson's

Levodopa

A progressive, untreatable disorder which patients lose their ability to function and experience increasing dementia

Huntington's disease

The initial symptoms indicative of this disease generally being to appear ______ years of age

45-44

What kind of disease Huntington's

Genetic disorders inherited in autosomal dominant fashion

What is the Huntington disease due to

Mutation on the short arm of chromosome 4

Huntington's disease at the molecular level

Mutated gene has multiple copies of the DNA sequence CAG, which codes for glutamate

What do the CAG repeated in huntingtons result in

Addition of glutamate residues inside the gen coding for the protein. Huntington

Dysfunction Huntington does what

Leads to premature death of neurons in the striatum

When is Huntington's more severe

Patients with larger numbers of repeats have a more severe illness with an earlier onset

Trinucleotide repeat disorders

- DNA replication error - abnormal amplification of sequence of 3 nucleotides. This may prevent normal expression of the gene or encode a dysfunctional protein - will worsen with each generation - most repeats contain guanine and or cytosine

What is the trinucleotide repeat in huntingtons disease

CAG

What is the primary responsibility for huntingtons

Glutamate exitotoxicity especially at caudate nucleus

What happens when glutamate binds its receptor

Opens calcium channels

Glutamate binding receptors in huntingtons

An unknown mechanism causes glutamate to persist at the NMDA receptor, which opens calcium ion channels, the resulting influx of Ca causes an increase in intracellular calcium, which triggers a cascade that leads to cell death

Signs and symptoms of huntingtons

Initial symptoms are susally subtle chorea and behavioral disturbances -subtly eye abenormalities such as slow saccades, impaired smooth pursuit, sluggish nystagmus

Early movement abnormalities of huntingtons

Clumsiness and subtle chorea, such as mild jerking, fidgety movements

Psychiatric manifestations of huntingtons

- affective disorders such as depression and anxiety - OCD - impulsive or destructive behavior - psychosis

Cognitive impairments with huntingtons

- decreases attention - memory disorder that affects both recent and remote memories - atomic aphasia - impaired executive functions

Advanced huntingtons

Patients are profoundly demented and lose the ability to make nearly all purposeful movement, they are bedbound, cannot speak, and usually die of respiratory infection

Median survival from onset of huntingtons

15 years

Huntington's and MRI

Flattening of the head of the caudate nucleus

MRI of huntingtons more advanced

Milder atrophy of the cerebral cortex also occurs