Case Files Neurology Flashcards
PET scanning shows what for essential tremor?
Increased thalamic activity
What other conditions can mimic essential tremor?
MS, closed head injury damage to red nucleus, hyperthyroidism, heavy metal poisoning
Essential tremor treatment options
propranolol [better for young or those without asthma, diabetes, heart conditions], primidone [Mysoline] 50-700 mg/d; diazepam or xanax, Botox A (head or voice, good for 3 months), DBS thalamic stimulator
Tremor onset latency for PD vs. ET
9 sec PD vs. 1-2 sec ET
Features of HD
dance-like choreiform movements, personality change, altered cognition, altered balance, slowed saccades, primitive reflexes, hyperreflexia
Chorea
sudden jerky irregular movements with muscle contractions that are not repetitive or rhythmic but appear to flow from one muscle to the next
Athetosis
twisting, writing movements associated with chorea
Dystonia
sustained muscle contractions cause twisting and repetitive movements or abnormal postures
Tardive Dyskinesia
long-term DA antagonist use -> impaired involuntary movements
HD genetic locus
CAG triplet repeat >40x 4p16/3 huntingtin gene, worse with paternal transmission
Westphal variant
Form of HD early onset (~5% cases of HD) with parkinsonism: bradykinesia and rigidity, dystonia, myoclonus and seizures can occur
HD neuroimaging findings
atrophy of caudate head and putamen
Syndenham Chorea
Age 5-15 or during pregnancy; self limited d/o affecting voluntary movements, associated with rheumatic fever
Differential diagnosis for chorea
Sample list: Hereditary-> HD, SCA, Fahr’s, parathyroid dx; Autoimmune-> SLE, MS; Neoplasm ->paraneoplastic; Vascular-> infarct, AVM, SDH; Infectious ; Metabolic-> Na, Ca, Gly, hyperthyroid, renal failure, B1, niacin; toxins-> EtOH, CO, Hg, Mn, anoxia; Drugs-> anti-sz, amphets, steroids, opiates
Tx for chorea
Haldol
