Clinical Approach to Movement Disorders (Hon)

Question 1

Movement disorders are generally classified into what two types?

Answer 1

1) Bradykinetic

2) Hyperkinetic

Question 2

What is the most common bradykinetic Disorders (aka Akinetic Rigid Syndromes)?

Answer 2

Parkinsonism

Question 3

Idiopathic Parkinson’s Disease is caused by?

Answer 3

Depletion of dopamine in the nigrostriatal system which disrupts the balance of dopamine and acetylcholine

Question 4

What are the cardinal features of Parkinson’s?

Answer 4

1) Resting tremor (often unilateral at first)
2) Cogwheel rigidity (increased resistance to passive movement)
4) Bradykinesia

Question 5

What symptoms are seen with Progressive Supranuclear Palsy?

Answer 5

1) Bradykinesia
2) Rigidity
3) Loss of voluntary control of eye movements (especially vertical gaze)

Question 6

What symptoms are seen with Multiple Systems Atrophy (Shy-Drager Syndrome)?

Answer 6

1) Bradykinesia
2) Rigidity
3) Pronounced autonomic dysfunction

Question 7

What symptoms are seen with Cortical Basal (Ganglionic) Degeneration?

Answer 7

1) Bradykinesia
2) Rigidity
3) Cortical sensory loss, apraxia, myoclonus or aphasia

Question 8

What is Chorea

Answer 8

Hyperkinetic movement disorder

Irregular, brief, “dancelike” movement

Question 9

What is Athetosis?

Answer 9

hyperkinetic movement disorder is characterized as writhing, sinuous movements?

Question 10

What is Dystonia?

Answer 10

Hyperkinetic movement disorder

Sustained muscle contraction that produce twisting and repetitive movements and abnormal postures?

Question 11

What is Ballism?

Answer 11

Hyperkinetic movement

Large Amplitude, Flinging movement, usually from proximal part of extremity

Question 12

What is a Tic?

Answer 12

Hyperkinetic movement disorder

Brief, rapid, repetitive action involving single or multiple muscle group

Question 13

Huntington’s Disease is characterized by what symptoms?

What is its inheritance pattern?

When do symptoms generally begin?

Answer 13

1) Chorea and dementia
2) AD
3) Age 30-50

Question 14

Sydenham’s Chorea occurs mainly in what population?

It occurs as a complication from what previous infection?

It is characterized by what movements?

What is the treatment?

Answer 14

1) Pediatrics
2) Group A hemolytic strep
3) Unilateral chorea
4) Bedrest and antibiotics

Question 15

What is Idiopathic Torsion Dystonia?

What kind of clinical findings?

Answer 15

Dystonic movements and postures of anywhere is the body without other signs

• Torticollis (Neck twisted to one side)
• Blepharospasm (Spontaneous involuntary forced closure of eyes)
• Oromandibular dystonia (spasm of mouth muscles)

Question 16

What is Focal Torsion Dystonia

-What are the treatments?

Answer 16

Dystonic movements confined to one area of the body

Botox

Question 17

What can be used to treat Idiopathic Torsion Dystonia?

What can be used to treat Focal Torsion Dystonia?

Answer 17

1) Low dose levodopa

2) BOTOX

Question 18

Wilson’s disease is characterized by?

What is its inheritance pattern?

When does it usually present?

What clinical features are present?

What is used to Dx

What is the treatment?

Answer 18

1) Disorder of copper metabolism that produces neuro and hepatic dysfunction
2) AR
3) Childhood or young adulthood
4) Bradykinetic and hyperkinetic movements
5) History, Increased Cu excretion, decreased serum ceruloplasm, Kayser-Fleischer ring
5) Penicillamine (Cu chelating agent) + Restrict dietary Cu

Question 19

What is Gilles De La Tourette’s syndrome characterized by?

Answer 19

Chronic multiple motor and vocal tics with onset before the age of 21

Question 20

What is the clinical presentation of essential tremor?

Answer 20

Postural or kinetic tremor of both hands and may involve the head or voice

Question 21

What often decreases the tremor temporarily?

Answer 21

Alcohol