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Neuro 2 Exam 2 > DSA 32 Movement Disorders > Flashcards

DSA 32 Movement Disorders Flashcards

1
Q

what is most common movement disorder?

A

postural tremor

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2
Q

identify: increased by stress, fatigue, or caffeine. also called action tremor

A

postural tremor

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3
Q

identify: disappears with complete relaxation

A

postural tremor

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4
Q

how do you test for postural tremor?

A

ask the patient to draw a spiral without allowing the hand or arm to touch the paper

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5
Q

patient presents with tremor at rest and with movement. neuro exam is otherwise normal. what is the likely type of tremor?

A

postural tremor

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6
Q

etiology: over-activity of the beta-sympathetic nervous system

A

postural tremor

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7
Q

treatment for postural tremor?

A

usually the treatment can be worse than the symptom but if they want a drug usually benzodiazepines (alprazolam), beta-blockers, primidone (barbiturate) or botox, Gabapentin

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8
Q

when do patients notice a resting tremor?

A

usually NOT the first symptom; preceded by bradykinesia, and stiffness of movement

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9
Q

how does a resting tremor begin?

A

unilaterally

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10
Q

why can you not just assume resting tremor has to do with parkinsons?

A

may be other medication causing these symptoms such as haloperidol or metoclopramide, compazine because these drugs are dopamine receptor antagonists

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11
Q

What if the patient has a resting tremor and their neuro exam is normal?

A

essential tremor with an atypical appearance

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12
Q

what if the patient has a resting tremor and an abnormal neuro exam?

A

think Parkinson’s although in rare cases it can present with a normal neuro exam

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13
Q

masked facies

A

bradykinesia which precedes the tremor in parkinson’s

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14
Q

triad of Parkinson’s

A

resting tremor, bradykinesia, and cogwheel rigidity

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15
Q

what is an advanced symptom of Parkinson’s

A

memory loss

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16
Q

What does brain imaging look like for parkinson’s

A

normal; done to rule out other causes

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17
Q

etiology of parkinson’s

A

neurodegeneration causes loss of the pigmented neurons of the zona compacta of the substantia nigra in the midbrain

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18
Q

slow, zig zag motion when pointing/extending toward a target

A

intention tremor

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19
Q

what does a intention tremor indicate?

A

cerebellar dysfunction

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20
Q

What is important to ask when someone comes in with an intention tremor?

A

family history

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21
Q

How does an intention tremor differentiate from a postural tremor?

A

intention tremor is like postural tremor in that a tremor occurs with attempt at movement however intention tremor worsens as the target is reached (increases in amplitude and frequency)

also there will be an abnormal neuro exam on someone with a intention tremor while a postural tremor will have a normal neuro exam

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22
Q

What test is abnormal in a patient with intention tremor?

A

physical exam will reveal abnoramlities of coordination

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23
Q

What will you see on imaging for someone with a intention tremor?

A

cerebellar lesion or cerebellar atrophy

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24
Q

What other disease is associated with intention tremor?

A

spinocerebellar ataxia whichiis a genetic abnormality

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25
Q

what is the onset for cerebellar ataxia?

A

adult or childhood

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26
Q

what are possible causes of acute cerebellar ataxia?

A

trauma or stroke

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27
Q

what are possible causes of subacute cerebellar ataxia?

A

intoxication or abscess

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28
Q

what are possible causes of chronic cerebellar ataxia?

A

hereditary, degenerative, or neoplasm

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29
Q

Cerebellar ataxia: dominant hereditary

A

will show in family history

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30
Q

cerebellar ataxia: recessive hereditary

A

may not show in family history

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31
Q

What degenerative disease can cause cerebellar ataxia?

A

MS

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32
Q

frequent spinal cord sensation and motor dysfunction + cerebellar dysfunction

A

spinocerebellar ataxia

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33
Q

etiology of spinocerebellar ataxia

A

usually hereditary

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34
Q

What is imaging like for spinocerebellar ataxia?

A

normal

35
Q

What is a spinocerebellar ataxia that is inherited?

A

Friedreich ataxia

36
Q

What are the symptoms of someone with Friedreich ataxia?

A

staggering gait, frequent falling, diabetes, hypertrophic cardiomyopathy

37
Q

What is the mutation in Friedreich ataxia?

A

frataxin (iron binding protein)

38
Q

sensory ataxia: onset

A

subacute or chronic

39
Q

how do you separate sensory ataxia from spinocerebellar or cerebellar ataxia?

A

NO complaint of dysarthria or nystagmus

40
Q

How is sensory ataxia distinguished from cerebellar ataxia?

A

coordination with eyes shut vs. open

41
Q

disease that causes sensory ataxia?

A

Tabes Dorsalis

42
Q

What affects the DTRs?

A

sensory ataxia; usually absent

43
Q

What previous or current health conditions may cause sensory ataxia?

A

toxic-metabolic diseases such as DM, hypothyroidism, B12, HIV

44
Q

Huntington’s age of onset

A

40s to 50s

45
Q

gradual onset of fidgetiness giving way to jerky movements; personality changes leading to dementia

A

huntington’s

46
Q

Imaging for Huntington’s

A

atrophy of the caudate nuclei with enlargement of the anterior horns of the lateral ventricles

47
Q

genetics of Huntington’s

A

CAG trinucleotide repeat of >38 on chromosome 4

48
Q

chorea

A

sudden jerky purposeless movements

49
Q

what lesion does chorea indicate?

A

basal ganglia

50
Q

progressive supranuclear palsy: age of onset

A

6th decade or older

51
Q

progressive supranuclear palsy: onset of symptoms

A

gradual

52
Q

symptoms of progressive supranuclear palsy

A 
increased axial muscle tone
unstable gait and falls
dysarthric sppech
dysphagia
impaired eye movement (downward eye movements first affected)

eventually ALL eye movmeents will be affected

53
Q

dystonia

A

sustained, involuntary muscle contraction; writer’s cram; or sustained eyelid twitch (blepharospasm)

54
Q

usual etiology of dystonia/dyskinesia?

A

due to anti-dopaminergic antipsychotics or antiemetics drugs

55
Q

dyskinesias

A

focal asyncrhonous msucle movements which may occur in any muscle group but are particularly common in the oral/facial/lingual and limb muscles

56
Q

generalized dystonia

A

Dystonia musculorum deformans

57
Q

What if dystonia/dyskinesia is not caused by drugs?

A

idiopathic

58
Q

how do you differentiate between a pathologic tremor and a physiologic one?

A

pathologic tremors will disappear during sleep but physiologic tremors will remain

59
Q

What is the first line drugs for tourette Syndrome?

A

alpha adrenergic agonists: clonidine and guanfacine Tenex (less sedating an done daily dosing)

60
Q

What is second line therapy for TS?

A

atypical antipsychotic olanzapine or risperidone

61
Q

What are the third line agents for TS?

A

haloperidol, pimozide, fluphenazine–block D2 receptors

62
Q

identify: this tremor may occur with posture holding, but worsens as the patient gets closer to the target.

A

intention tremor

63
Q

what is the anatomical diagnosis of essential tremor?

A

believed to be sympathetic NS mediated

64
Q

what is the etiology of essential tremor?

A

idiopathic

65
Q

what is the most effective treatment for essential tremor?

A

beta blockers, benzodiazepines, and barbiturates–these drugs have to be central acting

66
Q

how do we distinguish Parkinson’s disease from drug induced Parkinson’s?

A

stop the antipsychotic drug and see what happens–the patient’s psychosis might get worse

67
Q

where is the lesion likely to be in drug-induced Parkinson’s?

A

basal ganglia

68
Q

where is the lesion in progressive supranuclear palsy?

A

in the midbrain

69
Q

what is the anatomic pathophysiology of Parkinson’s disease?

A

substantia nigra and multiple other areas of the CNS are affected

70
Q

what is an intention tremor a sign of?

A

cerebellar dysfunction

71
Q

what would brain CT scan of patient with normal pressure hydrocephalus show?

A

enlarged ventricles. no cortical atrophy (normal cortical markings)

72
Q

identify: asynchronous, focal abnormal movements.

A

tics

73
Q

how long does transient tic disorder last?

A

a year at most

74
Q

what is the difference between acute dyskinesia and tardive dyskinesia?

A

acute dyskinesia disappears when the patient stops taking antipsychotics. tardive dyskinesia is often irreversible even when you stop the medication.

75
Q

what is the most effective treatment for cervical dystonia?

A

botulinum toxin injection into the muscles

76
Q

patient presents with tremor at rest and with movement. exam shows rigidity and slowness of movement. what is the likely type of tremor?

A

Parkinsonian tremor

77
Q

patient presents with tremor at rest and with movement. exam reveals ataxia. what is the likely type of tremor?

A

intention tremor

78
Q

contrast rigidity in Parkinson’s disease to rigidity in progressive supranuclear palsy.

A

PSP rigidity is usually in extension while PD rigidity is usually in flexion

79
Q

what is the clinical presentation of progressive supranuclear palsy?

A

gait disturbance and falls, rigidity, dysarthria and dysphagia, difficulty with eye movements (particularly downward vertical gaze)

80
Q

what are the clinical features of cerebellar disease?

A

ataxia, intention tremor, dysarthria, ocular movement abnormalities, hypotonia

81
Q

what is the clinical presentation of normal pressure hydrocephalus?

A

dementia, gait disturbances, urinary incontinence

82
Q

what will be present on brain imaging of NPH?

A

ventricular enlargement and absence of atrophy

83
Q

what are the treatment options for dystonias?

A

anticholinergics, benzodiazepine, botox

Neuro 2 Exam 2 (16 decks)

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