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Gwen - Neurology > Dyskinetic disorders > Flashcards

Dyskinetic disorders Flashcards

1
Q

What are dyskinetic disorders charcterised by?

A

Characterised by impaired panning, control or execution of movement

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2
Q

What is a resting tremor?

A

https://www.youtube.com/watch?v=AYPzyOK2H2E

Tremor which is abolished with on voluntary movement

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3
Q

What is the cause of a resting tremor?

A

Parkinsonism

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4
Q

What is an intention tremor?

A

https://www.youtube.com/watch?v=4Sf-TuXMK64

Intention tremor is a slow (2–4 Hz) tremor during voluntary movement that develops as the limb approaches the target.

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5
Q

What tests would you do to assess for an intention tremor?

A
  • Finger-to-nose test
  • Heel-shin sign
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6
Q

Why does an intention tremor occur?

A

Delays in motor initiation and movement termination, and abnormalities of movement force and acceleration, contribute to intention tremor

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7
Q

What can cause an intention tremor?

A
  • Intoxication – alcohol, benzodiazepine
  • Cerebellar infarction
  • Multiple sclerosis
  • Vertebral artery dissection
  • Cerebellar mass lesion – tumour, abscess, AVM
  • HSV cerebellitis
  • Hereditary cerebellar degeneration (Freidreich’s ataxia)
  • Paraneoplastic cerebellar degeneration
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8
Q

What is a postural tremor?

A

https://www.youtube.com/watch?v=ZHUXI6OGdjo

A tremor which is absent at rest, but present on maintained posture (e.g. outstretched arms) and may persist on movement

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9
Q

What are causes of postural tremor?

A
  • Benign essential tremor
  • Thyrotoxicosis
  • Anxiety
  • B-agonists
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10
Q

What is chorea?

A

https://www.youtube.com/watch?v=1hKtmtu2pCw

Non-rhythmic, jerky, purposeless movements flitting from one place to another e.g. facial grimacing, raising the shoulders, flexing/extending fingers

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11
Q

What can cause choreic movements?

A
  • Systemic disease - thyrotoxicosis, SLE, antiphospholipid syndrome, primary polycythaemia
  • Genetic diseaseb - Huntingtons disease, neuroacanthocytosis
  • Drugs - levodopa, OCP
  • Post infection - Syndenham’s chorea
  • Pregnancy
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12
Q

What is syndenham’s chorea?

A

https://www.youtube.com/watch?v=wTCnbga3sqg

A rare atuoimmune complication of group A strep infection, characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. It is caused by destruction of cells in the corpus striatum of the basal ganglia

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13
Q

What drug can worsen chorea symptoms?

A

Levodopa

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14
Q

What is hemiballismus?

A

https://www.youtube.com/watch?v=1iSnmwXfN5o

Large-amplitude, flinging hemichorea (affecting proximal muscles) conttralateral to a vacular lesion of the subthalamic nucleus - often elderly diabetics

Violent swinging movements of one side of the body.

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15
Q

Typical causes of hemiballismus?

A

Usually by infection or haemorrhage in the contralateral subthalamic nucleus

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16
Q

What is athetosis?

A

https://www.youtube.com/watch?v=J_wIDm1_ax4

Slow, sinuous, confluent, puposeless movements (esp. digits, hands, face, tongue) which are often difficult to distinguish from chorea

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17
Q

What are causes of atheotosis?

A

Most common cerebral palsy

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18
Q

What is pseudoathetosis?

A

Athetosis caused by severe proprioceptive loss

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19
Q

What are tics?

A

https://www.youtube.com/watch?v=M0CBmmxufAk

Brief, repeated, sterotyped movements which patients may suppress for a while. Usually involve face and shoulders.

Eg tourette’s

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20
Q

What is myoclonus?

A

https://www.youtube.com/watch?v=bHG3GdvZOps

Sudden involuntary focal o general jerks arising from cord, brainstem or cerebral cortex

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21
Q

What are causes of myoclonus?

A
  • Physiological myoclonus
  • Myoclonic Epilepsy
  • Variant CJD
  • Metabolic disorders - hepatic/renal failure, dementia/neurodegenrative disorders
  • Encephalitis
22
Q

What is myoclonus caused by hepatic/renal failure called?

A

https://www.youtube.com/watch?v=-R3lRmu7dbk

Asterixis (metabolic flap) - jerking (1-2 per sec) of outstretched hands, worse with wrists exteded, from loss of etensor tone (type of negative myoclonus caused by imbalance between flexors and extensors)

23
Q

What can cause asterixis?

A
  • Liver failure
  • Kidney failure
  • Hyponatraemia
  • Hypercapnia
  • Gabapentin
  • Thalamic stroke - if unilateral
24
Q

What are tardive syndromes caused by?

A

Irreversible tardive symptoms caused by chronic exposure to dopamine antagonists

25
Q

What are the different types of tardive syndromes?

A
  • Tardive dyskinesia
  • Tardive dystonia
  • Tardive akasthesia
  • Tardive myoclonus
  • Tardive tremor
  • Tardive tourettism
26
Q

What are features of tardive dyskinesia?

A

Orobuccolingual, trunal or choreiform movements:

  • Vacuous chewing
  • Lip smacking/pouting
  • Grimacing facial movements

https://www.youtube.com/watch?v=FUr8ltXh1Pc&t=19s

27
Q

What are features of tardive dystonia?

A

https://www.youtube.com/watch?v=M6haSEEuxZw

Sustained, sterotyped muscle spasms of a twisting or turning character e.g. retrocollis and back arching/opisthotonic posturing

28
Q

What is tardive akasthisia?

A

https://www.youtube.com/watch?v=-xiG4R7AWdc

Sense of restlessness or unease +/- repetative, puposeless movements (e.g. pacing)

29
Q

How would you treat tardive dyskinesia?

A

Gradually withdraw neuroleptics and wait 3-6 months

30
Q

What is the defintion of dystonia?

A

Prolonged muscle contraction causing abnormal posturing or repetitive movements

31
Q

What is a primary dystonia?

A

Where dystonia is the only/main clinical manifestation

32
Q

What is secondary dystonia?

A

Dystonia caused by a disease process e.g. brain injury, cerebral palsy or drugs,

wilson’s disease

33
Q

What is acute dystonia?

A

May occur on starting many drugs (including neuroepileptics and some antiemetics)

34
Q

What is torticollis?

A

https://www.youtube.com/watch?v=45bWI1xKemM

Dystonic spasms gradually develop in neck muscles causing the head to turn (torticollis) or to be drawn backwards (retrocollis). There may also be a jerky head tremor. A gentle touch with a finger tip at a specific site may relieve the spasm temporarily (sensory trick or ‘geste’).

35
Q

What is blephorospasm?

A

https://www.youtube.com/watch?v=hGesxOGNdfY

These consist of spasms of forced blinking or involuntary movement of the mouth and tongue (e.g. lip-smacking and protrusion of the tongue and jaw).

36
Q

What is writer’s cramp?

A

A specific inability to perform a previously highly developed repetitive skilled movement, e.g. writing. The movement provokes dystonic posturing. Other functions of the hand remain normal. Overuse may lead to task-specific dystonias in certain occupations, e.g. musicians, typists and even golfers.

37
Q

What are examples of focal dystonias?

A
  • Spasmodic torticollis
  • Writer’s cramp
  • Blepharospasm
38
Q

What are acute dystonic reactions?

A

Reactions which can occur on starting new medicaitons. Following features present:

  • Torticollis
  • Trismus
  • Oculogyric crisis
39
Q

What is trismus?

A

Oromandibular spasm

40
Q

What is oculogyric crisis?

A

Bilateral elevation of the visual gaze, but several other responses are associated with the crisis

41
Q

What drugs can cause acute dystonic reactions?

A
  • Antipsychotics
  • Antiemetics — e.g. metaclopramide, proclorperazine
  • Antidepressants and serotonin receptor agonists — e.g. SSRIs, buspirone, sumitriptan
  • Antibiotics — e.g. erythromycin
  • Antimalarials — e.g. chloroquine
  • Anticonvulsants — e.g. carbamazepine, vigabatrin
  • H2 receptor antagonists — e.g. ranitadine, cimetidine
  • Recreational drugs — e.g. cocaine
42
Q

How would you manage an acute dystonic reaction?

A

Anticholinergic

43
Q

What is huntington’s disease?

A

https://www.youtube.com/watch?v=IuSaXiRVqg0

A dominantly inherited neurodegenerative condition that produces progressive movement disorder and dementia

44
Q

What is the cause of huntington’s chorea?

A

Genetic mutation of huntington gene, with extra triplet repeates of glutamine - trinucleotide repeat expansion disease.

This produces an expanded polygluatmine protein.

The mutated protein aggregates in the caudate and putamen, which causes neuronal cell death. This stops inhibition of movements, leading to chorea and other movement disorders (loss of striatum GABA-nergic and cholinergic neurones).

45
Q

How is huntington’s disease inherited?

A

Autosomal dominant (chromosome 4)

46
Q

What is the relationship between number of repeat sequences in huntingtin gene and age of onset?

A

More repeats, earlier onset of disease

47
Q

What is the phenomenon of anticipation seen in huntington’s disease?

A

A tendency for successive generations to have earlier onset and more severe disease due to unstable CAG repeat expansion during meiosis (particularly when inherited from the father)

48
Q

What are the main features of huntington’s chorea?

A
  • Personality changes - erratic and argumentative behaviour
  • Movement disorder - chorea, athetosis (hyperkinesia)
  • Bizarre gait
  • Abnormal eye movements
  • Poor coordination
  • Dementia
  • Depression
49
Q

What neurotransmitters are affected in huntington’s chorea?

A
  • Decreased GABA
  • Decreased Acetylcholine
  • Increased Dopamine
50
Q

When does huntington’s typically present?

A

Usually in middle age

Gwen - Neurology (38 decks)

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