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Neuro > Extrapyramidal diseases > Flashcards

Extrapyramidal diseases Flashcards

1
Q

How do we recognize Parkinson’s disease?

A

Asymmetric movement disorder
Akinesia
Rest tremor
Rididity
Postural instability

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2
Q

Esencial tremor. Differential diagnosis with Parkinson

A

Symmetric upper limb tremor
Action and positional (not at rest)
No other parkinsonian signs

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3
Q

Dyskinesia

A

Tremor
Dystonia
Chorea
Tics
Myoclonus

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4
Q

Asymmetric atrophy of the parietal lobe on head MRI

A

Corticobasal degeneration

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5
Q

How do we treat a young patient with signs of moderate Parkinson’s disease

A

Dopamine agonist

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6
Q

How to treat Parkinsonism

A

L-dopa
Anticholinergics
Amantadine
Deep brain stimulation
MAO inhibitors
Dopamine agonists

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7
Q

68 years old with Parkinson’s disease who is motor regulated, presents symptoms of psychosis. Adjustment of dopaminergic has not improved the condition. Which neuroleptic would you use

A

Clozapine, because it has least extrapyramidal effects

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8
Q

Type of gaze palsy expected in Steel-Richardson-Olszewski syndrome

A

Vertical gaze palsy

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9
Q

Basis of symptomatic treatment for Parkinson’s disease is based on deprivation

A

Dopamine

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10
Q

In Parkinsonism an excess of ___ is found in the striatum

A

acetylcholine

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11
Q

Dopamine what stimulates and inhibits

A

Dopamine stimulates the direct pathway via D1 receptors and inhibits the indirect pathway via D2 receptors, inhibiting cholinergic neurons in the putamen

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12
Q

Motor dysfunction of the basal ganglia due to dopamine deficiency in the striatum manifests as

A

Akinetic-rigid syndrome

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13
Q

After long-term dopamine deficiency

A

Hypersensitivity of striata neurons

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14
Q

Depletion of dopaminergic cells in the nucleus reduces dopamine levels in

A

Striatum

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15
Q

Uncoordinated movements of the tongue and lips (dyskinesias) are characteristic of

A

Tardive dyskinesia due to neuroleptics

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16
Q

Essential tremor therapy

A

Propanolol

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17
Q

Treatment of Huntington’s chorea

A

Haloperidol

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18
Q

Is myoclonus common in Creuzfeldt-Jacob disease

A

Yes

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19
Q

The most effective treatment for focal dystonias is

A

botulinum

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20
Q

Treatment of dystonias

A

Focal dystonias: botulinum
Levodopa
Anticholinergics
Stereotactic brain surgery
Deep core stimulation

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21
Q

Young patient with Wilson’s disease clinical

A

Dystonia
Parkinsonism
Dysarthria
Tremor

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22
Q

DYT1 dystonia

A

Starts in childhood, affects the lower limb first and then generalizes
AD inherited. DYT1 is the gene that encodes the protein torsion A.

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23
Q

Tremor in Wilson disease is

A

Fluttering

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24
Q

Dyskinesias are the result of

A

Elevated levodopa concentrations in plasma

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25
Q

Progressive supranuclear palsy name

A

Steel-Richardson-Olszewski syndrome

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26
Q

Fall back in

A

Progressive supranuclear palsy

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27
Q

38 years old. Right hand trembles at rest. Bradykinetic without rigidity incipient Parkinson’s disease. Treatment

A

Anticholinergics

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28
Q

78 years old. Long-standing Parkinsons’s disease and severe motor complications. Treatment

A

Stimulation of the subthalamic nucleus

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29
Q

Myoclonus and cortical sensitivity disturbances are expected in

A

Corticobasal degeneration

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30
Q

Corticobasal degeneration

A

rare sporadic cause of adult-onset Parkinsonism. movement disorder.
Unilateral upper limb fixed dystonia, akinesia, rigidity, myoclonus, apraxia, cortical sensory loss.
Later, dementia and supranuclear gaze problem

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31
Q

Corticobasal degeneration MRI

A

Asymmetric atrophy of the parietal lobe

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32
Q

Dystonia in a child who later develops idiopathic torsion dystonia sill start at

A

Legs

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33
Q

Young patient with signs of moderate Parkinson’s disease drug

A

Dopamine agonist

34
Q

In Parkinson’s disease what happens in the striatum

A

Increased acetylcholine tone in the striatum

35
Q

Hemibalism in hyperglycemia?

36
Q

Hemibalism in hypoglycemia?

37
Q

Hemibalism in hypokalemia?

38
Q

Hemibalism in hyperkalemia?

39
Q

Hemibalism in hypernatremia?

40
Q

Treatment of focal dystonias

A

Botulinum injections

41
Q

55 years old with apparent Parkinson. Treatment

A

Dopamine agonists

42
Q

Pathology in Parkinson is in

A

substancia nigra pars compacta

43
Q

MRI Huntington’s disease

A

Enlargement of the lateral ventricle

44
Q

Essential tremor treatment

A

Primidone
Deep brain stimulation of thalamus
Propanolol
Benzodiazepines

45
Q

Levodopa enters the central nervous system by

46
Q

In Parkinson, the dopaminergic-cholinergic imbalance in the striatum is causes by

A

increased released (liberación) of acetylcholine from cholinergic interneurons due to dopamine deficiency in the striatum

47
Q

Wilson’s diseases caused by a defect in

A

ceruloplasmin function

48
Q

Huntington’s disease type of disease

A

An autosomal dominant disorder caused by a mutation in the Huntington gene on chromosome 4

49
Q

Diagnostic procedures for Parkinson’s disease from the most important to the least important

A

Clinical presentation, levodopa test, MRI

50
Q

Therapeutic options for blepharospasm from those to be tried first to those to be tried last

A

Botulinum toxin injection, pharmacological treatment, surgery

51
Q

Which motor effects which are side effects of L-dopa treatment

A

Dystonias
Chorea form movements
motor fluctuations

52
Q

How does Levodopa work

A

precursor of dopamine

53
Q

L-dopa uptake % into the brain without dopa carboxylase inhibitors is

54
Q

Substance located in striatum is

55
Q

Amantadine

A

Increases the release of endogenous dopamine

56
Q

Can cause neuroleptic malignant syndrome

A

Abrupt cessation of dopamine agonist

57
Q

Apomorphine claims

A

postsynaptic dopamine receptor agonist

58
Q

Wilson’s disease what type of disease

A

Inheriting. autosomal recessive

59
Q

Wilson’s disease. Clinical

A

Dystonia, Parkinson, dysarthria, tremor
B12 deficiency, uremia, hepatic
Keyser-Fleisher ring
Basal ganglia damage (more the putamen)

60
Q

MSA (atrofia multisistémica) Clinical

A

Parkinsonism, ataxia, urinary incontinence, paraparesis

61
Q

Defect in the dopamine pathway in multiple system atrophy (MSA) is in

A

Pre and postsynaptic

62
Q

Treatment of chromatic joints in Huntington’s disease

A

Haloperidol

63
Q

How do we distinguish Parkinsonism plus from Parkinson’s disease

A

Levodopa test

64
Q

Focal dystonias. Clinical

A

Spastic torticolis
Blefarospasm
Meigs syndrome
L-dopa-responsive dystonia

65
Q

Wilson’s disease type of illness

A

Extrapyramidal, inherited. Chromosome 13

66
Q

Defect basal ganglia-thalamus-cortex pathway. Which impairment in Parkinson’s disease

67
Q

Parkinson’s disease is caused by presynaptic or postsynaptic

A

Presynaptic

68
Q

Premotor symptoms in Parkinson

A

Decreased sense of smell, depression, night-time sleep disturbances, mood and gastrointestinal problems

69
Q

How to treat chromatic dyskinesias after levodopa

A

Taking lower doses of levodopa more often

70
Q

Treatment for painful leg dystonia that occurs in the early morning after several years of Levodopa treatment

A

Botulinum injections into the affected muscle

71
Q

Gene mutation associated with the onset of early Parkinson’s disease

A

alfa-synuclein

72
Q

Progressive supranuclear palsy is

A

pre and postsynaptic impairment of dopaminergic synapses

73
Q

System excised in Parkinson’s disease

A

Glutaminergic

74
Q

Parkinsonism plus response to dopamine agoinst

A

Respond poorly to treatment with dopamine agonists

75
Q

Glial inclusions stained for alfa-synuclein is found in

A

Multiple system atrophy

76
Q

Sensory trick

A

physical genture or posotion that a patient with dystonia can adopt to relieves or eliminates dystonic symtoms

77
Q

How to worsen Parkinson

A

Inhibition of the nigrostrial pathway

78
Q

Wilson’s disease treatment

A

Penicillamine

79
Q

Test in a young patient with Parkinsonism

A

Measure copper in urine

Neuro (30 decks)

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