Extrapyramidal diseases Flashcards
How do we recognize Parkinson’s disease?
Asymmetric movement disorder
Akinesia
Rest tremor
Rididity
Postural instability
Esencial tremor. Differential diagnosis with Parkinson
Symmetric upper limb tremor
Action and positional (not at rest)
No other parkinsonian signs
Dyskinesia
Tremor
Dystonia
Chorea
Tics
Myoclonus
Asymmetric atrophy of the parietal lobe on head MRI
Corticobasal degeneration
How do we treat a young patient with signs of moderate Parkinson’s disease
Dopamine agonist
How to treat Parkinsonism
L-dopa
Anticholinergics
Amantadine
Deep brain stimulation
MAO inhibitors
Dopamine agonists
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
Clozapine, because it has least extrapyramidal effects
Type of gaze palsy expected in Steel-Richardson-Olszewski syndrome
Vertical gaze palsy
Basis of symptomatic treatment for Parkinson’s disease is based on deprivation
Dopamine
In Parkinsonism an excess of ___ is found in the striatum
acetylcholine
Dopamine what stimulates and inhibits
Dopamine stimulates the direct pathway via D1 receptors and inhibits the indirect pathway via D2 receptors, inhibiting cholinergic neurons in the putamen
Motor dysfunction of the basal ganglia due to dopamine deficiency in the striatum manifests as
Akinetic-rigid syndrome
After long-term dopamine deficiency
Hypersensitivity of striata neurons
Depletion of dopaminergic cells in the nucleus reduces dopamine levels in
Striatum
Uncoordinated movements of the tongue and lips (dyskinesias) are characteristic of
Tardive dyskinesia due to neuroleptics
Essential tremor therapy
Propanolol
Treatment of Huntington’s chorea
Haloperidol
Is myoclonus common in Creuzfeldt-Jacob disease
Yes
The most effective treatment for focal dystonias is
botulinum
Treatment of dystonias
Focal dystonias: botulinum
Levodopa
Anticholinergics
Stereotactic brain surgery
Deep core stimulation
Young patient with Wilson’s disease clinical
Dystonia
Parkinsonism
Dysarthria
Tremor
DYT1 dystonia
Starts in childhood, affects the lower limb first and then generalizes
AD inherited. DYT1 is the gene that encodes the protein torsion A.
Tremor in Wilson disease is
Fluttering
Dyskinesias are the result of
Elevated levodopa concentrations in plasma
Progressive supranuclear palsy name
Steel-Richardson-Olszewski syndrome
Fall back in
Progressive supranuclear palsy
38 years old. Right hand trembles at rest. Bradykinetic without rigidity incipient Parkinson’s disease. Treatment
Anticholinergics
78 years old. Long-standing Parkinsons’s disease and severe motor complications. Treatment
Stimulation of the subthalamic nucleus
Myoclonus and cortical sensitivity disturbances are expected in
Corticobasal degeneration
Corticobasal degeneration
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
Corticobasal degeneration MRI
Asymmetric atrophy of the parietal lobe
Dystonia in a child who later develops idiopathic torsion dystonia sill start at
Legs