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Neurology SB > Gait, Tremor, Dystonia, Chorea > Flashcards

Gait, Tremor, Dystonia, Chorea Flashcards

1
Q

what causes a pyramidal gait

A

an UMN lesion

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2
Q

what is a pyramidal gait

A

upper limb is held in flexion
ankle joint is relatively extended
toes strike the ground whilst walking

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3
Q

how do people often compensate for a pyramidal gait

A

by swinging the leg outwards at the hip

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4
Q

when does foot drop occur

A

when there is a LMN lesion affecting the lower limb

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5
Q

what is affected in foot drop that leads to the abnormal gait

A

weakness of ankle dorsiflexion

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6
Q

what can be heard with a foot drop gait

A

slapping noise as the foot hits the ground

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7
Q

what causes a myopathic gait and why

A

proximal muscle weakness

- in muscle disease, hip movements not fixed and trunk movements are exaggerated

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8
Q

what is a myopathic gait also called

A

rolling or waddling gait

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9
Q

what can cause an ataxic gait

A

lesion in the cerebellum, vestibular apparatus, or peripheral nerves

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10
Q

how do patients walk when the lesion is in the cerebellum

A

ataxic gait similar to walking when drunk

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11
Q

how do patients walk when the lesion is in the vestibular apparatus

A

similar to cerebellum but have associated vertigo which distinguishes them

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12
Q

what can you ask a patient to do to distinguish if there is a lesion in the vermis of the cerebellum

A

ask patient to walk heel-to-toe

if there is a lesion in the vermis they are unable to do this

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13
Q

what in relation to MSK, can also cause an ataxic gait

A

dysfunction in proprioception

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14
Q

what are the features of an apraxic gait

A

when there is normal power in the legs, no cerebellar ataxia and no proprioception loss
but the patient still cannot formulate the motor act of walking

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15
Q

what are the features of an extra-prymamidal gait

A
  • difficulty initiating walking
  • difficulty controlling pace
  • may get “stuck”; called freezing
  • shuffling
  • have difficulty stopping
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16
Q

what is meant by a “festinant gait” seen in extra-prymidal dysfunction

A

initial stuttering steps that quickly increase in frequency while decreasing in length

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17
Q

what type of tremor is seen in Parkinson’s disease and what are features of it

A

rest tremor

  • characteristically ‘pill-rolling’
  • usually presents asymmetrical
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18
Q

what is a physiological tremor

A
  • most common type of action tremor
  • occurs at 8-12 Hz
  • common in normal subjects
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19
Q

how is an essential tremor different than a physiological

A
  • it is slower and can be quite disabling

- often inherited

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20
Q

what is used to treat an essential tremor

A

Beta Blockers e.g. propranolol

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21
Q

what characterises an intention tremor and when does it typically occur

A
  • repetitive up and down movements at the end of a movement

- occurs is cerebellar disease

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22
Q

what condition can cause a severe intention tremor

A

MS

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23
Q

what causes a flapping tremor

A

metabolic disturbances

e.g. liver flap

24
Q

what is chorea

A

brief irregular purposeless movements which flit and flow from one body part to another

25
Q

how does chorea in the face present and what does this suggest

A

grimacing
- suggest disease in the caudate nucleus (e.g. Huntington’s disease) OR excessive activity in the stratum due to dopaminergic drugs used to treat parkinson

26
Q

what is dystonia

A

sustained involuntary contraction that causes abnormal posture or movement

27
Q

what is myoclonus

A

brief, isolated, random, non-purposeful jerks of muscle groups in the limb

28
Q

how does myoclonus compare to chorea

A

chorea - much smoother movements, ‘dance-like’

myoclonus - brief, explosive, like they have just received an electric shock

29
Q

what are examples of hyperkinetic movement disorders

A 
tremor
tics
chorea
myoclonus 
dystonia
30
Q

what is a postural tremor

A

when a person holds a body part against gravity and a tremor develops

31
Q

what is a dystonic tremor

A

tremor produced by dystonic muscle contraction
associated with dystonia
can occur at rest, sustain posture and in voluntary movement

32
Q

what is dystonia

A

involuntary sustained muscle contraction

leading to twisting/repetitive movement and abnormal posture of the affected body part

33
Q

what is first line treatment for dystonic tremor

A

Propanolol

Primidone

34
Q

how can types of dystonia be categorised

A

primary - born with it

secondary - caused by a pathology e.g. stroke, Parkinsons

35
Q

what is DYT1

A

torsion dystonia

autosomal dominant

36
Q

what are the features of DYT1

A

starts before 28y/o normally childhood
starts in limbs (usually legs)
progress to become generalised

37
Q

what is a possibly Tx for dystonia

A

botox

38
Q

what is the next line if botox does not work in dystonia

A

surgery

- can lead to improvement in pain and function

39
Q

what are common causes of chorea

A 
Huntington's Disease
SLE
Parkinson's Disease
Wilson's disease
Anti-phospholipid syndrome
40
Q

how should a patient with chorea be examined

A

at rest
with arms outstretched
while walking

41
Q

what is the genetics of huntington’s disease

A

CAG triplet-repeat expansion disorder affecting the huntingtin gene on chromosome 4

42
Q

what are Kayser-Fleischer rings

A

dark rings that appear to encircle the iris of the eye

seen in Wilson’s disease

43
Q

what is a syndrome that can cause a primary tic

A

Gilles de la Tourette’s syndrome

44
Q

what are conditions that can cause secondary tics

A 
Huntingtons
Wilsons Disease
Down Syndrome
Fragile X syndrome
Autism
45
Q

what is the diagnosis criteria for Tourette syndrome

A

Both multiple motor tics and one or more vocal tics must be present

The tics must occur many times a day, nearly every day, or intermittently for more than 1 year with no longer than 3 months interval of tic-freeness

Age of onset < 18

Exclusion of obvious secondary causes

46
Q

Tx for Tourettes Syndrome

A

clonidine, tetrabenazine

cognitive behavioural therapy

47
Q

what is the definition of myoclonus

A

brief electric shock like jerks

48
Q

what are normal and common forms of myoclonus

A

Hiccups or hypnic jerks (when falling asleep)

49
Q

what causes a myoclonus

A

brief activation of a group of muscles leading to a jerk of the affected body part. This activation can arise from the cortex, subcortical structures, spinal cord, or nerve root and plexus.

50
Q

what is negative myoclonus

A

temporary cessation of muscle activity

e.g. liver flap in liver failure

51
Q

what are the causes of myoclonus WITH encephalopathy

A 
liver failure
renal failure
drug intoxication (alcohol, lithium)
toxins (lead)
post hypoxia
52
Q

what are the causes of myoclonus WITHOUT encephalopathy WITH dementia

A

AD
Dementia with lewy bodies
Creutzfeldt-Jakob disease

53
Q

what is juvenile myoclonus epilepsy

A

onset in teen years of myoclonic jerks and generalised seizures

54
Q

what are features of juvenile myoclonus epilepsy

A

Sx worse in the morning

EEG shows characteristic 3-5Hz polyspike and wave pattern

55
Q

what EEG is characteristic of juvenile myoclonus epilepsy

A

3-Hz polyspike and wave pattern

56
Q

Tx for juvenile myoclonus epilepsy

A

Sodium valproate and levetiracetam

Neurology SB (23 decks)

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