Gait, Tremor, Dystonia, Chorea Flashcards
what causes a pyramidal gait
an UMN lesion
what is a pyramidal gait
upper limb is held in flexion
ankle joint is relatively extended
toes strike the ground whilst walking
how do people often compensate for a pyramidal gait
by swinging the leg outwards at the hip
when does foot drop occur
when there is a LMN lesion affecting the lower limb
what is affected in foot drop that leads to the abnormal gait
weakness of ankle dorsiflexion
what can be heard with a foot drop gait
slapping noise as the foot hits the ground
what causes a myopathic gait and why
proximal muscle weakness
- in muscle disease, hip movements not fixed and trunk movements are exaggerated
what is a myopathic gait also called
rolling or waddling gait
what can cause an ataxic gait
lesion in the cerebellum, vestibular apparatus, or peripheral nerves
how do patients walk when the lesion is in the cerebellum
ataxic gait similar to walking when drunk
how do patients walk when the lesion is in the vestibular apparatus
similar to cerebellum but have associated vertigo which distinguishes them
what can you ask a patient to do to distinguish if there is a lesion in the vermis of the cerebellum
ask patient to walk heel-to-toe
if there is a lesion in the vermis they are unable to do this
what in relation to MSK, can also cause an ataxic gait
dysfunction in proprioception
what are the features of an apraxic gait
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
what are the features of an extra-prymamidal gait
- difficulty initiating walking
- difficulty controlling pace
- may get “stuck”; called freezing
- shuffling
- have difficulty stopping
what is meant by a “festinant gait” seen in extra-prymidal dysfunction
initial stuttering steps that quickly increase in frequency while decreasing in length
what type of tremor is seen in Parkinson’s disease and what are features of it
rest tremor
- characteristically ‘pill-rolling’
- usually presents asymmetrical
what is a physiological tremor
- most common type of action tremor
- occurs at 8-12 Hz
- common in normal subjects
how is an essential tremor different than a physiological
- it is slower and can be quite disabling
- often inherited
what is used to treat an essential tremor
Beta Blockers e.g. propranolol
what characterises an intention tremor and when does it typically occur
- repetitive up and down movements at the end of a movement
- occurs is cerebellar disease
what condition can cause a severe intention tremor
MS
what causes a flapping tremor
metabolic disturbances
e.g. liver flap
what is chorea
brief irregular purposeless movements which flit and flow from one body part to another
how does chorea in the face present and what does this suggest
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
what is dystonia
sustained involuntary contraction that causes abnormal posture or movement
what is myoclonus
brief, isolated, random, non-purposeful jerks of muscle groups in the limb
how does myoclonus compare to chorea
chorea - much smoother movements, ‘dance-like’
myoclonus - brief, explosive, like they have just received an electric shock
what are examples of hyperkinetic movement disorders
tremor tics chorea myoclonus dystonia
what is a postural tremor
when a person holds a body part against gravity and a tremor develops
what is a dystonic tremor
tremor produced by dystonic muscle contraction
associated with dystonia
can occur at rest, sustain posture and in voluntary movement
what is dystonia
involuntary sustained muscle contraction
leading to twisting/repetitive movement and abnormal posture of the affected body part
what is first line treatment for dystonic tremor
Propanolol
Primidone
how can types of dystonia be categorised
primary - born with it
secondary - caused by a pathology e.g. stroke, Parkinsons
what is DYT1
torsion dystonia
autosomal dominant
what are the features of DYT1
starts before 28y/o normally childhood
starts in limbs (usually legs)
progress to become generalised
what is a possibly Tx for dystonia
botox
what is the next line if botox does not work in dystonia
surgery
- can lead to improvement in pain and function
what are common causes of chorea
Huntington's Disease SLE Parkinson's Disease Wilson's disease Anti-phospholipid syndrome
how should a patient with chorea be examined
at rest
with arms outstretched
while walking
what is the genetics of huntington’s disease
CAG triplet-repeat expansion disorder affecting the huntingtin gene on chromosome 4
what are Kayser-Fleischer rings
dark rings that appear to encircle the iris of the eye
seen in Wilson’s disease
what is a syndrome that can cause a primary tic
Gilles de la Tourette’s syndrome
what are conditions that can cause secondary tics
Huntingtons Wilsons Disease Down Syndrome Fragile X syndrome Autism
what is the diagnosis criteria for Tourette syndrome
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
Tx for Tourettes Syndrome
clonidine, tetrabenazine
cognitive behavioural therapy
what is the definition of myoclonus
brief electric shock like jerks
what are normal and common forms of myoclonus
Hiccups or hypnic jerks (when falling asleep)
what causes a myoclonus
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.
what is negative myoclonus
temporary cessation of muscle activity
e.g. liver flap in liver failure
what are the causes of myoclonus WITH encephalopathy
liver failure renal failure drug intoxication (alcohol, lithium) toxins (lead) post hypoxia
what are the causes of myoclonus WITHOUT encephalopathy WITH dementia
AD
Dementia with lewy bodies
Creutzfeldt-Jakob disease
what is juvenile myoclonus epilepsy
onset in teen years of myoclonic jerks and generalised seizures
what are features of juvenile myoclonus epilepsy
Sx worse in the morning
EEG shows characteristic 3-5Hz polyspike and wave pattern
what EEG is characteristic of juvenile myoclonus epilepsy
3-Hz polyspike and wave pattern
Tx for juvenile myoclonus epilepsy
Sodium valproate and levetiracetam
