Headaches and General movement disorders

Question 1

What is the presentation of:

Akathisia

Answer 1

Restless and intense urge to move

Question 2

What is the presentation of:

Asterixis

Answer 2

Extension of wrists causes “flapping” motion

Question 3

What is the presentation of:

Athetosis

Answer 3

Slow, snake-like, writhing movements; especially seen in the fingers

Question 4

What is the presentation of:

Chorea

Answer 4

Sudden, jerky, purposeless movements

Question 5

What is the presentation of:

Dystonia

Answer 5

Sustained involuntary muscle contractions

Question 6

What is the presentation of:

Essential Tremor

Answer 6

High-frequency tremor with sustained posture (eg. outstreched arms) worsened with movement or when anxious

Question 7

What is the presentation of:

Hemiballismus

Answer 7

Sudden, wild flailing of 1 arm +/- ipsilateral leg

Question 8

What is the presentation of:

Intention tremor

Answer 8

Slow zigzag motion when pointing/extending toward a target

Question 9

What is the presentation of:

Myoclonus

Answer 9

sudden brief uncontrolled muscle contraction

Question 10

What is the presentation of:

Resting Tremor

Answer 10

Uncontrolled movement of distal appendages (most noticable in hands); tremor alleviated by intentional movement

Question 11

What is the presentation of:

Restless leg syndrome

Answer 11

Worse at rest/nighttime

Question 12

A lesion of the basal ganglia would give you what type of movement disorders?

Answer 12

Athetosis

Chorea

Question 13

in what conditions would you see akathisia

Answer 13

Can be seen with neuroleptic use or as a side effect of parkinson treatment

Question 14

In what conditions would you see asterixis

Answer 14

Hepatic encephalopathy
Wilsons disease
Other metabolic derangements

Question 15

In what conditions would you se Chorea

Answer 15

Huntingtons disease

Acute rheumatic fever

Question 16

What are conditions associated with dystonia

Answer 16

Writers cramp
Blepharospasm: (closure of eyelids)
Torticollis: abnormal head or neck contract

Question 17

What conditions are associated with Essential tremmor

Answer 17

Usually a familial condition

Question 18

How would familial essential tremor present and how would you treat it

Answer 18

Pts usually self medicate with alcohol to dec tremor amplitude
Treat with nonselective beta blockers (propranolol) or primidone

Question 19

In what conditions is myoclonus common

Answer 19

metabolic abnormalities such as renal and liver failure

Question 20

What conditions are associated with resting tremor

Answer 20

Parkinsons (pill rolling tremor)

Question 21

What conditions are associated with RLS and how would you treat it

Answer 21

associated with iron deficiency and CKD

Treat with dopamine agonists (pramipexole or ropinirole)

Question 22

What lesion would cause:

Hemiballismus

Answer 22

Contralateral subthalamic nucleus (lacunar stroke)

Question 23

What lesion would cause:

Intention tremor

Answer 23

Cerebellar dysfunction

Question 24

What lesion would cause:

Resting tremor

Answer 24

Substantia nigra (parkinsons)

Question 25

What is the duration of: | Cluster Headache

Answer 25

15min - 3 hours; repetitive

Question 26

Describe the presentation of: | Cluster Headache

Answer 26

``` Unilateral Awful Periorbital pain W/ Lacrimation and rhinorrhea May present with Horner syndrome (more common in males) ```

Question 27

What is the treatment for: | Cluster Headache

Answer 27

Acute: sumatriptan and 100% o2 Proph: Verapamil

Question 28

What is the duration of: | Tension Headache

Answer 28

> 30 min (typically 4-6 hours); constant

Question 29

Describe the presentation of: | Tension Headache

Answer 29

BILATERAL Steady "Band like" pain No Photophobia, phonophobia, or aura

Question 30

What is the treatment for: | Tension Headache

Answer 30

Analgesics, NSAIDs, Acetaminophen | Amitriptyline for chronic pain

Question 31

What is the duration of: | Migraine Headache

Answer 31

4-72 hours

Question 32

Describe the presentation of: | Migraine Headache

Answer 32

``` Unilateral Pulsating pain Nausea, photophobia, or phonophobia May present with "aura" (due to irritation of CN V, meninges, or bv: release of substance P, calcitonin gene related peptide, and vasoactive peptides) ```

Question 33

What is the treatment for: | Migraine Headache

Answer 33

Acute: NSAIDs, triptans, dihydroergotamine Proph: lifestyle changes, b blockers, amitriptyline, topiramate, valproate

Question 34

What is the duration of: | Trigeminal Neuralgia

Answer 34

seconds to minutes (episodes generally increase in intensity and frequency over time)

Question 35

Describe the presentation of: | Trigeminal Neuralgia

Answer 35

Unilateral repetitive shooting pain in the distribution of CN V triggered by chewing, talking, or touching certian parts of the face

Question 36

What is the treatment for: | Trigeminal Neuralgia

Answer 36

Carbamazepine

Question 37

Other then the listed headaches, what other things should be considered with "worst headache of my life presentation"

Answer 37

``` Subarachnoid hemorrhage Meningitis Hydrocephalus Neoplasia Giant Cell (temporal) arteritis ```