Hyperkinetic Movement Disorders Flashcards
ex seen in cerebral palsy
dystonai
myoclonus
tics
slow writingcontinuous and involuntary movements
athetosis
tremor
chorea
Ballism
A rest tremor is virtually synonymous with ___, whereas an intention (___) tremor often indicates a ____ lesion
Intention tremors are involuntary, rhythmic muscle contractions (oscillations) that occur during a purposeful, ___ movement. The oscillations’ amplitude typically worsens as the movement proceeds, meaning that the tremor increases in intensity upon reaching a target.Think parkinsonism
Postural tremor occurs when a person maintains a position against ___, such as holding the arms outstretched. –> Think __ tremor
Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
Think __ lesion
A rest tremor is virtually synonymous with parkinsonism, whereas an intention (kinetic) tremor often indicates a cerebellar lesion
Intention tremors are involuntary, rhythmic muscle contractions (oscillations) that occur during a purposeful, voluntary movement. The oscillations’ amplitude typically worsens as the movement proceeds, meaning that the tremor increases in intensity upon reaching a target.
Think parkinsonism
Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched. Think essential tremor
Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
Think cerebellar lesion
diagnostic criteria for tourettes syndrome
Tourette’s Syndrome
Two or more motor tics AND at least one vocal tic (do not need to occur at the same time)
Have had tics for at least a year
Begins before 18 years of age
Not due to medication, drugs or another medical condition
Symptomatic treatment of Tics
Treat the comorbidities (ADHD, Anxiety, depression, migraine)
Cognitive behavioural therapy
ALpha 2 agonists
Antipsychotics
Clonazepam
Tetrabenazine
Botulinum toxin
Deep brain stimulation
key movement features of chorea
Irregular, purposeless, nonrhythmic, abrupt, rapid, unsustained movements.– more smooth than myoclonus
Involuntary movements, especially with lip pursing and eyebrow raising.
Flow from one body part to another
Characteristically unpredictable.
Huntingtons is a prototypical example, but there are many autoimmune and drug related causes of generalized chorea
what neoplasias are assocaited with chorea?
- small cell ung carcinoma and thumoma (collapsin repsonse mediator protein (CRMP5, Hu, Yo)
NR1 ovarian tumor
Huntington’s Chorea
Etiology: autosomal dominant ___ repeats (with anticipation) in Huntington’s gene on Chromosome ___.
Most common cause of hereditary neurodegenerative ___ syndrome.
Mechanism: defective ___ in neurons
Epi: onset 35-44yo, varies with degree of ___
Symptoms: insidious onset of clumsiness, fidgetiness, irritability that progresses over 15yr to major NCD, psychosis and chorea.
- Movement: __ (eyebrows, forehead, pursing of lips) → __→ dystonia + rigidity
- Mood: irritability, depression, anhedonia, impulsivity, violence Investigations:
- MRI: enlarged ventricles, atrophy of cerebral cortex + caudate nucleus
- Genetics: Huntington gene expansion of __
Management: no disease altering treatment, anti-___/___ (for psych); __ + __ (chorea), ___ toxin (dystonia)
Huntington’s Chorea
Etiology: autosomal dominant CAG repeats (with anticipation) in Huntington’s gene on Chromosome 4.
Most common cause of hereditary neurodegenerative choreic syndrome.
Mechanism: defective protein in neurons
Epi: onset 35-44yo, varies with degree of anticipation
Symptoms: insidious onset of clumsiness, fidgetiness, irritability that progresses over 15yr to major NCD, psychosis and chorea.
- Movement: chorea (eyebrows, forehead, pursing of lips) → ballism→ dystonia + rigidity
- Mood: irritability, depression, anhedonia, impulsivity, violence Investigations:
- MRI: enlarged ventricles, atrophy of cerebral cortex + caudate nucleus
- Genetics: Huntington gene expansion of CAG
Management: no disease altering treatment, anti-depressant/psychotics (for psych); neuroleptics + benzo (chorea), botulinum toxin (dystonia)
Sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures or both. Typically patterned, affecting always the same muscles
dystonia
Symptomatic Treatment of Dystonia
Anticholinergics, levodopa (selected cases), baclofen, muscle relaxants
Botulinum toxin injections
Pallidal Deep Brain Stimulation
Myokymia
Fine quivering or rippling of muscles
Most commonly occurs in facial muscles
Can happen if you drink too much coffee or if youre too fatigued. (ex/ “my eye is twitching, i need to go to bed)
Can be associated with brainstem gliomas though
If the myokymia is not episodic (ie its repetitive or continuous), you should rule out structural causes/more sinister causes
