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RB Y3 1.2 Neurology > Hyperkinetic Movement Disorders > Flashcards

Hyperkinetic Movement Disorders Flashcards

1
Q

what type of tremor does Parkinsons’s cause, and is it uni or bilateral

A

resting - pill rolling

often unilateral at first, progressing to bilateral

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2
Q

what are tremors classified by

A

position, distribution, frequency, amplitude

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3
Q

what can you ask the pt to draw to examine a tremor

A

write or draw a spiral

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4
Q

what blood tests should be done when diagnosing tremor

A

thyroid function, copper and ceruloplasmin conc (Wilsons)

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5
Q

what is the most common cause of a cerebellar pathway tremor (intention)

A

multiple sclerosis

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6
Q

what is Wilsons disease

A

genetic defect (AuR) resulting in loss of ceruloplasmin, which normally binds copper. Leads to accumulation of excess copper

  • tremor, CNS signs, mood, movement, Kayler-Fleischer rings, liver disease
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7
Q

management of Wilsons

A

life long copper chelating drugs - penicillamine

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8
Q

a cerebellar tremor is typically slow/fast and high/low amplitude

A

slow and high of extremities

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9
Q

what test can be done for intentino tremor

A

finger to nose test

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10
Q

what are the most common causes of cerebellar tremor (intention and holmes)

A

MS, stroke or trauma, chronic alcoholism can damage cerebellum

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11
Q

when is a holmes tremor present

A

rest, intention and postural

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12
Q

cause of essential tremor, and at what age does it present

A

prevalence increases with age

can be inherited in autosomal dominant fashion

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13
Q

which body part does essential tremor affect

A

upper extremities

can involve voice, palate, head and jaw - quivering sound to voice

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14
Q

when is essential tremor present

A

posture and action eg when holding a glass

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15
Q

does essential tremor usually cause signficant impairement

A

is usually mild and stable for years, it does slowly progress but rarely causes severe disability - does impair ADL

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16
Q

what exacerbates and relieves essential tremor

A

exacerbated - anxiety, sympathomimetics (eg salbutamol)

made better by small amounts of alcohol

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17
Q

is there good treatment for essential tremor?

A

not really, often unecessary and unsatisfactory

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18
Q

what pharmacological agents are used in teh management of essential tremor

A

propanolol and primidone

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19
Q

what is the class and action of primidone

A

agonist of GABA A

anticonvulsant of barbiturate class

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20
Q

how does the pt feel if they try to suppress tics?

A

anxious and uncomfortable, when allowed to relax they will respond with a flurry of tics

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21
Q

what sort of things make tics worse

A

excitement, stress, anxiety

decrease with distraction

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22
Q

when do tics usually develop

A

childhood, adult onset is rare

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23
Q

what is a common first tic

A

blinking

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24
Q

where do tics usually start

A

in head and face

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25
Q

give some examples of simple tics

A

sniffing, coughing, throat clearing, snorting

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26
Q

give some examples of complex vocal tics

A

barking, making of animal noises, inappropriate voice intonations and uttering strings of words.

27
Q

what is copropraxia and coprolalia

A

production of obscene gesture and words

28
Q

echopraxia and echolalia

A

copying movements/words of others

29
Q

what is palilalia

A

repetition of same phrase, word or syllable

30
Q

which psychiatric disorders are commonly seen alongside tics

A

90% psychiatric co morbidity - ADHD and OCD common

31
Q

what time frame distinguishes between simple transient and chronic tics of childhood

A

1 year

32
Q

what type of tics must be present in Tourettes?

A

multiple motor and at least one vocal

33
Q

what is the most common cause of tics

A

Tourettes

34
Q

criteria for Tourettes diagnosis

A

tics occur many times a day, nearly every day/intermittent for more than 1 year

no longer than 3 months w/out tics

35
Q

is Tourettes more common in M or F

A

males

36
Q

when must onset be for a diagnosis of Tourettes

A

<18 (mean age of 6), adult onset Tourettism is a separate diagnosis

37
Q

what is the first line psychotherapy for Tourettes

A

habit reversal training

38
Q

what medication is considered the best option for tic control in Tourettes

A

risperidone

39
Q

what medication is used for co existing ADHD and Tourettes

A

clonidine

40
Q

describe chorea

A

Continuous, spontaneous jerky movements, irregularly timed and randomly distributed.

Brief irregular purposeless movements which flit and flow from one body part to another, pt appears constantly restless or fidgety

41
Q

what are the 2 main types of chorea

A

Huntingtons and Syndenhams

42
Q

what is syndenhams chorea caused by

A

rheumatic fever

43
Q

who gets syndenhams chorea

A

children (5-15), mainly girls, rare now in developed countries

44
Q

what other features os sydnenhams chorea associated with

A

behavioural disturbance and OC symptoms

45
Q

management and prognosis of syndenhams chorea

A

self limiting and usually resolves within 6 months

46
Q

what causes myoclonus

A

brief activation of group of muscles - body part jerks

47
Q

what is negative myoclonus

A

muscle jerks resulting from a brief cessation of muscle activity, eg liver flap in those with liver failure

48
Q

physiological myoclonus

A

common and nonpathological feature - nocturnal myclonus is sudden jerk (with a feeling of falling) when dropping off to sleep or waking up

49
Q

what is dystonia

A

an involuntary muscle spasm which leads to a sustained abnormal posture of the affected body part

50
Q

what are the muscles doing to cause dystonia

A

co contraction of agonist and antagonist muscle

51
Q

does the abnormal posture in dystonia remain fixed?

A

no, often there is slow writhing movements (athetosis) - dominant muscle activity switches back and forth from agonist to antagonist

52
Q

does dystonia affect one body part or whole body?

A

focal or generalised

53
Q

what tricks can improve dystonia

A

sensory trick - geste antagoniste - touching face/head with arm

54
Q

which medications can be used for dystonia

A

anticholinergics

anti spasmodics

botulinum toxin in focal dystonias

55
Q

are early onset or late onset dystonias more common

A

late onset

56
Q

what mutationis found in early onset dystonias

A

DYT1

57
Q

torticollis

A

a primary dystonia, SCM problem - head is turned or drawn backwards (retrocollis)

58
Q

what is the hemiballismus movement like

A

dance like, contorting and continuous

usually of arm and leg on one side

59
Q

a lesion in which area causes hemiballismus

A

sub thalamic lesion

60
Q

what does a pt with restless leg syndrome describe

A

unpleasant senation/urge to move legs

61
Q

at what time of the day is restless leg syndrome most prominent

A

at night

62
Q

what relieves restless leg syndrome

A

getting up and walking about - instant relief

63
Q

pharmacoloigcal management of restless leg syndrome

A

dopamine agonists eg pramipexole and ropinirole

64
Q

task specific dystonias

A

Specific inability to perform a previous highly developed repetitive skill, e.g. writing, musicians

RB Y3 1.2 Neurology (23 decks)

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