hypertonic

Question 1

Rigidity

Answer 1

• increased resistance to passive range of motion
• “lead pipe” phenomenon
• Overactive agonista nd antagonist muscles
• most often seen with basal ganglia dysfunction
• “cog wheeling” may relate to superimposed tremor

Question 2

Spasticity

Answer 2

• UMN syndrome
  
  • exaggeration of flexion/extension skeletal muscle reflexes
  • resulting from corticospinal tract dysfunction
• “clasp knife” phenomenon/clonus
• Always pathologic –> measure on passive range of motion

Question 3

Spasticity clinical manifestations

Answer 3

• abnormal posturing
• flexor/extensor spasms
• abnormal synergistic movements
• babinksi sign/exaggerated cutaneous reflexes
• decreased postural/trunk stability
• Decreased range of motion
  
  • contractures/join stiffness

Question 4

Cerebral palsy

Answer 4

• Non-progressive disorder of posture/motor control
• Co-Morbidities = visual impairment, hearing loss, speech/language delay, epilepsy, depression, behavioral problems
• management:
  
  • evaluate for treatable disease (MRI, lab tests)
  • pysical/occupational therapy (bracing)
  • surgical release of tendons/grafting
  • botox
• Tx objectives = mobility, physical fitness, education

Question 5

tremor

Answer 5

• rhythmic oscillations about a joint
• amplitude/velocity similar in both driections
  
  • three types
    
    • resting
    • postural
    • intention

Question 6

resting tremor

Answer 6

• associated with basal ganglia pathology
• most prominent at rest
• Pill rolliwng character
• little functiona impairment

Question 7

Postural tremor

Answer 7

• often seen without identifiable pathology
• distal in limbs
• head/neck/lips/gonue involvment
• worse with stress/fatigue/stimulants
• better with rest
• gone during sleep
• may be disabling

Question 8

Intention tremor

Answer 8

• Kinetic tremor = brought out with movement
• scanning at end point of movement
• assocaited with disease of cerebellum and its connections
• associated with ataxia

Question 9

Tic

Answer 9

• involuntary/stereotyped/quick movements
• irregular intervals
• simple/complex
• buildup of psychic tension
• vocal/guttural tics

Question 10

Gilles de la tourette sydrome

Answer 10

• multiple motor tics
• at least 1 vocal/sonic tic
• onset < 18 years
• duration > 1 year
• affect daily function/cause distress
• 1/2 with obsessive/compulsive symtpoms

Question 11

Dystonia

Answer 11

• abnormal posturing
• may be
  
  • focal/mutli-focal
  • generalized
  • segmental
  • task specific - writer’s cramp, yips
• trial of L-dopa
• botox tx

Question 12

Athetosis

Answer 12

• Writhing/snake-like involuntary movements
• movement between two dystonic postures

Question 13

Chorea

Answer 13

• Involuntary random movements sufficient to move a body part
• patients may finish with voluntary movement

Question 14

Hemi-ballismus

Answer 14

• Large amplitude/violent form of chorea
• Limb/limbs fling out into space
• typically one sided
• associated with lesions in the contralteral subthalamic nucleus

Question 15

tardive dyskinesia

Answer 15

• abnormal movemetns brought on by medications/neuroleptics
• Oral/facial/lingual most common
• also limb/trunk involvement

Question 16

Ataxia

Answer 16

• decomposition of voluntary movement
  
  • decreased movement speed
  • decreased coordination
  • halting/imprecise movement
• affects limbs, speech, eyes, trunk
• resulting from disease in cerebellum and its connections

Question 17

Asterixis

Answer 17

• Intermittent loss of postural tone
• affects limbs/trunk
• seen with metabolic/toxic encephalopathies
• Negative myoclonus

Question 18

Myoclonus

Answer 18

• involuntary jerks/shock like movements of muscle groups
• focal/multifocal/generalized
• Cortical
  
  • epilepsy/degenerative disorders
  • metabolic encepahlopathies (anoxia)
• Subcortical/spinal/peripheral (hemifacial spasm)
• physiologic = hypnic jerks

Question 19

Restless legs

Answer 19

• uncomfortable urge to move legs/body parts
• worse at rest
• associated sleep disorder
• assocaited iron deficiecny
• treated with
  
  • reassurance, DOPA agonists, sedatives, opiates

Question 20

Psychogenic

Answer 20

• difficult diagnostic problem
• inconsistent findings/incongruent with known pathologic entities
• impovement when distracted
• may see other false neuro signs/symptoms
• 2-5% movements disorders clinic patients
• psychaitric patients often have abnormal movements