Hypokinetic disorders

Question 1

What does tar dive mean?

Answer 1

late-occurring

Question 2

What is chorea?

Answer 2

continuous small jerks of limbs

Question 3

What are the types of (hyperkinetic) Dyskinesia?

Answer 3

• tremor
• dystonia
• chorea
• hemiballismus
• tics
• myoclonus

Question 4

What are the types of hypo kinetic movements?

Answer 4

• Parkinson’s disease
• Lewy body dementia
• Parkinsonism
• chronic traumatic encephalopathy

Question 5

What are the types of tremor?

Answer 5

• Resting tremor

- Action Tremor (occurs along with voluntary movement)

Question 6

What are the types of action tremor?

Answer 6

postural
isometric
kinetic

Question 7

What are the causes of tremors?

Answer 7

enhanced physiological tremor
essential tremor 
genetic tremor 
degenerative disorders 
Drug induced 
Toxins 
Functional

Question 8

What is the common presentation of essential tremor?

Answer 8

• most common tremor
• bilateral and action tremor
• no other neuro symptoms
• slow progression
• shouldn’t be disabling
• Handwriting shaky but not small
• often family history

Question 9

What is Dystonia defined as?

Answer 9

involuntary sustained contraction of opposing muscle groups causing twisting movements or abnormal posture

Question 10

What does dystonia usually present with?

Answer 10

Abnormal posture
pain
cramps
Possible tremor

Question 11

What are the types of laryngeal dystonia?

Answer 11

Adductor - speech sounds strangled and words cut off

Abductor - voice weak and breathy

Question 12

How can Laryngeal dystonia be diagnosed and treated?

Answer 12

laryngoscopy

treat with Botulinum toxin injections

Question 13

Define Chorea?

Answer 13

rapid jerky movements that flit from one part of body to another

Question 14

What are the possible causes of chorea?

Answer 14

Huntington disease
Rheumatic fever
Drugs
Pregnancy

Question 15

What is the treatment for chorea?

Answer 15

Dopamine receptor blockers

Question 16

What is the pathophysiology of Huntingtons?

Answer 16

loss of nerve cells in caudate nucleus and putamen (reduced in GABA)

Question 17

How does Huntington present?

Answer 17

• jerky uncontrollable movements
• unsteady gait
• dysarthria
• dysphagia
• anxiety
• depression
• insomnia

Question 18

What is the treatment for Huntington?

Answer 18

Tetrabenzine and antipsychotics often required

Question 19

What is the prognosis of Huntingtons?

Answer 19

progressive, get chorea and dementia, death usually occurs 10-20 years after onset

Question 20

What is Hemiballismus?

Answer 20

severe proximal form of chorea (violent flinging movement of one side of body)

Question 21

What usually causes hemiballismus?

Answer 21

infarction
Haemorrhage
(in sub thalamic nucleus)

Question 22

How is hemiballismus treated?

Answer 22

not always required but can get dop blockers

Question 23

What is a tic?

Answer 23

sudden repetitive, non-rhythmic stereotyped movement or vocalisation

Question 24

Are tics voluntary?

Answer 24

Tics are not involuntary, there is a build up of tension which they then choose to release at some point (suppressible yet irresistible)

Question 25

When are tics likely to improve or get worse?

Answer 25

worse when excited

better when concentrating on task

Question 26

What are the types of tics?

Answer 26

Motor tics - simple (e.g blinking) and complex (e.g. kicking)
Vocal tics - simple (grunting, sniffling) complex (repeating words)

Question 27

When is the most common onset of Tourettes?

Answer 27

more common in men
5-7 years
to be diagnosed as Tourettes onset must be before 18y

Question 28

What is myoclonus?

Answer 28

brief involuntary twitch of muscles or muscle group
Positive myoclonus = contractions
Negative myoclonus = relaxations

Question 29

When does myoclonus occur?

Answer 29

• can be normal

- can be caused by: epilepsy, CJD, uraemia and liver failure

Question 30

What drugs can cause dyskinesia?

Answer 30

salbutamol, lithium, valproate or levodopa

Question 31

What are symptoms of Wilsons disease?

*****

Answer 31

• get Kayer-Fleischer ring (copper ring around eye)

- movement disorder (

Question 32

What are symptoms of Wilsons disease?

*****

Answer 32

• get Kayer-Fleischer ring (copper ring around eye)
• movement disorder (progressive tremor, dystonia and chorea)
• rigidity
• dysarthria
• cog and psych impairment

Question 33

What are the causes of ataxia?

Answer 33

cerebellar, sensory, optic and frontal dysfunction

Question 34

What are the symptoms of cerebellar ataxia?

Answer 34

• Dysarthria
• intention tremor
• Dysmetria
• Dysdiadochokinesia
• Titubation (head tremor)
• Gait ataxia
• nystagmus
• rebound phenomenon
• limb hypotonia

Question 35

What are the localised causes of cerebellar ataxia

Answer 35

demyelination
tumour
infarct
haemorrhage

Question 36

What are the causes of localised cerebellar ataxia

Answer 36

demyelination
tumour
infarct
haemorrhage

Question 37

What are the causes of global cerebellar ataxia?

Answer 37

infection 
myxoedema 
immune mediated (paraneoplastic) 
MSA
Spinocerebellar ataxia 
episodic ataxia 
Toxic poisoning

Question 38

How can sensory and cerebellar ataxia be distinguished?

Answer 38

sensory exacerbated by removal of visual cues e.g. closing eyes
- sensory has loss of proprioception

Question 39

What is the cause and treatment of Wilsons?

Answer 39

• mutation in gene for Cu transporting protein

- treated with copper cheating drugs

Question 40

What is Akathisia?

Answer 40

unpleasant sensation of restlessness, manifests as inability to sit or remain motionless

Question 41

What are the symptoms of tardive dyskinesia?

Answer 41

• smacking of lips

- grimacing of face

Question 42

What causes tardive dyskinesia?

Answer 42

use of neuroleptics

Question 43

How are acute dystonic reactions treated?

Answer 43

IV anticholinergic