Hypokinetic disorders Flashcards
What does tar dive mean?
late-occurring
What is chorea?
continuous small jerks of limbs
What are the types of (hyperkinetic) Dyskinesia?
- tremor
- dystonia
- chorea
- hemiballismus
- tics
- myoclonus
What are the types of hypo kinetic movements?
- Parkinson’s disease
- Lewy body dementia
- Parkinsonism
- chronic traumatic encephalopathy
What are the types of tremor?
- Resting tremor
- Action Tremor (occurs along with voluntary movement)
What are the types of action tremor?
postural
isometric
kinetic
What are the causes of tremors?
enhanced physiological tremor essential tremor genetic tremor degenerative disorders Drug induced Toxins Functional
What is the common presentation of essential tremor?
- 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
What is Dystonia defined as?
involuntary sustained contraction of opposing muscle groups causing twisting movements or abnormal posture
What does dystonia usually present with?
Abnormal posture
pain
cramps
Possible tremor
What are the types of laryngeal dystonia?
Adductor - speech sounds strangled and words cut off
Abductor - voice weak and breathy
How can Laryngeal dystonia be diagnosed and treated?
laryngoscopy
treat with Botulinum toxin injections
Define Chorea?
rapid jerky movements that flit from one part of body to another
What are the possible causes of chorea?
Huntington disease
Rheumatic fever
Drugs
Pregnancy
What is the treatment for chorea?
Dopamine receptor blockers
What is the pathophysiology of Huntingtons?
loss of nerve cells in caudate nucleus and putamen (reduced in GABA)
How does Huntington present?
- jerky uncontrollable movements
- unsteady gait
- dysarthria
- dysphagia
- anxiety
- depression
- insomnia
What is the treatment for Huntington?
Tetrabenzine and antipsychotics often required
What is the prognosis of Huntingtons?
progressive, get chorea and dementia, death usually occurs 10-20 years after onset
What is Hemiballismus?
severe proximal form of chorea (violent flinging movement of one side of body)
What usually causes hemiballismus?
infarction
Haemorrhage
(in sub thalamic nucleus)
How is hemiballismus treated?
not always required but can get dop blockers
What is a tic?
sudden repetitive, non-rhythmic stereotyped movement or vocalisation
Are tics voluntary?
Tics are not involuntary, there is a build up of tension which they then choose to release at some point (suppressible yet irresistible)
When are tics likely to improve or get worse?
worse when excited
better when concentrating on task
What are the types of tics?
Motor tics - simple (e.g blinking) and complex (e.g. kicking)
Vocal tics - simple (grunting, sniffling) complex (repeating words)
When is the most common onset of Tourettes?
more common in men
5-7 years
to be diagnosed as Tourettes onset must be before 18y
What is myoclonus?
brief involuntary twitch of muscles or muscle group
Positive myoclonus = contractions
Negative myoclonus = relaxations
When does myoclonus occur?
- can be normal
- can be caused by: epilepsy, CJD, uraemia and liver failure
What drugs can cause dyskinesia?
salbutamol, lithium, valproate or levodopa
What are symptoms of Wilsons disease?
*****
- get Kayer-Fleischer ring (copper ring around eye)
- movement disorder (
What are symptoms of Wilsons disease?
*****
- get Kayer-Fleischer ring (copper ring around eye)
- movement disorder (progressive tremor, dystonia and chorea)
- rigidity
- dysarthria
- cog and psych impairment
What are the causes of ataxia?
cerebellar, sensory, optic and frontal dysfunction
What are the symptoms of cerebellar ataxia?
- Dysarthria
- intention tremor
- Dysmetria
- Dysdiadochokinesia
- Titubation (head tremor)
- Gait ataxia
- nystagmus
- rebound phenomenon
- limb hypotonia
What are the localised causes of cerebellar ataxia
demyelination
tumour
infarct
haemorrhage
What are the causes of localised cerebellar ataxia
demyelination
tumour
infarct
haemorrhage
What are the causes of global cerebellar ataxia?
infection myxoedema immune mediated (paraneoplastic) MSA Spinocerebellar ataxia episodic ataxia Toxic poisoning
How can sensory and cerebellar ataxia be distinguished?
sensory exacerbated by removal of visual cues e.g. closing eyes
- sensory has loss of proprioception
What is the cause and treatment of Wilsons?
- mutation in gene for Cu transporting protein
- treated with copper cheating drugs
What is Akathisia?
unpleasant sensation of restlessness, manifests as inability to sit or remain motionless
What are the symptoms of tardive dyskinesia?
- smacking of lips
- grimacing of face
What causes tardive dyskinesia?
use of neuroleptics
How are acute dystonic reactions treated?
IV anticholinergic
