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Y4R3 - Medicine II 🩺 > L10: Movement Disorders > Flashcards

L10: Movement Disorders Flashcards

1
Q

Def of Extrapyramidal Disorders

A

disorders which impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function.

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2
Q

Types of Extrapyramidal Disorders

A
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3
Q

Def of Extrpyramidal System

A

Functional system including all nuclei & descending neural pathways outside pyramidal system acting on lower motor neurons.

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4
Q

Functions of Extrpyramidal System

A
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5
Q

Def of Parkinson’s Disease

A
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6
Q

Etiology of Parkinson’s Disease

A

Degeneration of nigrostriatal dopamine system in brain.

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7
Q

Epidemeology of Parkinson’s Disease

A
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8
Q
  • The most common Extra-pyramidal disease is ……
A

PD

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9
Q

Epidemeology of Parkinson’s Disease

  • Age
A
  • 40 - 70 years of age,
  • peak age of onset in the 6th decade
  • infrequent before 30 years of age.
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10
Q

Epidemeology of Parkinson’s Disease

  • Sex
A

Men are more affected (3:2)

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11
Q

Epidemeology of Parkinson’s Disease

  • Ethnicity
A

a) All ethnic groups, all socioeconomic classes are affected more in some countries.

b) Egypt: 2nd in prevalence more in rural and boxers

c) Less prevalent in China and other Asian countries, and in African Americans.

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12
Q

Functional Neuroanatomy of Parkinson’s Disease

A
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13
Q

Neurochemistry in Parkinson’s Disease

A
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14
Q

Neuropathology of Parkinson’s Disease

A
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15
Q

Pathogenesis of Parkinson’s Disease

A
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16
Q

RF for Parkinson’s Disease

A
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17
Q

CP of Parkinson’s Disease

A
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18
Q

CP of Parkinson’s Disease

  • Face
A

Mask expressionless face.

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19
Q

CP of Parkinson’s Disease

  • Limbs & trunck
A

Flexed rigid attitude

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20
Q

CP of Parkinson’s Disease

  • cardinal Symptoms
A
  • Resting Iremors (main symptom)
  • Bradykinesia
  • Muscle Rigidity
  • Postural instability
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21
Q

what is the most common symptom of Parkinson’s Disease?

A

Resting tremors

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22
Q

CP of Parkinson’s Disease

  • Tremors
A
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23
Q

CP of Parkinson’s Disease

  • Bradykinesia
A
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24
Q

CP of Parkinson’s Disease

  • Voluntary movements
A
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24
Q

CP of Parkinson’s Disease

  • Associative Symptoms
A

Diminution or loss (e.g. loss of swinging of arms in walking).

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25
Q

CP of Parkinson’s Disease

  • Speech
A

slow, quite & monotonous.

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26
Q

CP of Parkinson’s Disease

  • Writing
A

becomes progressively smaller (Micrographia).

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27
Q

CP of Parkinson’s Disease

  • Muscle Rigidity
A
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28
Q

CP of Parkinson’s Disease

  • Postural Instability
A

D2 loss of postural reflexes.

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29
Q

CP of Parkinson’s Disease

  • Gait
A
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30
Q

CP of Parkinson’s Disease

  • Propulsion, Retropulsion & Lateropulsion
A

patient is unable to stop quickly when pushed forwards, backwards, or laterally.

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31
Q

CP of Parkinson’s Disease

  • Fesinating Gait
A

spontaneous propulsion during walking

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32
Q

CP of Parkinson’s Disease

  • kinesia Paradox
A

patient can do rapid movements better than slow ones e.g. He can walk only very slowly, but may be able to run quite fast.

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33
Q

CP of Parkinson’s Disease

  • Reflexes
A
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34
Q

CP of Parkinson’s Disease

  • sensation
A

Intact: in most cases..

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35
Q

CP of Parkinson’s Disease

  • Autonomic System
A

Impaired GIT motility, bladder dysfunction, sialorrhea, excessive head and neck sweating, and orthostatic hypotension.

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36
Q

CP of Parkinson’s Disease

  • Depression
A

Mild to moderate depression in 50% of patients.

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37
Q

CP of Parkinson’s Disease

  • Cognitive Impairment
A
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38
Q

Dx of Parkinson’s Disease

A
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39
Q

TTT of Parkinson’s Disease

A

medical & surgical

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40
Q

Medical Options for Parkinson’s Disease

A

Dopamenrigic Thrapy:

  • DOPA subs.
  • Dopamine receptor Agonist
  • Metabolism Inhibitors

Others:

  • Amantadine
  • Anticholinergic Drugs
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41
Q

Dopamenergic Therapy for Parkinson’s Disease

A

…

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42
Q

TTT of Parkinson’s Disease

  • DOPA subs
A
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43
Q

Cornerstone for TTT of Parkinson’s Disease

A

DOPA Substitution L-dopa + decarboxylase inhibitor (Sinemet)

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44
Q

TTT of Parkinson’s Disease

  • DOPA subs
45
Q

Mechanism of L-dopa & decarboxylase inhibitor

46
Q

TTT of Parkinson’s Disease

  • Limitations of DOPA Subs
47
Q

Examples of Dopamine Receptor Agonists

48
Q

TTT of Parkinson’s Disease

  • Metabolism Inhibitors
49
Q

TTT of Parkinson’s Disease

  • Other therapies
50
Q

TTT of Parkinson’s Disease

  • MOA of Amantadine
51
Q

TTT of Parkinson’s Disease

  • SE of Amantadine
A

as L-dopa but milder

52
Q

TTT of Parkinson’s Disease

  • MOA of Anticholinergic Drugs
A

Effective on tremor

53
Q

TTT of Parkinson’s Disease

  • SE of Anti-cholinergics
A

Dry mouth, blurring of vision, constipation, urinary retention, confusion state, hallucinations & impairment of memory.

54
Q

TTT of Parkinson’s Disease

  • Surgical TTT
55
Q

Def of Myoclonus

A

Sudden, brief, shock-like involuntary movements.

56
Q

Types of Myoclonus

57
Q

Types of Generalized Myoclonus

58
Q

Types of Generalized Myoclonus

  • Physiologic
59
Q

Types of Generalized Myoclonus

  • essential
60
Q

Types of Generalized Myoclonus

  • Epileptic
61
Q

Types of Generalized Myoclonus

  • Symptomatic
62
Q

Causes of Segmental Myoclonus

63
Q

Examples of Segmental Myoclonus

64
Q

TTT of Myoclonus

A
  1. Valproic acid is drug of choice.
  2. May respond to benzodiazepines e.g. clonazepam.
65
Q

Notes

66
Q

Def of Hemiballismus

67
Q

Etiology of Hemiballismus

A

Usually due to a CVA in contralateral subthalamic nucleus

68
Q

CP of Hemiballismus

69
Q

Characters of Chorea

70
Q

Causes of Chorea, Dystonia & Athetosis

71
Q

Causes of Chorea, Dystonia & Athetosis

  • Hereditary
72
Q

Causes of Chorea, Dystonia & Athetosis

  • Drugs
73
Q

Causes of Chorea, Dystonia & Athetosis

  • CVD
A

(schemia, hemorrhage) Most common acquired cause of chorea

74
Q

Causes of Chorea, Dystonia & Athetosis

  • Structural Lesions
A

subthalamic nucleus)

75
Q

Causes of Chorea, Dystonia & Athetosis

  • 2ry to medical Disorders
76
Q

Causes of Chorea, Dystonia & Athetosis

  • Miscellaneous
77
Q

RF for Rheumatic (Sydenham’s) Chorea

78
Q

Infections predisposing for Rheumatic (Sydenham’s) Chorea

79
Q

CP of Rheumatic (Sydenham’s) Chorea

80
Q

Clinical Varities of Rheumatic (Sydenham’s) Chorea

81
Q

Chorea Gravidarum

82
Q

TTT of Rheumatic (Sydenham’s) Chorea

83
Q

TTT of Rheumatic (Sydenham’s) Chorea

  • Bed Rest
A

(physical & mental) for 4 weeks, longer stay is necessary in carditis.

84
Q

TTT of Rheumatic (Sydenham’s) Chorea

  • Sedatives
A

phenobarbitone,

85
Q

TTT of Rheumatic (Sydenham’s) Chorea

  • corticosteroids
A

for active carditis, rheumatic fever& failure of other lines of treatment.

86
Q

TTT of Rheumatic (Sydenham’s) Chorea

  • Tonsilectomy
A

if there is a history of recurrent tonsillitis & sore throat, performed after convalescence from chorea.

87
Q

TTT of Rheumatic (Sydenham’s) Chorea

  • Long-acting penicillin
A

(prophylactic against streptococcal infection).

88
Q

Wilson’s disease

89
Q

Idiopathic torsion dystonia

90
Q

Dopa-responsive dystonia

91
Q

Site of Athetosis

A
  • distal parts of limbs (hands, fingers).
  • Can also affect face and tongue
92
Q

Characters of movements of Athetosis

A

Involuntary movements characterized by :

  • Slow, flowing, often twisting
  • Continuous
  • Snake-like movements
93
Q

choreoathetosis

A

Often use term “ choreoathetosis” due to overlap () syndromes ( chorea referring to less smooth, more jerky movements)

94
Q

Characters of Dystonia

A

Condition in which the patient assumes a sustained, abnormal posture or limb position

95
Q

Pathology in Dystonia

A

Due to co-contraction of agonist and antagonist muscles in part of body

96
Q

Types of Dystonia

A
  1. Generalized (Torsion) dystonia.
  2. Focal dystonia.
97
Q

Def of Generalized (torsion) Dystonia

A

Involuntary torsion movements of trunk & proximal segment of limbs.

98
Q

CP of Generalized (torsion) Dystonia

99
Q

CP of Generalized (torsion) Dystonia

  • Age
A

childhood or adolescence (Familial type).

100
Q

CP of Generalized (torsion) Dystonia

  • No ….
A

pyramidal signs or wasting.

101
Q

CP of Generalized (torsion) Dystonia

  • Normal …..
A

Reflexes, sensations, mentality & speech.

102
Q

CP of Generalized (torsion) Dystonia

  • tone
A

Hypertonia during spasms & hypotonia in-between them.

103
Q

Examples of Focal Dystonia

104
Q

Managment of Focal Dystonia

105
Q

Def of TICS

A

Recurrent, stereotyped abnormal movements

106
Q

Etiology of TICS

A
  1. Primary; Tourette’s syndrome.
  2. Secondary: Huntington’s disease.
107
Q

Characters of TICS

A

A. May be suppressed voluntarily or with distraction

B. Voluntary suppression leads to anxiety and a build-up of internal unrest.

C. Worsen under

108
Q

Def of tremors

109
Q

Classification of tremors

110
Q

Clinical class. of tremors

111
Q

TTT of tremors

Y4R3 - Medicine II 🩺 (35 decks)

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