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Clinical Conditions II > Lecture 3: Parkinsons/Movement Disorders > Flashcards

Lecture 3: Parkinsons/Movement Disorders Flashcards

1
Q

Physiological Tremor

A
  • 6-12Hz
  • Normal finding
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2
Q

Intention tremor

A
  • During activity
  • Cerebellar injury → superior cerebellar peduncle involvement
  • Tremor increases when trying to focus a laser to a target
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3
Q

Resting tremor

A
  • 4-6Hz
  • associated with parkinsons disease
  • Think → basal ganglia
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4
Q

Chorea

A
  • Dance like movements
  • Involuntary rapid, irregular muscle jerks
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5
Q

Chorea is associated with a lesion to

A

caudate or putamen

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6
Q

Can voluntary movements be distorted with chorea?

A

Yes; especially if strong facial and tongue movements can be observed

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7
Q

chorea when unilateral is called

  • what muscles are most invovled
A

hemibalismus

Proximal muscles of a single limb are the most involved

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8
Q

Dystonia & Athetosis

A
  • Slow, purposeless, writhing movements (athetosis)
  • Dystonia refers to those movements which are more like or turn into postures
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9
Q

Are dystonia and Athetosis present during sleep?

What are they effected by?

A

No

Stress and intention

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10
Q

Athetosis and dystonia are associated with:

A

perinatal anoxia, CP, Huntington’s & drug side effect

can be categorized as inhereited or required

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11
Q

Myoclonus

A

Sudden, violent muscle jerks

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12
Q

physiologic myoclonus examples

A

nocturnal myoclonus and hiccups

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13
Q

Essential myoclonus

A
  • isolated abnormality
  • myoclonic muscle jerks are the most prominent or only clinical finding
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14
Q

Epiletic myoclonus

A

manifestation of epilepsy

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15
Q

Tics

A
  • sudden, recurrent, coordinated abnormal movements or verbilizations
    • occur repeatedly
    • can be voluntarily supressed for short periods of time
    • worsen with stress
    • diminished during voluntary movements or mental concentration and dissapear during sleep
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16
Q

transient simple tics

A

common in children; usually go away within a year

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17
Q

chornic simple tics

A

begin in childhood; benign but don’t go away

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18
Q

persistent single or multiple tics of childhood or adolesence

A

verbal and/or motor with complete remission by the end of adolesence

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19
Q

Tourette’s Syndrome

A

chronic multiple motor and vocal

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20
Q

Involuntary verbal tics typical to include

A

grunts, barks, hisses, or coughing

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21
Q

Tourettes

Coprolalia

A

vulgar or obscene utterances

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22
Q

Tourettes

Echolalia

A

parroting of another’s speech

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23
Q

Tourettes

parilalia

A

repeating the same word over and over

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24
Q

involuntary motor tics common to include

A

blinking, grimacing, sniffing

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25
Q

Tourettes

echopraxia

A

imitation of another’s movement

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26
Q

Tourettes

Self-mutilation

A
  • 40-50%
  • Biting nails, picking nose, pulling hair
27
Q

Other related phenomena related to tourretes:

A
  • Attention defecits
  • Learing difficulties
  • Impulse control and OCD
28
Q

Lesions of the basal ganglia decompose ___ into _____

A

decompose behavior into isolated motor acts

29
Q

Lesions of basal ganglia decompose intended motor acts into ____

A
  • movements of innapropriate amplitude
    • too little or too much
30
Q

Idopathic Parkinsons

A
  • Progressive neurodegenerative disease
  • Deficits due to loss of dopamine degeneration of dopaminergic neurons in substatina nigra parts compacta
31
Q

Idopathic parkinsons have ___ symptoms and respond to ____

A

Hypokinetic symptoms

levodopa - works my converting to dopamine in the brain

32
Q

Idopathic Parkinsons

Temor dominant

A
  • Resting Tremor is the first sign
  • Akineitic
  • More common in younger people
33
Q

Idopathic Parkinsons

PIGD

A

More postural instability, gait difficulty - associated with worse prognosis

more common in older people

34
Q

Genetic factors of parkinsons

A
  • 5-10% familial inheritance
  • role of alpha-synuclein protein
    • Lewy bodies
35
Q

Environemtal risk factros for PD

A

environmental toxins

36
Q

High Risk of Parkinsons

A
  • Rural living
  • well water
  • Agriculture occupation
  • High dairy consumption
  • Head injury
  • Methamphet. use
  • Melanona
37
Q

Low risk of Parkinsons

A
  • Cigs
  • Alcohol
  • Caffiene
  • Physical activity
  • Regualar ibuprofen use
  • Calcium channel blocker
38
Q

Pathology of Parkinsons

A

Distribution of Lewy bodies is more widespread than originally appreciated

39
Q

Early non-motor signs of PD

A
  • High level of evidence for olfaction involvement (hyposomia)
  • constipation
  • REM sleep behavior disorder
40
Q

Severity of PD correlates with the extent of degeneration of ___ neurons in SNpc.

A

dopamineric

41
Q

Cardinal features of sporadic PD

A
  • Resting tremor
  • Rigidity -cogwheel or lead pipe
  • Bradykinesia- slow movement
  • Postural instability
42
Q

PD has a ___ onset

A
  • unilateral onset with persistent assymetry
    • always starts unilaterally and becomes a bilateral disease
  • Progressive
  • responses to dopamine therapy
  • Olfactory dysfunction
43
Q

exclusion criteria of PD

A
  • Lack of benefit from dopamine
  • Current or recurrent use of dopaminergic blockers
  • documentation of alternative cause
    • hydrocephalus, encephalitis, trauma, toxins, vascular disorder
44
Q

exclusion criteria of PD - phyisical exam

A
  • Cerebellar signs
  • Early dimentia
  • Supranuclear gaze
  • PD limited to LEs for more than 3 years
  • Cortical signs (aphaasia, apraxia, astero-agnosia)
45
Q

Diseases that may look like PD

A
  • Progressive supranuclear palsy
  • multiple system atrophy
  • lewy body disease
46
Q

PD voluntary movement

A
  • Akinesia
    • no movement
    • delay in initiation
  • bradykinesia
    • slow movement
  • Hypokinesia
    • low amplitude movement
47
Q

PD involuntary movement

A
  • Tremor
    • pill rolling
    • resting (4-6times/s)
  • Rigidity
    • different than spasticity
48
Q

PD and walking

A
  • Flexed posture
  • anterior COM
  • Short, shuffling steps
  • loss of associated movements
  • festinating gait (a hard time stepping)
49
Q

PD and static balance

A
  • postural Predisposition to lose balance
50
Q

PD and dynamic balance

A
  • impairments in prep post. adjustments
  • loss of righting and protective responses
51
Q

Cognitive function and PD

A
  • Can occur early
    • 20% have cogntitive impairment early
    • significant declines happen later
    • dimentia in 40-70%
  • Visual disturbances (hallucinations)
  • Depression
52
Q

Treatment for PD

A
  • Precursor to dopamine (L-dopa)
    • 2-5 yr max benefit
53
Q

PD treatment aimed to restore balance

A
  • Dopamine
  • Dopamine agonsits
  • Anticholinergfics
  • Monoamine oxidase
54
Q

Brain stimulation and PD

A
  • Symptoms not responsive to drugs will not be helped by this
    • Subthalamic nucleus
55
Q

Huntintons Disease

A
  • Proressive degenerative disorder of striatum
  • Heridataary disorder - manifests itself in early adult to mid life
    • each child of affected parent has 50% change of inhereting the gene
    • ½ of offspring get it (autosomal dominant) - if you have the gene youll have HD
    • Earlier onsent more likely when disease is inherited from the father
56
Q

average lifespan after HD diagnosis

A

15 years

57
Q

what makes definitive diagnosis for HD

A

degenerative testing

genetic counseling is indicated

58
Q

Clinical findings of HD

A
  • Chorea: restlessness, cant supress blinks, proresses to choreifrom movements
  • Motor impersistence
    • cant hold tongue out
    • drop objects
    • minor car accidents
  • Dystonia
    • abnormal posture - super imposed on chorea
      • example: landing on lateral aspect of foot
  • Westphal variant
    • Juveinelle form
59
Q

With OCD & chorea ___ is a huge problem in HD patients

A

weight loss

60
Q

Hemiballismus

A
  • Unilateral
  • Acute onset of flinging - choreic movements (proximal muscle involvement)
  • lesion of subthal. nucleus in BG
    • usually result of CVA
61
Q

Tardive dyskinesia

A
  • Choreo- movements of face, mouth, and jaw
    • pursing mouth
    • fish gaping
  • Associated with prolonged use of psycoactive drugs
62
Q

Damage to the cerebellum signs

A
  • Incoordination
  • Delays in movement initiation and termination
  • Hypotonia
  • Intention temor
  • Dysequilirbium & vertigo
63
Q

Fridreich’s Ataxia

A
  • one of the most common heridiatry disorders of the NS
  • Autosomal recessive
  • Age of onset = 13
    • wheelchair bound by 20
  • Ataxia in lower limbs
  • Nystagmus & dysarthia
  • Impairment of sensaation
  • Scoliosis
64
Q

Olivopontocerebellar atrophy

A
  • Degneration of cerebellum, pons, inferior olives
  • Progressive ataxia
    • later onset than friedreichs ataxia
      • slow proression over 20 years uually leading to death
    • gait aaffected first with resultant decreased movement speed and balance defecits

Clinical Conditions II (5 decks)

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