Lecture 3: Parkinsons/Movement Disorders Flashcards
(64 cards)
1
Q
Physiological Tremor
A
- 6-12Hz
- Normal finding
2
Q
Intention tremor
A
- During activity
- Cerebellar injury → superior cerebellar peduncle involvement
- Tremor increases when trying to focus a laser to a target
3
Q
Resting tremor
A
- 4-6Hz
- associated with parkinsons disease
- Think → basal ganglia
4
Q
Chorea
A
- Dance like movements
- Involuntary rapid, irregular muscle jerks
5
Q
Chorea is associated with a lesion to
A
caudate or putamen
6
Q
Can voluntary movements be distorted with chorea?
A
Yes; especially if strong facial and tongue movements can be observed
7
Q
chorea when unilateral is called
- what muscles are most invovled
A
hemibalismus
Proximal muscles of a single limb are the most involved
8
Q
Dystonia & Athetosis
A
- Slow, purposeless, writhing movements (athetosis)
- Dystonia refers to those movements which are more like or turn into postures
9
Q
Are dystonia and Athetosis present during sleep?
What are they effected by?
A
No
Stress and intention
10
Q
Athetosis and dystonia are associated with:
A
perinatal anoxia, CP, Huntington’s & drug side effect
can be categorized as inhereited or required
11
Q
Myoclonus
A
Sudden, violent muscle jerks
12
Q
physiologic myoclonus examples
A
nocturnal myoclonus and hiccups
13
Q
Essential myoclonus
A
- isolated abnormality
- myoclonic muscle jerks are the most prominent or only clinical finding
14
Q
Epiletic myoclonus
A
manifestation of epilepsy
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
16
Q
transient simple tics
A
common in children; usually go away within a year
17
Q
chornic simple tics
A
begin in childhood; benign but don’t go away
18
Q
persistent single or multiple tics of childhood or adolesence
A
verbal and/or motor with complete remission by the end of adolesence
19
Q
Tourette’s Syndrome
A
chronic multiple motor and vocal
20
Q
Involuntary verbal tics typical to include
A
grunts, barks, hisses, or coughing
21
Q
Tourettes
Coprolalia
A
vulgar or obscene utterances
22
Q
Tourettes
Echolalia
A
parroting of another’s speech
23
Q
Tourettes
parilalia
A
repeating the same word over and over
24
Q
involuntary motor tics common to include
A
blinking, grimacing, sniffing
25
Tourettes
*echopraxia*
imitation of another's movement
26
Tourettes
*Self-mutilation*
* 40-50%
* Biting nails, picking nose, pulling hair
27
Other related phenomena related to tourretes:
* Attention defecits
* Learing difficulties
* Impulse control and OCD
28
Lesions of the basal ganglia decompose ___ into \_\_\_\_\_
decompose ***behavior*** into ***isolated motor acts***
29
Lesions of basal ganglia decompose intended motor acts into \_\_\_\_
* movements of innapropriate amplitude
* too little or too much
30
Idopathic Parkinsons
* Progressive neurodegenerative disease
* Deficits due to loss of **dopamine degeneration** of dopaminergic neurons in **substatina nigra parts compacta**
31
Idopathic parkinsons have ___ symptoms and respond to \_\_\_\_
Hypokinetic symptoms
levodopa - works my converting to dopamine in the brain
32
*Idopathic Parkinsons*
Temor dominant
* Resting Tremor is the first sign
* Akineitic
* More common in younger people
33
*Idopathic Parkinsons*
PIGD
More ***postural instability, gait difficulty*** - associated with worse prognosis
more common in older people
34
Genetic factors of parkinsons
* 5-10% familial inheritance
* role of alpha-synuclein protein
* Lewy bodies
35
Environemtal risk factros for PD
environmental toxins
36
High Risk of Parkinsons
* Rural living
* well water
* Agriculture occupation
* High dairy consumption
* Head injury
* Methamphet. use
* Melanona
37
Low risk of Parkinsons
* Cigs
* Alcohol
* Caffiene
* Physical activity
* Regualar ibuprofen use
* Calcium channel blocker
38
Pathology of Parkinsons
Distribution of Lewy bodies is more widespread than originally appreciated
39
Early non-motor signs of PD
* High level of evidence for olfaction involvement (hyposomia)
* constipation
* REM sleep behavior disorder
40
Severity of PD correlates with the extent of degeneration of ___ neurons in SNpc.
dopamineric
41
Cardinal features of sporadic PD
* Resting tremor
* Rigidity -cogwheel or lead pipe
* Bradykinesia- slow movement
* Postural instability
42
PD has a ___ onset
* unilateral onset with persistent assymetry
* always starts unilaterally and becomes a bilateral disease
* Progressive
* responses to dopamine therapy
* Olfactory dysfunction
43
exclusion criteria of PD
* Lack of benefit from dopamine
* Current or recurrent use of dopaminergic blockers
* documentation of alternative cause
* hydrocephalus, encephalitis, trauma, toxins, vascular disorder
44
exclusion criteria of PD - phyisical exam
* Cerebellar signs
* Early dimentia
* Supranuclear gaze
* PD limited to LEs for more than 3 years
* Cortical signs (aphaasia, apraxia, astero-agnosia)
45
Diseases that may look like PD
* Progressive supranuclear palsy
* multiple system atrophy
* lewy body disease
46
PD voluntary movement
* Akinesia
* no movement
* delay in initiation
* bradykinesia
* slow movement
* Hypokinesia
* low amplitude movement
47
PD involuntary movement
* Tremor
* pill rolling
* resting (4-6times/s)
* Rigidity
* different than spasticity
48
PD and walking
* Flexed posture
* anterior COM
* Short, shuffling steps
* loss of associated movements
* festinating gait (a hard time stepping)
49
PD and static balance
* postural Predisposition to lose balance
50
PD and dynamic balance
* impairments in prep post. adjustments
* loss of righting and protective responses
51
Cognitive function and PD
* Can occur early
* 20% have cogntitive impairment early
* **significant declines happen later**
* **dimentia in 40-70%**
* Visual disturbances (hallucinations)
* Depression
52
Treatment for PD
* Precursor to dopamine (L-dopa)
* 2-5 yr max benefit
53
PD treatment aimed to restore balance
* Dopamine
* Dopamine agonsits
* Anticholinergfics
* Monoamine oxidase
54
Brain stimulation and PD
* Symptoms not responsive to drugs will not be helped by this
* Subthalamic nucleus
55
Huntintons Disease
* 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
average lifespan after HD diagnosis
15 years
57
what makes definitive diagnosis for HD
degenerative testing
genetic counseling is indicated
58
Clinical findings of HD
* 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
With OCD & chorea ___ is a huge problem in HD patients
weight loss
60
Hemiballismus
* Unilateral
* Acute onset of flinging - choreic movements (proximal muscle involvement)
* lesion of subthal. nucleus in BG
* usually result of CVA
61
Tardive dyskinesia
* Choreo- movements of face, mouth, and jaw
* pursing mouth
* fish gaping
* Associated with prolonged use of psycoactive drugs
62
Damage to the cerebellum signs
* Incoordination
* Delays in movement initiation and termination
* Hypotonia
* Intention temor
* Dysequilirbium & vertigo
63
Fridreich's Ataxia
* 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
Olivopontocerebellar atrophy
* 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
