Module 6: Movement Disorders

Question 0

Patient presents with a shuffling gait without swinging arms – suspected diagnosis if unilateral? if bilateral?

Answer 0

Parkinson’s disease versus Parkinson’s plus syndrome (Lewy body disease, etc.)

Question 1

Relative Amplitude/frequency of resting versus postural tremor?

Answer 1

Low-frequency and high amplitude

Versus

high-frequency and low amplitude

Question 2

Non-neuropathological causes of postural tremor?

Answer 2

#Nervousness
#Thyroid disease
#Stimulants

Question 3

Facial version of chorea?

Diseases associated with chorea?

Answer 3

Tardiva dyskinesia

#Huntington's
#Poststreptococcal
#Lupus
#Neuroleptics

Question 4

Hemiballismus – area of brain lesioned? Associated with?

Answer 4

STN

HONK

Question 5

Patient presents with “smile like the Joker” dystonia of the face - suspected diagnosis?

Answer 5

Wilson’s disease

Question 6

Dystonia of the neck called?

Answer 6

Torticollis

Question 7

Definition of dystonia? Causes of dystonia?

Answer 7

Dystonia - involuntary muscle contractions

#Neuroleptics
#Metoclopramide

Question 8

Common form of tics?

Answer 8

echolalia

Question 9

Myoclonus associated with?

Answer 9

#Renal/hepatic failure
#Post cardiac resuscitation
#CJD
#Valproic acid/Levetiracetam

Question 10

Akathisia? Associated with?

Answer 10

Inner sense of restlessness that is relieved with movement

Iron deficiency anemia

Question 11

Function of the basal ganglia versus cerebellum?

Answer 11

Higher order movement processing (planning cortex)

Versus

Gets copy of motor plan (MCP) and manages sensory feedback (ICP)

Question 12

Features of parkinsonism? Order of symptoms?

Answer 12

TRAP

Tremor – pill-rolling and only present at rest
Rigidity - increased tone in muscles independent of velocity
Akinesia – slowness
Postural instability – small shuffling gate and decreased arm swing

Bradykinesia then tremor then gait instability

Question 13

Patient presents with falling backwards many times. Type of problem?

1. If also demented, suspected diagnosis?
2. If also has autonomic dysfunction, suspected diagnosis?
3. If Early falls and eye movement problems - suspected diagnosis?

Answer 13

Postural instability

1. Lewy body dementia
2. Multiple system atrophy
3. Progressive supranuclear palsy

Question 14

Treatment options for Parkinson’s?

Answer 14

#Levodopa + carbidopa
#Selegiline (MAO-PD inhibitor)
#Dopamine agonists
#Trihexyphenidyl

Question 15

Drug induced parkinsonism usually related to? Usually does not have this symptom? Alternative drug that does not cause the syndrome?

Answer 15

Neuroleptic use

Gate instability

Clozapine

Question 16

Vascular parkinsonism usually involves? Etiology? Response to levodopa?

Answer 16

Legs >arms

Strokes in basal ganglia

Poor response

Question 17

Treatment option for Lewy body dementia?

Answer 17

Central acetylcholinesterase inhibitors – donepezil

Question 18

Conditions associated with postural tremor?

Answer 18

#Physiologic tremor
#Essential tremor

Question 19

Tremor that improves with alcohol? Symmetric or asymmetric? Most commonly affected areas?

Better treatment?

If asthmatic?

Answer 19

Essential tremor; symmetric; hand or vocal tremor

propranolol; Primidone

Question 20

Wilson’s disease – classic triad? Labs? Treatment?

Answer 20

#Movement disorders (parkinsonism, dystonia, chorea)
#Psychiatric disturbance
#hepatic failure

Penicillamine, zinc, Dimercaprol

Question 21

Focal dystonia presents with? Responds to?

Answer 21

#Blepharospasm (involuntary closure of an eye)
#Torticollis (involuntary contraction of SEM)
#Writers cramp

Local Botox

Question 22

Classic triad of Huntington’s disease?

Answer 22

#Chorea
#dementia
#Positive family history