Moevment Disorders Flashcards
Asterixis
Uncontrolled Extension of the wrists which results in a “flapping of the wrists”
Seen in:
- hepatic encephalopathy
- Wilson disease
- metabolic disorders
Athetosis
Slow undulating snake-like movements usually in the fingers and hands
Seen in:
- lesions of the basal ganglia
- degenerative disorders
Blepharospasm
A type of dystonia that affects only the eyes
- uncontrolled blinking or eyelid movement
Seen in:
- some medications
- OD of medications
- genetic defects
Chorea
Uncontrolled sudden jerking or dance-like movements
Seen in:
- lesions to the basal ganglia
- Huntington’s
- rheumatic fever
- Wilson’s disease
Dystonia
Sustained muscle contractions that are uncontrolled
Hemiballsmus
Uncontrolled flailing/flinging motions of the extremities
Seen in:
- lesions to the contralateral STN
- lacunar strokes
Tardive dyskinesia
Controlled repetitive Orofacial movements (usually smacking of lips or abnormal tongue movements)
Seen in:
- dopamine antagonist uses
- absence seizures
Torticolis
Sustained muscle contractions of the neck similar to dystonia
Huntington’s disease
A type of hyperkinetic movement disorder
Is a autosomal dominant w/ complete penetrance disease that results in a CAG triplet on chromosome 4 and repeat expansions of HTT genes on chromosome 4
Results in corpus striatum atrophy which lowers number of GABA neurons in the corpus striatum and reduced inhibitory output from the striatum
Clinical features of Huntington’s
Doesn’t show until 30-50s usually
Clinical features:
- chorea
- dysarthria
- dysphagia
- abnormal eye movements
- neurobehavioral disorders
- dementia
*(Is autosomal dominant)
Diagnosis:
- family history/ genetic testing
- symptoms
- CT/MRI
Treatment:
- D2 antagonists
- mood medications
Restless leg syndrome
Hyperkinetic disorder
Etiology
- genetics
- iron deficiencies
- diabetic neuropathy
- uremia
- OSA
- pregnancy
Symptoms
- leg sensations (akathisa) that worsen at night
- symptoms are present only at rest, movement makes it better
Diagnosis
- polysomnography
- history
- labs
Treatment
- treat underlying cause
Types of tremors
Postural:
- occurs when the body part is voluntarily maintained against gravity
Action:
- occurs with voluntary contraction of muscles
Kinetic:
- occurs with any form of voluntary movement
Intention:
- subtype of kinetic tremor amplified as the target is reached
- always implies direct or pathway lesions of the cerebellum
Rest:
- occurs in a body part that is relaxed and completely supported against gravity
- usually implies Parkinsonism
Essential tremor (familial)
Hyperkinetic disorder
Most common type of tremor
50% of the time is autosomal dominant genetic caused
High frequency quick tremors that usually affects only the upper extremities (Can affect face and voice however)
Clinical features:
- bimodal distribution that results in bilateral, postural or kinetic tremors.
- usually one hand is worse (although this isnt usually clinically relevant)
- alcohol actually fixes these tremors
Treatments:
- life style modifications
- BBs
- anti-epileptics
- thalamic surgery (severe cases only)
Wilson’s disease
hyperkinetic disorder
Autosomal recessive disorder of copper metabolism
- excessive build up of copper since it cannot bind to ceruloplasmin (its transfer protein)
Clinical features
- people under 40 yrs
- hepatic issues
- action tremors
- asterixis
- *presence of kayser-flesicher rings (brown ring on the outside edge of the iris)
- hemolytic anemia
- behavioral disturbances
Diagnosis
- elevated urinary copper
- low ceruloplasmin
- genetic testing
Treatment:
- penicillamine (chelating agent that binds to coppe)
Parkinson’s disease
Hypokinetic disorder that is the 2nd most common movement disorder
Degeneration of the substantia Nigra and respective dopamine neurons
- results in inability to inhibit GABA output from the striatum (net negative for movement)
Causes
- genetic neurodegenerative
- therapeutic drugs in high doses
- toxins
- post traumatic stress and trauma
Symptoms:
- unilateral/slow frequency resting tremors
- cogwheel rigidity*
- akinesia/ bradykinesia
- mask-like faces
- hypotonia
- dysphagia
- micrograph is
- postural instability w/ shuffling gate
- autonomic dysfunction
- cognative and behavioral dysfunctions
