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CNS CLINICAL MEDICINE > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What are movement disorders?

A

Disorders in which there are abnormal involuntary changes in normal movement attributed to basal ganglia pathology; in absence of weakness or coordination problem

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2
Q

What are types of movement disorders?

A

Hypo-kinetic movement disorders

Hyperkinetic movement disorders

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3
Q

What are the 3 things that control motor system?

A
  1. Pyramidal system (UMN and LMN)
  2. Cerebellum ( control fine movement)
  3. Basal ganglia
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4
Q

What is an example of hypo-kinetic movement disorder?

A

Parkinsonism

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5
Q

What is an example of hyperkinetic movement disorder?

A
  1. Tics
  2. MYoclonus
  3. Ballismus
  4. Dystonia
  5. Chorea
  6. Athetosis
  7. Tremor
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6
Q

Talk about parkinson’s disease

A

The most common major movement disorder
( tremor is the commonest)

Second most common neurodegenerative disorder after Alzheimer disease

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7
Q

What is the cause of Parkinson?

What is the age onset of parkinson?

A

Exact cause not known may be genetic predisposition

Age onset typically begins in the age group 50-60 years

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8
Q

What are the cardinal features of parkinson disease ?

A 
BRITish gentlemen
Bradykinesia 
Rigidity 
Instability (postural) 
Tremor ( resting)
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9
Q

What does the following indicates ?
Difficulty rising from chair ( take longer time)
In face :
Reduced frequency of blinking
Diminished facial animation (mask face ) = poker face

A

Bradykinesia

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10
Q

What most disabling symptom of PD?

A

Bradykinesia

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11
Q

Absent movement

A

Akinesia

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12
Q

Presents at rest and usually improves when affected limb performs
a motor tasks

A

Resting tremor

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13
Q

It is tremor that begins unilaterally
“ Pill-rolling” tremor in hands
Earliest clinical sign

A

Resting tremor

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14
Q

What sign indicate advanced stage of parkinson disease?

A

Postural instanility and gait disturbance

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15
Q

What indicate postural instability and gait disturbance ?

A
  1. Indicate advanced stage of PD
  2. Slight flexion of neck / trunk
Gait: 
Slow with short stride length 
Instability to turn quickly (big u turn to turn around) 
Reduced arm swing 
(Early feature)
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16
Q

What happens if u pull pt with parkinson?

A

When u pull pt with parkinson, he will take several steps and mostly will fall

When u push them from the back they will keep moving forward

Ask the patient to lean backs against your hands while u put your hands on the back, he will fall

Due push and pull test

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17
Q

What is rigidity ?

A

Increased resistance to passive movement

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18
Q

What indicates rigidity?

A
  1. Lead pipe ( sustained ) rigidity
    Constant throughout passive movement
  2. Cogwheel (intermittent) rigidity = lead pipe + tremor =

“Rigidity + resting”

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19
Q

Non-motor features of PD

A 
Depression 
Anxiety 
Psychosis 
Mild cognitive impairment 
Dementia 
REM 
And so on
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20
Q

How we diagnose parkinson

A

Presence of at least 2 out 4 cardinal features

Laboratory tests and imaging
Usually not necessary
To exclude secondary parkinsonism

Supported by response to dopaminergic drug

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21
Q

How we treat Parkinson’s disease?

A

Medications:
Dopamine replacement —> levodopa and dopamine agonists
Others Amanda dine and MAO-B inhibitors

Surgery —> deep brain stimulation

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22
Q

What is the difference between Parkinsonism and Parkinson’s disease

A

Parkinsonism: is a group of hypo kinetic movement disorders that have in common rigidity and bradykinesia
The most common is —> Parkinson’s disease

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23
Q

How we classify Parkinsonism?

A

Primary Parkinsonism
Secondary Parkinsonism
Atypical Parkinsonism syndromes

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24
Q

What is primary Parkinsonism?
What is secondary Parkinsonism?
What is atypical Parkinsonism?

A 
Primary Parkinsonism = Parkinson’s disease 
Secondary Parkinson’s = 
Infection 
Drugs 
Toxins 
Vascular 
Trauma 
Metabolic 
Atypical Parkinsonism?
Corticobasal degeneration (CBD) 
Progressive supranuclear palsy (PSP)
Multiple system atrophy (MSA)
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25
Q
  1. Sudden, repeated, brief movement
    Or
    Sudden, repeated, brief Sounds
  2. Can be voluntarily suppressed
  3. Stops or cease during sleep
A

Tics

26
Q 
It is a tics with 
More than 2 motor 
More than 1 vocal 
More than 1 year 
Need at least 2 motor + 1 vocal tics for more than 1 year
A

Tourette syndrome

27
Q

What are examples of motor tics?

A 
Blinking 
Grimacing 
Shoulder shrugging 
Kicking 
Odd gestures
28
Q

What are examples of vocal tics?

A

Coprolalia (profanities)
Echolalia (repeat what other say)
Palilalia (repeat own words)

29
Q

Meaning

Curse several times back to back

A

Coprolalia

30
Q

They repeat what others say

A

Echolalia

31
Q

They repeat their own words?

A

Palilalia

32
Q

It is a sustained involuntary muscular contraction —> fixed posture or repetitive twisting movement

A

Dystonia

33
Q

What are causes of dystonia?

A
  1. Idiopathic
  2. Genetic
  3. Medication adverse effect —> dopamine receptor blockers
  4. CNS disorders like trauma,stroke,etc = Basal ganglia damage
34
Q

How can we divide dystonia?

A

Focal
Generalized
Task specific

35
Q

Give examples of focal dystonia?

Give examples of task specific dystonia?

A

Focal dystonia?
A. Neck —> e.g. torticollis
B. Eyes —> e.g blepharospasm
C. Limb —> e.g foot dystonia

Task specific?

  1. Writer’s cramp
  2. Musician dystonia
  3. Throwing a ball
36
Q

Definition: a purposeful movement that suppresses the dystonia
Unique to dystonia

A

This is called sensory trick

37
Q

What are examples of sensory trick?

A

Touching back of head or side of face —> suppress torticollis
Running —> suppress leg dystonia
Placing object in mouth —> suppress orolingual dystonia
E.g chewing gum

38
Q

Sudden involuntary contraction or relaxation of muscles —> Brief shock-like jerks

A

Myoclonus (fastest hyperkinetic movement disorder)

39
Q

What are examples of myoclonus?

A

Positive myoclonus —> jerky movement
Negative myoclonus —> asterixis

Lesion can be cortical, subcritical, brain stem,spinal, peripheral nerve

40
Q

A rhythmic oscillation of a body part by alternating contraction of antagonist muscles

A

Tremor

41
Q

What are the parts affected in tremor?

A 
Hands 
Head 
Jaw 
Voice 
Tongue 
Lower limbs
42
Q

How we classify tremor?

A
  1. Resting tremor —> PD Parkinson’s disease
  2. Postural tremor —> e.g. holding arm outstretched against gravity
  3. Action tremor —> when start doing an action
    Essential tremor
    Intention tremor = cerebellar disease —> starts and gets worst as u get closer to the object
43
Q

Action/ postural tremor

Commonest movement disorder

A

Essential tremor

44
Q

How we diagnose essential tremor?

How we treat essential tremor?

A

Spiral drawing for diagnosis
Treatment:
Medication —> propranolol
Deep brain stimulation

45
Q

Irregular, involuntary, purposeless, non-rhythmic, unsustained movements that flow from one body part to another —> start in the hand go up to elbow then to shoulder

A

Chorea

46
Q

How patient try to camouflage it ?

A

By purposeful movement

47
Q

What are classical examples of chorea?

A

Huntington’s disease

Sydenham’s chorea

48
Q

What are causes of chorea?

A

Many but note:
Hereditary:
Dominant - Huntington’s disease
Recessive - Wilson’s disease

Others see in note

49
Q

Definition:

Large amplitude choroid movements of proximal parts of the limbic

A

Chorea

Note:
Chorea that come mostly from shoulder, hip

50
Q

Proximal high-amplitude flailing chorea limited to one side of the body

A

Hemi-ballism

51
Q

What is the commonest cause of hemi-ballism?

A

Stroke

52
Q

Is a slow continuous stream of sinuous, writhing movements, typically of the hands

A

Athetosis

53
Q

What happens if athetosis becomes faster?

A

It sometimes blends with chorea ; I.e. choreoathetosis or choreo-athetoid movements

Athetosis —> form of chore but it is slow

54
Q

Which of the following is a non-cardinal feature of Parkinson’s disease?

  1. Bradykinesia
  2. Postural instability
  3. Resting tremor
  4. Depression
A

Depression

55
Q

Suppressible, urge to move

A

Tics

56
Q

Rhythmic

A

Tremor

57
Q

Fast

A

Myoclonus

58
Q

Dancing like

A

Chorea

59
Q

Writhing, twisting, slow / is slow chorea

A

Athetosis

60
Q

Large amplitude, flailing/ is chorea of large muscles

A

Ballismus

61
Q

Sustained twisting of the body part

A

Dystonia

62
Q

BRITish gentleman

A

Parkinson’s disease

CNS CLINICAL MEDICINE (2 decks)

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