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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
1. Sudden, repeated, brief movement Or Sudden, repeated, brief Sounds 2. Can be voluntarily suppressed 3. Stops or cease during sleep
Tics
26
``` 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 ```
Tourette syndrome
27
What are examples of motor tics?
``` Blinking Grimacing Shoulder shrugging Kicking Odd gestures ```
28
What are examples of vocal tics?
Coprolalia (profanities) Echolalia (repeat what other say) Palilalia (repeat own words)
29
Meaning | Curse several times back to back
Coprolalia
30
They repeat what others say
Echolalia
31
They repeat their own words?
Palilalia
32
It is a sustained involuntary muscular contraction —> fixed posture or repetitive twisting movement
Dystonia
33
What are causes of dystonia?
1. Idiopathic 2. Genetic 3. Medication adverse effect —> dopamine receptor blockers 4. CNS disorders like trauma,stroke,etc = Basal ganglia damage
34
How can we divide dystonia?
Focal Generalized Task specific
35
Give examples of focal dystonia? | Give examples of task specific dystonia?
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
Definition: a purposeful movement that suppresses the dystonia Unique to dystonia
This is called sensory trick
37
What are examples of sensory trick?
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
Sudden involuntary contraction or relaxation of muscles —> Brief shock-like jerks
Myoclonus (fastest hyperkinetic movement disorder)
39
What are examples of myoclonus?
Positive myoclonus —> jerky movement Negative myoclonus —> asterixis Lesion can be cortical, subcritical, brain stem,spinal, peripheral nerve
40
A rhythmic oscillation of a body part by alternating contraction of antagonist muscles
Tremor
41
What are the parts affected in tremor?
``` Hands Head Jaw Voice Tongue Lower limbs ```
42
How we classify tremor?
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
Action/ postural tremor | Commonest movement disorder
Essential tremor
44
How we diagnose essential tremor? | How we treat essential tremor?
Spiral drawing for diagnosis Treatment: Medication —> propranolol Deep brain stimulation
45
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
Chorea
46
How patient try to camouflage it ?
By purposeful movement
47
What are classical examples of chorea?
Huntington’s disease | Sydenham’s chorea
48
What are causes of chorea?
Many but note: Hereditary: Dominant - Huntington’s disease Recessive - Wilson’s disease Others see in note
49
Definition: | Large amplitude choroid movements of proximal parts of the limbic
Chorea Note: Chorea that come mostly from shoulder, hip
50
Proximal high-amplitude flailing chorea limited to one side of the body
Hemi-ballism
51
What is the commonest cause of hemi-ballism?
Stroke
52
Is a slow continuous stream of sinuous, writhing movements, typically of the hands
Athetosis
53
What happens if athetosis becomes faster?
It sometimes blends with chorea ; I.e. choreoathetosis or choreo-athetoid movements Athetosis —> form of chore but it is slow
54
Which of the following is a non-cardinal feature of Parkinson’s disease? 1. Bradykinesia 2. Postural instability 3. Resting tremor 4. Depression
Depression
55
Suppressible, urge to move
Tics
56
Rhythmic
Tremor
57
Fast
Myoclonus
58
Dancing like
Chorea
59
Writhing, twisting, slow / is slow chorea
Athetosis
60
Large amplitude, flailing/ is chorea of large muscles
Ballismus
61
Sustained twisting of the body part
Dystonia
62
BRITish gentleman
Parkinson’s disease

CNS CLINICAL MEDICINE (2 decks)

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