Movement Disorders

Question 1

Huntington’s Disease

Answer 1

Genetic AD-needed to diagnose

chorea and dementia

Question 2

Circuit anatomy and physiology

Answer 2

Loop

1. Starts at motor cortex
2. Then to basal ganglia
3. Back to motor cortex
4. Final motor output: pyramidal and other tracts

Subthalamic nucleus linked to globus pallidus
Substantia nigra (dopamine outputs)

Question 3

Parkinsons patho

Answer 3

dopamine output to putamen is problem

Question 4

3 core features Parkinsons

Answer 4

1. slowness (bradykinesia)
2. shaking (tremor: resting)
3. stiffness (rigidity-cogwheel)
4. Postural hypotension

Question 5

Description Parks

Answer 5

Older patient
Starts unilateral, tremor in one hand
Degenerative
No UMN signs
Responds to L-dopa

Question 6

Non-motor features Parkinsons

Answer 6

1. REM Behaviour Disorder
2. Hyposmia
3. Constipation
4. Hypersomnia
5. Pain
6. Depression/Anxiety

Question 7

Bradykinesia:

Answer 7

Loss of automatic movements
shuffling gait
freezing gait
masked facies
small hand writing
finger tapping test slow

Question 8

Rigidity

Answer 8

Poor arm swing, flexed posture, freezing gait

Question 9

Resting tremor

Answer 9

Pill rolling

STOPS WITH ACTION

Question 10

Gait

Answer 10

Festinating

Question 11

Other neurological disorders that have parkinsonism

Answer 11

Multi-system atrophy
Progressive supranuclear palsy
other degen
other metabolic

Question 12

Drug management Parkinsons

Answer 12

anti-cholinergic (treats tremor)
main: increase dopamine via L-dopa (given with enzyme inhib to concentrate the production of dopamine in CNS instead of blood)
dopamine agonists

Question 13

Non drug management Parks

Answer 13

constipation
acting out ones dreams: RBD
Physical exercise

Question 14

Huntingtons

Answer 14

Too much dopamine
hyperkinetic movement disorder

chorea: fast, jerky, semipurposeful movements: face, limbs, trunk , gait
Looks fidgety and dystonic (grimace)
May look ataxic (but not actually coordination problem)
Can’t keep arms in steady extension or maintain a protruded tongue

Question 15

How many trinucleotide repeats in Huntingtons

Answer 15

More than 39
Autosomal Dominant
European
Chorea initially (facial tics, grimacing, dancing feet), then motor problems
Psychiatric behavioural problems, paranoia and hallucinations then dementia

Question 16

Other causes of chorea

Answer 16

Drugs
Pregnancy
SLE
Thyrotoxicosis
RHD
Metabolic neurodegen. disorders

Question 17

Essential tremor

Answer 17

worse with movement

Question 18

side effect Ldopa

Answer 18

postural hypotension