Movement Disorders

Question 1

Examples of hyperkinetic movements

Answer 1

Chorea, hemiballismus, athetosis, myoclonus, choreoathetosis

Question 2

What are chorea movements

Answer 2

Brief irregular fleeting jerky / fidgety involuntary movements

Question 3

What are hemiballismus movements

Answer 3

Unilateral violent rapid and involuntary movements

Question 4

What are athetosis movements

Answer 4

slow, sinuous, writing involuntary movements (combination of dystonia and chorea)

Question 5

What are dystonic movements

Answer 5

Sustained involuntary contractions of opposing muscle groups producing abnormal posture

Question 6

Common causes of Parkinsonism

Answer 6

Idiopathic, drug induced, neurodegenerative disorders, lower-body parkinsonism, genetic disorders, toxic or metabolic disease, hydrocephalus

Question 7

Drugs which can cause Parkinsonism

Answer 7

neuroleptics, antiemetics, antipsychotics (dopamine antagonists)

Question 8

Genetic disorders which can cause Parkinsonism

Answer 8

Wilsons disease, Spino-cerebellar ataxia, Huntingtons disease

Question 9

Neurodegenerative causes of Parkinsonism

Answer 9

Multiple systems atrophy, progressive supranuclear palsy, corticobasal degeneration syndrome

Question 10

What is multiple systems atrophy

Answer 10

Progressive akinetic-rigid syndrome with early prominent autonomic failure with cerebellar and UMN symptoms

Question 11

Sympatoms of multiple systems atrophy

Answer 11

Early gait instability and postural hypotension, and occasionally sleep-disordered breathing with inspiratory stridor, coat hanger pain and preserved cognition

Question 12

What is supranuclear palsy

Answer 12

Progressive akinetic-rigid syndrome with prominent eye signs and bradyphrenia

Question 13

Supranuclear gaze palsy

Answer 13

inability to generate voluntary saccadic eye movements, often associated photophobia and bledpharospasm

Question 14

Symptoms of supranuclear gaze palsy

Answer 14

Early gait instability and falls, later frontal dementia, and prominent eye signs

Question 15

Types of dystonia

Answer 15

Generalised or focal

Question 16

Common causes of dystonia

Answer 16

Drugs (neuroleptics), Parkinsons, genetic (Wilsons, primary DYT1 dystonia), idiopathic - mainly focal dystonias

Question 17

Treatment of dystonias

Answer 17

Drugs such as trihexyphenidyl, local botulinum toxin, DBS

Question 18

Different types of tremor

Answer 18

Benign essential / postural tremor, dystonic tremor, enhanced physiological tremor, parkinsonian rest tremor, cerebellar tremor, neuropathic tremor, tremor secondary to MS, primary orthostatic

Question 19

Treatment of benign essential / postural tremor

Answer 19

Beta blockers, primidone

Question 20

What type of tremor is cerebellar tremor

Answer 20

Intention type

Question 21

Causes of chorea

Answer 21

Huntington’s, benign hereditary chorea, idiopathic ‘senule’ chorea, endocrine causes, autoimmune causes, drug causes and lacunar infarct

Question 22

Drug causes of chorea

Answer 22

Neuroleptics, levadopa, COCP, stimulants

Question 23

Treatment of chorea

Answer 23

Treat underlying cause/adjust medication, neuroleptics, tetrabenezine

Question 24

Causes of acute or subacute ataxia

Answer 24

Acute alcohol intoxification, infarct, haemorrhage, primary or secondary neoplasm, MS, meningitis/encephalitis, paraneoplatic syndrome, Wernicke’s encephalopathy, drugs (phenytoin/lamotrigine intoxification)

Question 25

Causes of chronic ataxia

Answer 25

Alcoholic degeneration, idiopathic degeneration, MS, low-grade tumour, hypothyroidism, Prion disease, hereditary