movement disorders Flashcards
where is wernickes area + what blood vessel supplies it
superior temporal gyrus - left MCA
symptoms wenickes aphasia
receptive aphasia - sentences do not make sense and comprehension impaired
where is brocas area + what blood vessel supplies it
inferior frontal gyrus - left MCA
symptoms brocas aphasia
expressive aphasia - fluint is laboured and halting, comprehension normal
area affected in conduction aphasia
arcuate fasculus (connects wernickes and brocas)
symptoms conduction aphasia
speech is fluent but repetition poor, aware of errors, comprehension normal
symptoms global aphasia
laboured and halting aphasia that does not make sense, comprehension impaired
what is ataxia
problems with coordination, balance and speech - originate in cerbellum
which part of cerebellar causes peripheral ataxia eg fnger nose
hemisphere
which part of cerebellar causes gait ataxia
vermis
inheritance friedreich’s ataxia + gene
recessive, GAA repeat on chromosome 9, does not demonstrate anticipation
age of onset and symptoms friedreich’s ataxia (7)
10-15 // absent ankle jerk or plantars //cerebellar ataxia // optic atrophy //spinocerebellar tract degen // HCOM // DM // high arch palate
ataxia telangiectasia inheritance
recessive, defect in ATM gene
symptoms and onset ataxia telangiectasia i
age 1-5 // cerebellar ataxia // telangiectasia // IgA def –> chest infection // risk of malignancy
what type of immunodeficiency is ataxia telangiectasia i
combined
what are action/ postural tremors
worse with arms outsretched, absent at rest
what can cause active tremours
anxiety, alcohol, withdrawal, benign essential tremor, thyrotoxicosis, drugs eg salbutamol, coffee
what hz are active tremors
always below 13Hz
inheritance benign essential tremor
autosomal dominant
symtoms benign essential tremor
bilateral postural tremor (worse with out stretched hands) - most common head tremor
what relieves benign essential tremor
alcohol and rest
mx benign essenital tremor
beta blockers
what can cause postural active tremors
anxiety, alcohol, withdrawal, benign essential tremor, thyrotoxicosis, drugs eg salbutamol, coffee
what can cause intention tremors
worse with movement - cerebellar disease
parkinsons tremor
resting - better with movement, pin-rolling, bradykinesia
what is dystonia
involuntary, sustained muscle contractions that result in abnormal postures and twisting
what is focal dystonia and examples
limited to one muscle group - cervical neck torticollis // eye blephospasm // jaw clenching (trismus)
mx focal dystonia
botox injection
what usually causes generalised dystonia
genetic autosomal dominant condition
mx generalised dystonia
anticholergics eg procyclidine
what drugs usually cause acute dystonia
metoclompramide, antiphysotics
mx acute dystonia
anticholergics eg procyclidine
what is chorea
non-rythymical, irregular, jerky movements randomly distributed eg facial grimacing, writhing of shoulder, rapid finger movement
what can cause chorea
huntingtons, wilsons, sydenhams
what inheritance and mutation is huntingtons
CAG expansion chromsome 4 - autosomal dominant // genetic anticipation
pathology huntingtons
atrophy basal ganglia + caudate nucleus –> frontal and parietal atrophy
when does huntingtons present and what is the triad
40s: emotional cognitive and motor disturbance
early huntington symptoms
depression, clumsiness, chorea
late huntington symptoms
chorea, dementia, dysphagia and aphasia
mx huntingtons
tetrabenazine
what is sydenhams chorea + what usually causes it
strep throat –> rheumatic fever –> chorea in children
what is restless leg symptoms
uncontrollable urge to move leg, occur at night, worse at rest // parasthesia
assoc with restless leg
FH // iron deficiency // uraemia // DM // pregnant
invx restless leg
ferritin to exlude anaemia
mx restless leg
walking, massage // 1 = dopamine agonist, 2 = benzos or gabapentin
