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Neurology > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

“Intention tremor” is another name for what condition?

A

Benign Essential Tremor

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2
Q

What is affected in benign essential tremors and what are spared?

A

Postural tremors: Involves both hands, head, or both

Legs are spared (usually only diaphragm and up)

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3
Q

What substance typically improves the benign essential tremor?

A

EtOH

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4
Q

What typically worsens/enhances the benign essential tremor?

A

Emotional stress

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5
Q

Inflammatory condition with an unknown cause, with multifocal demyelination of the white matter of the brain and spinal cord

A

Multiple Sclerosis

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6
Q

What demographic do you typically see multiple sclerosis?

A

Primarily disease of Caucasians or northern European descent (strong genetic component)

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7
Q

What age range is Multiple Sclerosis typically diagnosed/seen?

A

Typically found in the third decade (Ages 16-40)

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8
Q

Describe the pattern of Multiple Sclerosis

A

Relapsing-remitting pattern with chronic progressive course (Flare up then resolve)

Overall slowly getting worse over time

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9
Q

What are potential causes for relapse in MS?

A

Infection

Trauma

Pregnancy

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10
Q

What symptom(s) may be the first manifestation of Multiple Sclerosis?

A

Blurred, double, or loss of vision in a single eye

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11
Q

How is the diagnosis of Multiple Sclerosis made?

A

Clinical history, physical exam, and MRI findings

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12
Q

What is a key presentation of Multiple Sclerosis?

A

New neurological symptoms in a young person

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13
Q

List CSF Abnormalities seen in Multiple Sclerosis

A

Increased immunoglobulin levels (IgG)

Increased lymphocytes

Oligoclonal bands (Presence of bands are not specific as they are found in a variety of inflammatory neurological disorders)

Myelin basic protein may be elevated

Glucose usually normal

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14
Q

What imaging is preferred in multiple sclerosis?

A

MRI more sensitive than CT (Demonstrates plaques = Dawson’s fingers)

CT scan can still show plaques

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15
Q

Describe the MRI findings in multiple sclerosis

A

Hypointense “black holes” – permanent axonal damage (Black hole = dead tissue)

Hyperintense lesions are areas of inflammation - helps to identify new lesions

MS should not be diagnosed unless there is evidence of two or more
different regions of white matter that have been affected

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16
Q

Describe the condition Clinical Isolated Syndrome

A

A single clinical event looking like MS

Patient does not meet the criteria for MS

These patients are at risk for developing MS

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17
Q

How often do you monitor with MRI a patient with a clinical isolated syndrome event?

A

Follow up MRI every 6-12 months

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18
Q

What condition was previously known as Devic disease and once regarded as MS variant?

A

Neuromyelitis Optica

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19
Q

What finding can help tell apart Neuromyelitis Optica from Multiple Sclerosis?

A

white matter on MRI

MS will have white matter (Neuromyelitis Optica will not)

20
Q

What is the specific antibody marker for Neuromyelitis Optica?

A

NMO-IgG

21
Q

Adult onset neurodegenerative disorder of the extrapyramidal system

Dopamine depletion due to degeneration of dopaminergic nigrostriatal system leads to imbalance of dopamine and acetylcholine in the corpus striatum

A

Parkinsonism

22
Q

Parkinsonism is characterized by combination of these four cardinal signs:

A

Tremor at rest (pill rolling tremor)

Rigidity (cogwheeling)

Bradykinesia (difficulty initiating motion)

Progressive postural instability

23
Q

What is the treatment goal in Parkinsonism?

A

Get more dopamine to the brain

24
Q

What ethnic groups are most affected in Parkinsonism?

A

Occurs in all ethnic groups

25
Q

List the four potential causes of parkinsonism (category)

A

Idiopathic
Genetic
Toxin exposure
Drugs

26
Q

How does Parkinsonism progess?

A

Usually upper extremities, then as it progresses you’ll start to see LE involvement (shuffling for example)

27
Q

What are the first and second line treatment for Parkinsonism?

A

First line treatment – dopaminergics

Second line treatment - anticholinergics

28
Q

Chronic degenerative disorder of CNS that is an inherited autosomal dominant disorder

A

Huntington’s Disease

29
Q

What are the Characteristics (3 manifestations) of Huntington’s Disease?

A

Involuntary movements = chorea

Progressive cognitive deterioration = dementia

Psychiatric symptoms (Psychosis; suicide is common)

30
Q

What is the age of onset for Huntington’s Disease?

A

Onset age 30-50

Develops insidiously after age 30

31
Q

What is the prognosis for Huntington’s Disease?

A

Fatal outcome – 15 to 20 years prognosis

32
Q

What chromosome is affected in Huntington’s Disease?

A

Chromosome 4 affected

Atrophic caudate nucleus
GABA and Substance P decrease

33
Q

Inherited disorder with abnormal movements and postures that occurs sporadically or hereditary

Dystonic movements of head and neck may take the form of torticollis,
blepharospasm, facial grimacing, or forced opening and closing of mouth

A

Idiopathic Torsion Dystonia

34
Q

What is the genetic mutation in Idiopathic Torsion Dystonia?

A

Mutation of CAG deletion in dominantly inherited disorders

35
Q

What disorder is described below?

Spasmodic torticollis – neck twisting to one side

Onset 25-50 years of age

A

Focal Torsion Dystonia

36
Q

What is the treatment in Focal Torsion Dystonia?

A

Botulinum A toxin

37
Q

List some causes of Restless Leg Syndrome

A

Idiopathic

Pregnancy

Iron deficiency anemia

Peripheral neuropathy

Periodic leg movements of sleep

38
Q

Restless Leg Syndrome is a diagnosis of exclusion. True or False?

A

True

Almost a diagnosis of exclusion – work patients up for underlying issues

39
Q

What is the clinical presentation of Restless Leg Syndrome?

A

Restlessness and curious sensory disturbances that lead to urge the limbs to move

40
Q

Disorder of multiple motor (80%) and phonic tics that is associated with OCD

A

Tourette’s Syndrome

41
Q

When do symptoms of Tourette’s start?

A

Symptoms begin prior to age 21 years

Tics first noted between ages 2-15

42
Q

What is the initial manifestation of Tourette’s and the most commonly seen?

A

tics

Most commonly of face

43
Q

Imitation of others’ movements is called what?

A

Echopraxia

44
Q

Repetition of speech of others is called what?

A

Echolalia

45
Q

What is the drug of choice in acute Tourette’s Syndrome?

A

Haldol

46
Q

What is the disorder of impaired motor functioning and posture that occurs prenatally, antenatally or during first year and is non-progressive?

A

Cerebral Palsy

47
Q

What is the most common type of Cerebral Palsy?

A

Spastic diplegia (Normal intelligence)

Neurology (15 decks)

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