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Neuro > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

How would Parkison’s Disease be defined

A

A chronic, idiopathic, progressive neurodegenerative movement disorder where symptoms continue to worsen over time

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2
Q

Describe the etiology of Parkinson’s

A
  • loss of dopaminergic neurons in the substantia nigra (excessive inhibition of the thalamus leads to reduced cortical motor activation)
  • loss of melanin from the pars compacta
    +/- the presence of lewy bodies
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3
Q

What are the cardinal signs of Parkinson’s

A

- resting tremor
- cogwheel rigidity
- bradykinesia
- postural instability

other syx include: intrinsic muscle issues, stiffness, voice fluctuations, instability, micrographia, stooped/flexed posture, propulsion/retropulsion

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4
Q

How do symptoms of Parkinson’s typically start

A

unilateral tremor

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5
Q

What are some characteristics of Parkinson’s that may be seen on physical exam

A
  • pill rolling, resting tremor
  • bradykinesia, gait impairment
  • postural reflexes impaired
  • ask about onset of symptoms and progression
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6
Q

What is the difference between Parkinsonism and Parkinson’s Disease

A

Parkinsonism = 2 or 3/4 cardinal signs

Parkinson’s Disease = 4/4 cardinal signs

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7
Q

What diagnostic testing may be done in Parkinson’s disease

A
  • no specific biomarker
  • Lewy bodies may be seen on MRI
  • olfactory testing
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8
Q

Describe the treatment of Parkinson’s Disease

A
  • provide symptom relief
  • levodopa-carbidopa
  • Entacapone (COMT Inhibitors)
  • MAO-B inhibitors
  • Anticholinergics
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9
Q

What are some hyperkinetic disorders

A
  • essential tremor
  • dystonia
  • Huntington’s Disease
  • Wilson’s Disease
  • Tardive Dyskinesia
  • Restless leg syndrome
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10
Q

Etiology of essential tremor

A
  • sporadic or familial (autosomal dominant)
  • most common movement disorder
  • onset childhood to elderly (usually 45)
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11
Q

What is the clinical presentation of essential tremor

A

-postural tremor with/without kinetic component
- tremor only
- bilateral and symmetric, usually upper extremity
- normal muscle tone

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12
Q

What may improve essential tremor symptoms

A

alcohol, only for 30-60 mins

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13
Q

What is the major differential for essential tremor

A

Wilson’s disease

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14
Q

What is the first line treatment for essential tremor

A

beta blockers: propranolol

refer to neuro if contraindicated for benzos

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15
Q

Define tremor

A

involuntary rhythmic oscillating movement of a body part secondary to intermittent muscle contraction

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16
Q

Describe the handwriting effects of essential tremor

A

gets bigger, shaky, no resting tremor

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17
Q

Describe the pathophys of dystonia

A

primarily unknown
- basal ganglion dysfunction
- excitability of motor cortex

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18
Q

Describe the 3 types of dystonia

A
  • primary
  • focal (MC)
  • secondary (drugs, neuro disorders)
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19
Q

Describe the major types of focal dystonia

A
  • blepharospasm
  • oromandibular dystonia
  • spasmodic dysphonia
  • cervical dystonia
  • limb dystonias
20
Q

describe the clinical presentation of dystonia

A

worse with emotional/physical stress or fatigue, decreases with sleep and rest

21
Q

Describe the diagnostic process for dystonia

A
  • rule out parkinson’s and Wilson’s
22
Q

Describe the management of dystonia

A
  • levodopa first line
  • muscle relaxers, pumps, botox, baclofen, DBS
23
Q

Describe the etiology of Huntington’s

A

progressive neurodegenerative disorder of the CNS - atrophy of the caudate nucleus head, putamen, cerebral cortex
- autosomal dominant

24
Q

Is Parkinson’s direct or indirect pathway?

A

direct

25
Q

Huntington’s - direct or indirect pathway?

A

indirect

26
Q

Tourette Syndrome - direct or indirect?

A

Indirect pathway

27
Q

Wilson’s Disease - direct or indirect pathway

A

Direct pathway

28
Q

Describe the common symptoms of Huntington’s

A

- chorea
- rigidity
- psychiatric
- progressive dementia
- seizures

29
Q

Diagnostics for Huntington’s

A
  • clinical
  • MRI, genetic testing
30
Q

treatment of huntingtons

A

symptom releif
- anti-choreic (tetrabenazine
- psychiatric treatment

31
Q

survival of huntingtons

A

10-30 years
- death commonly due to pulmonary issues, sepsis

32
Q

Etiology of Wilson’s disease

A
  • autosomal recessive
  • dysfunction of copper metabolism
33
Q

Symptoms of Wilsons

A
  • copper rings in cornea
  • speech disorder, extrapyramidal syx
34
Q

Diagnosis of wilson’s

A

slit lamp (copper rings in cornea), ceruloplasmin levels

35
Q

treatment of wilson’s

A

chelating agents to bind and remove copper

36
Q

Tardive dyskinesia etiology

A

commonly severe and secondary to antipsychotic drugs

months to years

37
Q

symptoms of tardive dyskinesia

A
  • extrapyramidal symptoms: restlessness, dystonia, parkinsonism, chorea
38
Q

etiology of restless leg syndrome

A
  • limbs associated with sleep complaint
  • W>M
39
Q

symptoms of restless leg

A

involuntary forceful dorsiflexion of foot, sleep disturbance, fatigue, repetitive periodic jerking

pins and needles, internal itch, creeping crawling

40
Q

diagnostics for restless leg

A

- CBC with diff
- iron panel
- BUN
- Blood gluc
- TSH
- Vitamin B12
- folate

41
Q

treatment of restless leg

A

First line: dopaminergic agents (ropinirole)
- clonidine
- iron supplementation
- education and sleep hygeine

42
Q

What condition is this

A

huntington’s

43
Q

what might this disease be characterized by

A

tardive dyskinesia

44
Q

Which diseases of the basal ganglia affect the direct pathway

A
  • parkinson’s disease
  • Wilson’s disease
  • Essential tremor
  • bradykinesia/akinesia
45
Q

Which diseases of the basal ganglia affect the indirect pathway

A
  • Huntington’s disease
  • Hemiballism
  • Tics
  • Dystonia
  • Myoclonus
  • Tardive dyskinesia

Neuro (22 decks)

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