movement disorders Flashcards
what is the most common cause of a resting tremor
parkinsons disease
what is a cause of a postural tremor
essential tremor
what is the general cause of a kinetic tremor
cerebellar disorder
what is a kinetic tremor
occurs during movement towards a target and becomes more pronounced as the person reaches the endpoint of the movement
what is another name for a kinetic tremor
intention tremor
what is parkinsons disease
a progressive neurodegenerative movement disorder
what is the biggest risk factor for parkinsons
advancing age
what is the median age of onset for parkinsons
60
who is more likely to be affected by parkinsons
men
name 2 genes that have been linked to parkinsons
LRRK2
PARKIN
disease onset - death for parkinsons
15 years
what causes parkinsons (3)
degeneration of neurons in the pars compacta region of the substantia nigra
decrease in dopamine in the basal ganglia
causes greater inhibition of the motor system
neuro-histological hallmark of parkinsons
lewy bodies
classic triad of features in parkinsons
resting tremor
rigidity
bradykinesia
what is bradykinesia
slowness of movement with progressive loss of amplitude or speed
how is tremor in parkinsons often described
pill-rolling
how is rigidity in parkinsons often described and why
lead pipe - present throughout the range of movement and isn’t dependent on speed of movement
or cogwheel
describe gait in parkinsons
shuffling (festinating), stooped posture
name some other features of parkinsons
handwriting gets smaller, reduced facial movements and expressions
depression, sleep disturbance, anosmia
issues with speech and swallowing
what is anosmia
loss of sense of smell
what is a common terminal event in parkinsons
swallowing difficulty leading to aspiration pneumonia
what features are needed for a diagnosis of parkinsons
bradykinesia +1 of the following
- resting tremor
- rigidity
- postural instability
what scan is not necessary, but can be helpful when diagnosing parkinsons
DaTSCAN
what confirms a diagnosis of parkinsons
dopamine responsiveness
main drug used for symptom management of parkinsons
levodopa
what is a parkinson-plus syndrome
syndromes that present as parkinsonism + additional clinical features
what are the 4 parkinson-plus syndromes
progressive supranuclear palsy
multiple system atrophy
cortico-basal syndrome
lewy body dementia
what are the symptoms of progressive supranuclear palsy
parkinsonism +
early instability and frequent falls
impairment of vertical gaze
stiff, broad-based gate
characteristic MRI finding of progressive supranuclear palsy and what it is
hummingbird sign - shape of midbrain atrophy
what triad of symptoms is usually associated with multiple system atrophy
dysautonomia, cerebellar features and parkinsonism
name some cerebellar features of multiple system atrophy
incoordination
wide-based gait
action tremors
unusual eye movements
what causes a parkinsons presentation in multiple system atrophy
degeneration of the basal ganglia
characteristic MRI finding of multiple system atrophy and what it is
hot cross bun sign - cerebellar and pontine atrophy
what are common features of lewy body dementia
parkinsonism
- early changes in attention and executive function
- visual hallucinations
- less involvement with memory
what is the proposed pathophysiology of lewy body dementia
early death of dopaminergic neurons in the cerebrum, which extends to the basal ganglia (leading to motor symptoms)
motor symptoms associated with cortico-basal syndrome
asymmetric rigidity, akinesia and dystonia
cortical sensory loss, apraxia
what phenomena is associated with cortico-basal syndrome and what is it
alien limb
limb behaves as if it has a will of its own
what is akinesia
lack of movement
what is cortical sensory loss
patients cannot recognise objects by touch despite normal sensory input
what is apraxia
difficulty with purposeful movement despite intact motor function
name 3 other conditions that mimic parkinsonism
vascular parkinsonism
wilson’s disease
drug-induced parkinsonism
what is affected in vascular parkinsonism
the lower limbs - rigidity and bradykinesia
what is another name for dementia pugilistica
chronic traumatic encephalopathy
who usually presents with dementia pugilistica
boxers - repetitive head trauma
who do we need to consider drug-induced parkinsonism in
patients on antipsychotics (haloperidol, risperidone), metoclopramide and prochlorperazine
presentation of drug-induced parkinsonism
rapid and bilateral
coarse postural tremor
what is a complication of drug induced parkinsonism
neuroleptic malignant syndrome
management of drug induced parkinsonism
STOP DRUG
procyclidine
what is wilsons disease
disorder of copper metabolism, where it is deposited in the basal ganglia, cornea and liver
inheritance seen in wilsons disease
autosomal recessive
ocular signs of wilsons disease
kayser-fleischer rings and sunflower cateracts
neurological symptoms of wilsons disease
akinetic-rigid syndrome
pseudosclerosis dominated by tremor (coarse and flapping)
ataxia
dystonia
who should we consider wilsons disease in
patients below 50 who present with a hyperkinetic movement disorder or liver cirrhosis
hepatic signs of wilsons disease
liver failure
coomb’s negative haemolytic anaemia
jaundice
