Movement disorders Flashcards
What can cause movement disorders?
- age-environment toxins
- genetic disorders
- medication
- metabolic
- parkinson’s dz-stroke
Ex of genetic disorders?
-Huntington dz-wilson dz
Types of movement disorders?
- ataxia
- dystonia
- tics
- tremor
- myoclonus
- chorea
- athetosis
What is trunkal ataxia?
-cannot stand on own-normal strength in arms and legs
What are tics?
- involuntary muscle contractions
- has a strong urge/sensation –> relieved by contraction
Tic categorized?
-simple-complex
Ex of tics?
- blinking
- clearing of throat
- facial twitching
- grunting
- shrugging
- sighing
Tic compressed?
-can but feels uncomfortable
Tremor?
- hyperkinetic disorder
- fast or slow
- symmetric/non-symmetric
Categorization of tremor?
-rest-essential/intension
Rest tremor?
-basal ganglia
Intention tremor?
-cerebellar
What is important to ask about tremors?
-start with one hand or both?
What is dystonia?
- long lasting muscle contraction
- sometimes painful
What is myoclonus?
- sudden, brief muscle contraction
- can be confused w/tic
Does rest tremor get go away?
-no, it gets better when doing something
What is chorea?
- may look like fidgeting
- involves distal extremities
- “irregular timed, non repetitive, complex motor movements, random, abrupt”
What is athetosis?
-involves distal extremities
Similarities of chorea and athetosis?
- restlessness
- exaggerated gestures
- may look like fidgeting
- dance like gait
What dz is chorea and athetosis related to?
Hunnington dz
Essential tremor:
age
time
what is it
age: 40-60yo
time: progressive
what is it: kinetic and postural (occurs w/ voluntary maintenance; shakes when doing something but no tremor at rest)
Essential tremor- neurological findings?
- bilateral
- improves w/ walking
- tone and reflexes are normal
- gait and balances are normal
Essential tremor - difference from Parkinson?
- no bradykinesis
- no rigidity
- no masked face
Essential tremor - worse/better?
worse: stress
better: drinking
Essential tremor - tx?
betablockers
Parkinson - patho?
lacking dopaminergic cells of the basal ganglia (substantia nigra)
Parkinson - RF?
age
Parkinson - timeline?
early: movement probs (tremor)
later: behavior, mental
progressive dz
Parkinson - non movement PE?
sleep distrubances progressive supranuclear palsy depression fatigue constipation *does not improve w/ tx
Parkinson - PE?
- bradykinesis
- tremor at rest
- rigidity
- postural instability
- mask like face
- shuffling gate
Parkinson - tremor?
resting tremor
“pill rolling”
+/- vocal cords
Parkinson - rigidity?
stiff, resistance like PASSIVE muscle movements
“lead pipe rigidity” - bending a lead pipe
“cogwheeling” - ratchet feeling
Parkinson - bradykinesis?
not able to get out chair/walking (cannot initiate first step)
not able to write (fine motor skills goes downhill)
Parkinson - postural instability?
not able to walk/sit
arms not swinging as walking
Parkinson - labs?
nothing - clinical dx
r/o: CT/MRI/CSF: NORMAL
Parkinson - tx?
dopamine (dopamine agonist)
- levodopa
surgery
Tourette’s syndrome - sx?
- vocal/motor tics
- usually childhood
- linked w/ personality and physical
- many times a day
- best to see in corner of eye b/c they can suppress it (though it’s uncomfortable)
Tourette’s syndrome - timeline?
age 5: simple motor tics (blinking)
age 7: complex (snorts, shrugs)
age 14: violent head shake, vocals involved
age 17: subtle head shake, abdominal tense
Tourette’s syndrome - sx mental?
obsessive
compulsive behaviors
-rage attack
Transient tics?
-in childhood and goes away on its own
Huntington’s dz - timeline?
early behavioral changes (irritability, depression, apathy)
usually not until 30-40yo (but can be juvenile - 21yo)
subtle motor changes (restlessness, coordination probs, gait abnormalities)
Huntington dz - RF?
autosomal dominant
*be careful for suicide in pts and FH
Huntington dz - dx?
gene probe
Huntington dz - tx?
symptomatic - life expectancy 15-20 yrs after diagnosis
Restless leg syndrome - sx?
pt is restless when legs are at rest - esp at night "paresthesias" "dysesthesias" leg kicks while sleeping NORMAL neurologic examination
Restless leg syndrome - labs?
CBC - check iron
if anemic, tx anemia RLS might go away
Restless leg syndrome - dx?
1) urge to move legs
2) rge worse at night
3) legs»_space;> arms
4) sx, walk, sx again
Restless leg syndrome - tx?
lifestyle changes: avoid caffeine, exercise, hot baths
no med tx
Tardive dyskinesia - RF?
too much dopminergic antagonist properties
long term/HD anitpyschotics
schizophrenic/bipolar pts
elderly pts on potent meds
Tardive dyskinesia - sx?
smacking of lips
pursing of lips
rapid eye blinking
athetosis of fingers/toes
Tardive dyskinesia - tx?
remove drug
Tardive dyskinesia - prevention?
start of low and go slow/short (dopamine antagonist)
