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aNeuro Exam 3- Lindsey's > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

Dx?

  • dementia
  • diffuse Lewy body distribution
  • extralimbic cortices, brainstem, amygdala, and limbic cortices affected
A

Diffuse Lewy Body Disease

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2
Q

What is hemiparetic gait?

A
  • unilateral UMN injury
  • arm flexion, adduction, internal rotation on affected side
  • leg extension, plantar flexion when walking
  • hold arm to one side and drag affected leg in semicircle
  • ex: hemispheric stroke
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3
Q

Patients with truncal ataxia due to damage of the ______ have difficulty with gait tests.

A

cerebellar vermis or assoc. pathways

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4
Q

How can speech be used to test CN7?

A

have the pt repeat “PaPaPa” test

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5
Q

These are problems with synergistic mvmt- disruption of smooth trajectories of mvmts - disorders of the cerebellum

A

ataxia

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6
Q

What does having the pt repeat “PaPaPa” test?

A

CN7

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7
Q

What are the hallmarks of Multiple System Atrophy?

A
  • parkinsonism
  • progressive ataxia
  • dysautonomia (Shy-Drager syndrome)
  • degeneration of: striatonigra, pontocerebellum, intermediolateral columns
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8
Q

Gait dx?

  • foot drop
    • unilateral = peroneal nerve palsy, L5 radiculopathy
    • bilateral = ALS, Charcot-Marie-Tooth, DM
A

neuropathic gait

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9
Q

What does having the pt repeat “KaKaKa” test?

A

CN10

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10
Q

What are the signs of a cerebellar disorder?

A
  • ataxia
  • dysmmetria
  • dysdiadochokinesia
  • decomposition of mvmt
  • disequilibrium
  • hypotonia
  • action tremor
  • nystagmus
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11
Q

Where does the lesion lie, given these signs:

  • tremor (usu resting)
  • rigidity
  • bradykinesia
  • chorea
  • athetosis
  • akathisia
A

basal ganglia

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12
Q

Patients with _____ due to damage of the cerebellar vermis or assoc. pathways have difficulty with gait tests.

A

truncal ataxia

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13
Q

Gait Dx?

  • basal ganglia disorders
  • irregular, jerky, involuntary mvmts in all extremities
  • ex: Huntington’s disease
A

choreiform gait

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14
Q

What are the hallmarks of progressive supranuclear palsy?

A
  • akinesia, rigidity, dysarthria, dysphagia
  • frontotemporal dementia
  • neurofibrillary tangles in pallidum, subthalamic nucleus, substantia nigra, or pons
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15
Q

How are vestibular, cerebellar, and proprioceptive contributions to balance with vision removed?

A

the Romberg test

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16
Q

What does having the pt repeat “LaLaLa” test?

A

CN12

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17
Q

What does a positive pronator drift test indicate?

A

Either:

  • dysfunctional pyramidal tract (contralateral cortex)
  • parietal lobe dysfunction (contralateral)
  • cerebellar disease (ipsilateral)
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18
Q

Where does the lesion lie, given these signs:

  • ataxia
  • dysmmetria
  • dysdiadochokinesia
  • decomposition of mvmt
  • disequilibrium
  • hypotonia
  • action tremor
  • nystagmus
A

cerebellum

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19
Q

Dx?

  • adult onset
  • auto. dominant
  • choreiform mvmt disorder –> akinetic and rigid
  • variable dementia
  • chromosome 4
  • CAG repeats in Huntingtin protein
  • atrophy of neostratium (esp ant. caudate and dorsal putamen)
A

Huntington’s Disease

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20
Q

What is sensory gait?

A
  • loss of proprioceptive input
  • slamming foot to the ground
  • disorders of dorsal columns
  • ex: B12 deficiency, uncontrolled DM
21
Q

What is bradykinetic gait?

A
  • rigidity and bradykinesia
  • stooped posture w/ head and neck forward
  • flexion @ the knees
  • “marche a petits pas”
  • steps festination
  • difficulty initiating steps
  • ex: Parkinson’s/parkinsonisms
22
Q

Gait dx?

  • unilateral UMN injury arm flexion, adduction, internal rotation on affected side
  • leg extension, plantar flexion when walking
  • hold arm to one side and drag affected leg in semicircle
  • ex: hemispheric stroke
A

hemiparetic gait

23
Q

What are the features of Fredreich’s Ataxia?

A
  • onset before 20yo
  • auto. recessive
  • Chromosome 9 GAA repeats in frataxin protein
  • limb ataxia, dysarthria, loss of distal position and vibration sense, upper limb wasting, areflexia, UMN-like lower extremity weakness
  • loss of neurons in dorsal root ganglia –> loss of peripheral sensory fibers and dorsal columns; loss of cerebellar afferents and efferents
24
Q

What is ataxic gait?

A
  • cerebellar disease
  • clumsy, staggering mvmts with a wide-based gait
  • titubation
  • inability to heel-toe walk or walk in straight line
25
Q

Gait Dx?

  • rigidity and bradykinesia
  • stooped posture w/ head and neck forward
  • flexion @ the knees
  • “marche a petits pas”
  • steps festination
  • difficulty initiating steps
  • ex: Parkinson’s/parkinsonisms
A

bradykinetic gait

26
Q

Dx?

  • onset before 20yo
  • auto. recessive
  • Chromosome 9 GAA repeats in frataxin protein
  • limb ataxia, dysarthria, loss of distal position and vibration sense, upper limb wasting, areflexia, UMN-like lower extremity weakness
  • loss of neurons in dorsal root ganglia –> loss of peripheral sensory fibers and dorsal columns; loss of cerebellar afferents and efferents
A

Fredreich’s Ataxia

27
Q

This is an impairment in rapid alternating movements; a cerebellar disorder.

A

dysdiadochokinesia

28
Q

What is ataxia?

A
  • problems with synergistic mvmt
  • disruption of smooth trajectories of mvmts
  • disorder of the cerebellum
29
Q

Dx?

  • onset in 50-60s
  • clumsy, stiff –> rigid, akinetic
  • alien limb phenomenon
  • apraxia, sensorimotor disturbances, frontotemporal dementia
  • tau-immunoreactive inclusions in substantia nigra, locus cereleus, tegemental and raphe nuclei
A

Corticobasal Degeneration (CBD)

30
Q

What is diplegic gait?

A
  • bilateral periventricular lesions
  • spasticity in lower extremities
  • walk w/ abnormally narrow base, dragging both legs and scraping the toes
  • extreme tightness of hip adductors –> legs cross the midline (scissoring gait)
  • ex: cerebral palsy
31
Q

How can speech be used to test CN12?

A

have pt repeat “LaLaLa”

32
Q

What is dysdiadochokinesia?

A
  • an impairment in rapid alternating movements
  • a cerebellar disorder
33
Q

What is dysmetria?

A
  • past pointing/overshoot
  • a subtype of ataxia
  • a cerebellar disorder
34
Q

What does the Romberg test assess?

A

vestibular, cerebellar, and proprioceptive contributions to balance with vision removed

35
Q

What are the signs of a basal ganglia disorder?

A
  • tremor (usu resting)
  • rigidity
  • bradykinesia
  • chorea
  • athetosis
  • akathisia
36
Q

What are the hallmarks of Huntington’s Disease?

A
  • adult onset
  • auto. dominant
  • choreiform mvmt disorder –> akinetic and rigid
  • variable dementia
  • chromosome 4
  • CAG repeats in Huntingtin protein
  • atrophy of neostratium (esp ant. caudate and dorsal putamen)
37
Q

Gait Dx?

  • cerebellar disease
  • clumsy, staggering mvmts with a wide-based gait
  • titubation
  • inability to heel-toe walk or walk in straight line
A

ataxic gait

38
Q

What are the hallmarks of Diffuse Lewy Body Disease?

A
  • dementia
  • diffuse Lewy body distribution
  • extralimbic cortices, brainstem, amygdala, and limbic cortices affected
39
Q

What are the 8 categories of gait disorders?

A
  1. hemiparetic
  2. diplegic/paraparetic
  3. neuropathic
  4. myopathic
  5. bradykinetic
  6. choreiform
  7. ataxic
  8. sensory
40
Q

Both ____ and _____ demonstrate alpha-synuclein accumulations (synucleinopathies), but the accumulations are in different parts of the brain and intracellular loci.

A
  • Parkinson’s
  • Multiple systems atrophy
41
Q

What are the hallmarks of Corticobasal Degeneration (CBD)?

A
  • onset in 50-60s
  • clumsy, stiff –> rigid, akinetic
  • alien limb phenomenon
  • apraxia, sensorimotor disturbances, frontotemporal dementia
  • tau-immunoreactive inclusions in substantia nigra, locus cereleus, tegemental and raphe nuclei
42
Q

What is neuropathic gait?

A
  • foot drop
  • aka Steppage or Equine gait
    • unilateral = peroneal nerve palsy, L5 radiculopathy
    • bilateral = ALS, Charcot-Marie-Tooth, DM
43
Q

What is choreiform gait?

A
  • basal ganglia disorders
  • irregular, jerky, involuntary mvmts in all extremities
  • ex: Huntington’s disease
44
Q

This is past pointing/overshoot, a subtype of ataxia, a cerebellar disorder.

A

dysmetria

45
Q

Gait dx?

  • bilateral periventricular lesions
  • spasticity in lower extremities
  • walk w/ abnormally narrow base, dragging both legs and scraping the toes
  • extreme tightness of hip adductors –> legs cross the midline (scissoring gait)
  • ex: cerebral palsy
A

diplegic gait

46
Q

Dx?

  • parkinsonism
  • progressive ataxia
  • dysautonomia (Shy-Drager syndrome)
  • degeneration of: striatonigra, pontocerebellum, intermediolateral columns
A

Multiple System Atrophy

47
Q

How can speech be used to test CN10?

A

have the pt repeat “KaKaKa” test

48
Q

Gait Dx?

  • loss of proprioceptive input
  • slamming foot to the ground
  • disorders of dorsal columns
  • ex: B12 deficiency, uncontrolled DM
A

sensory gait

49
Q

Dx?

  • akinesia, rigidity, dysarthria, dysphagia
  • frontotemporal dementia
  • neurofibrillary tangles in pallidum, subthalamic nucleus, substantia nigra, or pons
A

progressive supranuclear palsy

aNeuro Exam 3- Lindsey's (20 decks)

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