Movement Disorders Flashcards
Dx?
- dementia
- diffuse Lewy body distribution
- extralimbic cortices, brainstem, amygdala, and limbic cortices affected
Diffuse Lewy Body Disease
What is hemiparetic gait?
- 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
Patients with truncal ataxia due to damage of the ______ have difficulty with gait tests.
cerebellar vermis or assoc. pathways
How can speech be used to test CN7?
have the pt repeat “PaPaPa” test
These are problems with synergistic mvmt- disruption of smooth trajectories of mvmts - disorders of the cerebellum
ataxia
What does having the pt repeat “PaPaPa” test?
CN7
What are the hallmarks of Multiple System Atrophy?
- parkinsonism
- progressive ataxia
- dysautonomia (Shy-Drager syndrome)
- degeneration of: striatonigra, pontocerebellum, intermediolateral columns
Gait dx?
- foot drop
- unilateral = peroneal nerve palsy, L5 radiculopathy
- bilateral = ALS, Charcot-Marie-Tooth, DM
neuropathic gait
What does having the pt repeat “KaKaKa” test?
CN10
What are the signs of a cerebellar disorder?
- ataxia
- dysmmetria
- dysdiadochokinesia
- decomposition of mvmt
- disequilibrium
- hypotonia
- action tremor
- nystagmus
Where does the lesion lie, given these signs:
- tremor (usu resting)
- rigidity
- bradykinesia
- chorea
- athetosis
- akathisia
basal ganglia
Patients with _____ due to damage of the cerebellar vermis or assoc. pathways have difficulty with gait tests.
truncal ataxia
Gait Dx?
- basal ganglia disorders
- irregular, jerky, involuntary mvmts in all extremities
- ex: Huntington’s disease
choreiform gait
What are the hallmarks of progressive supranuclear palsy?
- akinesia, rigidity, dysarthria, dysphagia
- frontotemporal dementia
- neurofibrillary tangles in pallidum, subthalamic nucleus, substantia nigra, or pons
How are vestibular, cerebellar, and proprioceptive contributions to balance with vision removed?
the Romberg test
What does having the pt repeat “LaLaLa” test?
CN12
What does a positive pronator drift test indicate?
Either:
- dysfunctional pyramidal tract (contralateral cortex)
- parietal lobe dysfunction (contralateral)
- cerebellar disease (ipsilateral)
Where does the lesion lie, given these signs:
- ataxia
- dysmmetria
- dysdiadochokinesia
- decomposition of mvmt
- disequilibrium
- hypotonia
- action tremor
- nystagmus
cerebellum
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)
Huntington’s Disease
What is sensory gait?
- loss of proprioceptive input
- slamming foot to the ground
- disorders of dorsal columns
- ex: B12 deficiency, uncontrolled DM
What is bradykinetic gait?
- 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
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
hemiparetic gait
What are the features of Fredreich’s Ataxia?
- 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
What is ataxic gait?
- cerebellar disease
- clumsy, staggering mvmts with a wide-based gait
- titubation
- inability to heel-toe walk or walk in straight line
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
bradykinetic gait
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
Fredreich’s Ataxia
This is an impairment in rapid alternating movements; a cerebellar disorder.
dysdiadochokinesia
What is ataxia?
- problems with synergistic mvmt
- disruption of smooth trajectories of mvmts
- disorder of the cerebellum
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
Corticobasal Degeneration (CBD)
What is diplegic gait?
- 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
How can speech be used to test CN12?
have pt repeat “LaLaLa”
What is dysdiadochokinesia?
- an impairment in rapid alternating movements
- a cerebellar disorder
What is dysmetria?
- past pointing/overshoot
- a subtype of ataxia
- a cerebellar disorder
What does the Romberg test assess?
vestibular, cerebellar, and proprioceptive contributions to balance with vision removed
What are the signs of a basal ganglia disorder?
- tremor (usu resting)
- rigidity
- bradykinesia
- chorea
- athetosis
- akathisia
What are the hallmarks of Huntington’s Disease?
- 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)
Gait Dx?
- cerebellar disease
- clumsy, staggering mvmts with a wide-based gait
- titubation
- inability to heel-toe walk or walk in straight line
ataxic gait
What are the hallmarks of Diffuse Lewy Body Disease?
- dementia
- diffuse Lewy body distribution
- extralimbic cortices, brainstem, amygdala, and limbic cortices affected
What are the 8 categories of gait disorders?
- hemiparetic
- diplegic/paraparetic
- neuropathic
- myopathic
- bradykinetic
- choreiform
- ataxic
- sensory
Both ____ and _____ demonstrate alpha-synuclein accumulations (synucleinopathies), but the accumulations are in different parts of the brain and intracellular loci.
- Parkinson’s
- Multiple systems atrophy
What are the hallmarks of Corticobasal Degeneration (CBD)?
- 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
What is neuropathic gait?
- foot drop
- aka Steppage or Equine gait
- unilateral = peroneal nerve palsy, L5 radiculopathy
- bilateral = ALS, Charcot-Marie-Tooth, DM
What is choreiform gait?
- basal ganglia disorders
- irregular, jerky, involuntary mvmts in all extremities
- ex: Huntington’s disease
This is past pointing/overshoot, a subtype of ataxia, a cerebellar disorder.
dysmetria
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
diplegic gait
Dx?
- parkinsonism
- progressive ataxia
- dysautonomia (Shy-Drager syndrome)
- degeneration of: striatonigra, pontocerebellum, intermediolateral columns
Multiple System Atrophy
How can speech be used to test CN10?
have the pt repeat “KaKaKa” test
Gait Dx?
- loss of proprioceptive input
- slamming foot to the ground
- disorders of dorsal columns
- ex: B12 deficiency, uncontrolled DM
sensory gait
Dx?
- akinesia, rigidity, dysarthria, dysphagia
- frontotemporal dementia
- neurofibrillary tangles in pallidum, subthalamic nucleus, substantia nigra, or pons
progressive supranuclear palsy
