Movement Disorders

Question 1

Define tremor

Answer 1

Fine stereotyped oscillation

Question 2

Define chorea

Answer 2

Medium speed complicated moves

Question 3

Define athetosis

Answer 3

Slow complicated movements

Question 4

Define ballism

Answer 4

Fast complicated movements (violent flinging of limbs)

Question 5

Define tics

Answer 5

Jerk like very brief repetitive movements

Question 6

Is glutamate excitatory or inhibitory?

Answer 6

Excitatory

Question 7

Is dopamine excitatory or inhibitory?

Answer 7

Either excitatory to D1 receptors or inhibitory to D2 receptors

Question 8

Is GABA excitatory or inhibitory?

Answer 8

Inhibitory

Question 9

Principle defect in Parkinson’s disease?

Answer 9

Loss of dopamine in substantia nigra of basal ganglia

Question 10

Basic features of Parkinson’s disease

Answer 10

1. Rigidity
2. Tremor at rest (3-5 Hz pill rolling)
3. Bradykinesia
4. Loss of postural reflexes

Question 11

How does Parkinson’s generally present early on?

Answer 11

Begins in one limb and spreads asymmetrically

Question 12

What are the most diagnostic features of PD?

Answer 12

Rigidity and bradykinesia

Question 13

Is it ok to delay treatment of PD?

Answer 13

Yes - meds are symptomatic not neuroprotective

Question 14

What is the most effective medication option for PD?

Answer 14

Carbidopa/Levodopa (Sinemet)

-Replaces presynaptic dopamine

Question 15

Which dopamine agonists are post-synaptic?

Answer 15

• Ropinirole (Requip)
• Pramipaxole (Mirapex)
• Pergolide (Ergot family)
• Bromocryptine (Ergot family)

Question 16

Define parakinesia

Answer 16

Cover up movement to make a choreiform movement look purposeful

Question 17

Describe Huntington’s disease

Answer 17

Autosomal dominant neurodegenerative disease with chorea, dementia, personality disorder

Question 18

Main traits of Huntington’s disease

Answer 18

1. Chorea
2. Dementia
3. Personality disorder

Question 19

Genetic feature of Huntington’s

Answer 19

CAG trinucleotide repeat (which makes longer than normal proteins)

Question 20

What is the MC movement disorder?

Answer 20

Tremor

Question 21

Types of tremor

Answer 21

• Resting (as in Parkinson’s, 3-5 Hz)
• Intention/Kinetic
• Essential (8-11 Hz, worse w/caffeine, better w/ETOH, bilateral)

Question 22

Define tremor

Answer 22

Rhythmic involuntary movement

Question 23

Features of Tardive Dyskinesia

Answer 23

• Repetitive purposeless movements often of the face (but can be on trunk or limbs)
• Tongue rolling, lip smacking

Question 24

Etiology of Tardive Dyskinesia

Answer 24

Usually iatrogenic - prolonged use of dopamine blockers (psych pts, diabetics w/gastroparesis)

Question 25

Is tardive dyskinesia hypo or hyperkinetic?

Answer 25

Hyperkinetic

Question 26

Define myoclonus

Answer 26

- Hyperkinetic disorder | - Involuntary sudden shocklike muscle jerks

Question 27

Etiology of myoclonus

Answer 27

Usually CNS insult - anoxic/ischemic/alcoholics

Question 28

Define restless leg syndrome

Answer 28

- Neuro movement disorder of the limbs often a/w sleep | - Mostly mild symptoms and do not need treatment

Question 29

Diagnosis of RLS

Answer 29

4 core symptoms: - Urge to move legs bc of irritating sensation - Worse at rest - Relief w/movement - Worse at night

Question 30

Treatment of primary RLS

Answer 30

- Dopamine agonists (pramipexole, ropinirole) - Benzos - Anticonvulsants

Question 31

Treatment of secondary RLS

Answer 31

Correct underlying disorder (anemia, TSH, B12, DM)

Question 32

Define ataxia

Answer 32

Inability to coordinate muscle activity during voluntary movement

Question 33

Pathophys of ataxia

Answer 33

- Degeneration of cerebellum | - Disease or damage to spinal cord and/or peripheral nerves

Question 34

What does a positive Romberg indicate in relation to ataxia?

Answer 34

Ataxia is sensory in nature

Question 35

Pure cerebellar lesions cause ____

Answer 35

Hyporeflexia

Question 36

Any disturbance of sensory or motor function will cause ____

Answer 36

Ataxia

Question 37

Mid-line cerebellar lesions cause ______

Answer 37

Gait and trunk instability

Question 38

Lateral cerebellar lesions show (ipsilateral/contralateral?) to the pathology

Answer 38

Ipsilateral

Question 39

What clinical sign is seen with cerebellar lesions (sometimes as the major physical feature)?

Answer 39

Nystagmus

Question 40

What is the MC cause of ataxia in older age groups (acute/non traumatic/non toxic etiology)?

Answer 40

Wallenberg stroke

Question 41

Describe Wallenberg stroke

Answer 41

Lateral medullary syndrome - Ipsilateral ataxia - Horner's - Pharynx dysfunction - MOTOR AND COGNITIVE INTACT