Movement Disorders Flashcards
In general, what 4 classifications do we look at when a patient presents with a tremor?
Rest vs. Action Body Part Affected Frequency Amplitude (fine/course)
How do we tell if a patient has a resting tremor?
Support the body part against gravity
What can increase or decrease a resting tremor?
Movement
If a patient goes to grab something and the shake, what’s it called?
Intention tremor
If a patient presents with a tremor that is high-frequency, and low amplitude (fine & fast), what diagnosis?
Physiologic tremor
When does someone typically have a physiologic tremor?
Hyper-adrenergic states (anxiety, caffeine, or withdrawals of caffeine or alcohol)
If a 65 year old patient presents with a tremor that is in the right arm and has slowly gotten worse over the past couple months, and their neurological exam is normal, what ddx?
Benign essential tremor
What are the main things we think of for a benign essential tremor?
60+, UE tremor, starts on one side and move to bilateral, SLOW progression
How do we treat a benign essential tremor?
Beta blockers, rest/sleep, eat well
A patient presents with a tremor involving the left hand and the first two fingers that’s been there for the past year or so. They have noticed a decrease in their affect, on PE they have no weakness and no changes in DTR’s but they do have cogwheel, what ddx?
Parkinson’s
What is decreased in Parkinson’s disease?
Dopamine in the substantia nigra
What are the 4 cardinal signs of Parkinson’s disease?
Tremor, rigidity, bradykinesia, and postural impairment
What is Bradykinesia?
Slowness of movements (gait and speech)
What’s the classic name for a Parkinson’s gait? How do they turn?
Festinating gait with Turn “en bloc” (along with freezing)
Although there’s no definitive diagnosis for Parkinson’s what can we look at?
Dopamine levels – high suspicion. Refer
What symptoms are NOT Parkinson’s?
No response to levodopa, symmetrical, rapid progression, abnormal eye movements (that’s MS)
At what point do we treat Parkinson’s?
When functional disabilities begins
How can we treat Parkinson’s?
Levodopa (so dopamine can cross the BBB) but it wears off :(
What are some S/E of levodopa?
Increase in uncontrolled movement (Dyskinesias)
When Levodopa begins to wear off, what can you add?
Entacapone
Dopamine Agonists: Ropinirole
Anticholinergics: Benztropine (Cogentin)
MAO-B inhibitor: Selegiline
What’s the absolute last source of treatment for Parkinson’s?
Deep brain stimulation
A 40 year old presents with spastic, involuntary movements of the arm, that they don’t seem to notice, ddx?
Huntington’s
How do you describe the involuntary movements of Huntington’s?
Chorea with Hemiballismus
What else would you notice about the movements of a person with Huntington’s?
Abnormal eye movements
What’s often untreated in Huntington’s?
Psych = Depression, OCD, Anxiety, Mania
What type of disease is Huntington’s?
Autosomal Dominant Disease
When treating a patient with Huntington’s what do we also need to consider?
Nutritional, PT/OT, Neuro, Speech Pathologist, Psych ANNNDD Genetic counseling
If a young boy presents with a very fine extra eye movement, such as excessive blinking, and tends to repeat the words of his parents excessively, what diagnosis?
Tourette’s
How can you actually make the diagnosis of Tourette’s?
It’s NOT explained by any other medical condition
It must occur almost every day for >1 year (most often before 18)
Where does Tourette’s initially start vs. over time?
Initially = head & face
Over Time = Changes with increasing complexity
When do tics increase vs. decrease?
Increase with stress & decrease with activities
How does Tourette’s change over the course of a lifetime?
Lifelong symptoms but often decrease in adulthood
When would you actually need to treat Tourette’s?
If their Tic presents a problem
What are some pharm & non-pharm treatments for Tourette’s?
Pharm = SSRI’s & Antianxiety Non-Pham = Habit reversal training, biofeedback, botox injections
What do many Tourette’s patients also have?
ADD, anxiety, OCD
What movement disorder involves intermittent or sustained muscle contractions causing twisting and repetitive movements?
Cerebral Palsy
If we see a child in the ER with CP, what do we always need to consider?
Non-traumatic fractures!
If a patient has a burning pain, often in the LE, what classification is this diagnosis?
Neuropathy
If a patient has a neuropathy what are the hypersensitive to?
Light touch
If a person show’s up with foot drop and after the excellent HPI you discover they were out drinking heavily last night and were fine when they went to bed, what diagnosis?
Saturday Night Palsy
If a swimmer presents with numbness and shooting pain through the upper extremity, what ddx? What special test to you do to confirm?
Thoracic Outlet Syndrome Adson’s sign!
If a patient is a long time ___ they can also get neuropathies
Alcoholic
If what levels in a diabetic are not well controlled they can develop diabetic neuropathies in the feet?
A1c’s
What medications can cause neuropathies?
Chemotherapies, phenytoin, metronidazole
If a patient has intermittent, lancing, facial pain what ddx?
Trigeminal Neuralgia
How old are patient’s with trigeminal neuralgia? What if they are younger?
Older than 50. If younger, think MS
What type of pressure hurts vs. doesn’t hurt a patient with trigeminal neuralgia?
Hurts = Breeze, kiss, shave, chewing
Doesn’t hurt = Deep/Firm pressure
What would you see on PE in a patient with trigeminal neuralgia?
Normal except for pain with soft touch
If a patient allodynia (pain from a non-painful stimulus) in a dermatomal pattern, what ddx?
Zoster
How do we treat Zoster and WHY?
Acyclovir
Treat to PREVENT post herpetic neuralgia
What must we always do during PE before giving the Dx of Zoster?
Florescence dye exam of the eye
