movement disorders Flashcards
a state of restlessness, can’t sit still
- akathisia
inability to coordinate movements of the limbs or trunk
ataxia
involuntary writhing limb movements
- athetosis
cause of idiopathic parkinson’s disease
- destruction of Dopamine in the substantia nigra pars compacta
four cardinal features of idiopathic parkinson’s disease
- rest tremor
- rigidity
- akinesia-bradykinesia
- postural instability
describe rest tremor in idiopathic parkinson’s disease
- unilatearl
- can be pill-rolling
explain rigitidy of idiopathic parkinson’s disease
- sustained resistance through passive range of motion
describe akinesia-bradykinesia associated with idiopathic parkinson’s disease
- loss of manual dexterity
- reduced facial expression (masked facies)
- slowing of movement
describe postural instability associated with idiopathic parkinson’s disease
- stooping
- retropulsion: tendency to walk backwards
- falls with turning
what are the autonomic features associated with idiopathic parkinson’s disease
- sweating abnormalities
- orthostatis hyoptension
- impotence
- constipation
two common rating scales for idiopathic partkinson’s disease
- unified parkinson’s disease rating scale
- modified hoehn and yahr staging
how does drug induced parkinsonism differ from idiopathic parkinson’s disease
- offending drug (phenergan, anti-psychotic)
- absence of rest tremor
- symmetric symtpoms
how does vascular disease differ from idiopathic parkinson’s disease
- gait disturbance
- spasticity
- hyper-reflexia
- pseudobulbar affect: inappropriate involuntary laughing/crying
how does normal pressure hydrocephalus differ from idiopathic parkinson’s disease
- apraxia of gait (feet stuck to ground, magnetic gait)
- cognitive impairment
- urinary incontinence
how does corticobasal degeration differ from idiopathic parkinson’s disease
- cognitive disorder
- limb apraxia
- unilateral limb rigidity
- myoclonus or dystonia
describe Progressive Supranuclear palsy
- pseudobulbar affect
- supranuclear gaze palsy (vertical gaze, down>up gaze)
- early falls
- absence of tremor
- poor L-dopa response
describe multi-system atrophy
-
prominent autonomic features early on
- severe constipation, orhostatic BP changes
- falls
- axial dystonia
- no rest tremor
- poor L-dopa response
describe dementia with lewy bodies
- cognitive disorder
- hallucination
- prominent dream enactment behavior
- mild autonomic symptoms
multi-system atrophy (MSA) has what sign on MRI
- hot cross bun
progressive supranuclear palsy has what sign on MRI
hummingbird sign
diagnostic workup if you suspect parkinsonism
MRI brain
normal pressure hydrocephalus has what sign on MRI
massively enlarged ventricles
any patient < 50 yo who presents with a movement disorder, you need to rule out
- wilson’s disease
- serum ceruloplasmin
- K-F rings