Movement Disorders

Question 1

Which parts of midbrain contain dopaminergic neurons?

Answer 1

substantia nigra
locus cereleus

loss of these = Parkinson’s

Question 2

Clinical signs of Parkinson’s

Answer 2

• resting pill rolling tremor
• BRADYkinesia
• cogwheel rigidity
• NARROW based shuffling gait with stooped posture
• masked facies/decreased blinking
• dysarthria/dysphagia, micrographia (small handwriting)
• personality changes/dementia/depression

Question 3

Parkinsonian symptoms + autonomic insufficiency?

Answer 3

Shy Drager syndrome

Question 4

Key microscopic neurological finding in brain of Parkinson’s disease

Answer 4

Lewy bodies (hyaline inclusion bodies)

Question 5

Another name for Lewy bodies

Answer 5

hyaline inclusion bodies

Question 6

Meds that cause Parkinsonian side effects?

Answer 6

• neuroleptics (chlorpromazine, haloperidol, perphenazine)
• metoclopramide
• reserpine

Question 7

1st line drug for treating Parkinson’s then what others

Answer 7

overall goal of treatment = increase dopaminergic, decrease cholinergic

• carbidopa-levodopa (Sinemet)
• dopamine agonists (pramipexole, bromocriptine)
• selegilline
• amantadine (antiviral)
• anticholinergics (benztropine)
• amitriptyline
• DEEP BRAIN STIMULATION (DBS)

Question 8

Side effects carbi/levodopa

Answer 8

dyskinesia (choreiform movements = big concern)

Question 9

Patient with Parkinsons presents with sudden episodes of hesitancy or immobility (“freezing”)…treat with what?

Answer 9

dopamine agonist like bromocriptine, pramipexole)

Question 10

MOA selegiline

Answer 10

inhibits monoamine oxidase B activity (increases dopamine) and reduces metabolism of levodopa

Question 11

Patient with progressive bradykinesia, limb rigidity, cognitive decline, WITHOUT tremor + opthalmoplegia

Answer 11

progressive supranuclear palsy (PSP)

degen condition of brainstem, basal ganglia, cerebellum

Question 12

young patient with movement disorder; what GI condition to keep in mind?

Answer 12

Wilsons

Question 13

molecular mechanism of Huntington’s

Answer 13

autosomal dominant expanded CAG triplet repeat on chromosome 4

Question 14

Which neurons are lost in Huntington’s

Answer 14

GABA producing neurons in the striatum

Question 15

clinical features of Huntingtons

Answer 15

• chorea
• altered behavior (irritability, personality changes, -antisocial, depression, OCD, psychosis…increased SUICIDE RISK!!!!)
• progressive dementia
• unstead/irregular gait
• incontinence

Question 16

MRI finding Huntington’s

Answer 16

atrophy of head of caudate nuclei

Question 17

How to confirm dx of Huntington’s

Answer 17

DNA testing

Question 18

treatment options Huntington’s

Answer 18

symptomatic

dopamine blockers (mvmt/psychosis)
antidepressants/anxiolytics

Question 19

metabolic causes tremor

Answer 19

hypoglycemia
hyperthyroidism
pheochromocytoma

Question 20

toxic causes of tremors

Answer 20

alcohol withdrawal
lithium/valproic acid
caffine/theophylline

Question 21

patient has tremor induced by intentional activity (drinking from cup) and has distorted handwriting that IMPROVES WITH ALCOHOL
dx and treatment

Answer 21

essential tremor (can be inherited)
treat with propanolol

Question 22

Association between essential tremor and Parkinson’s

Answer 22

THERE IS NONE

Question 23

gait instabililty
loss of balance
impaired limb coordination

Answer 23

ataxia

Question 24

Which infectious diseases can cause ataxia

Answer 24

AIDS and tertiary syphilis (tabes dorsalis)

Question 25

What vitamin deficiencies can cause ataxia

Answer 25

b12/thiamine deficiency

Question 26

Name two inherited causes of ataxia

Answer 26

Freidreich ataxia
ataxia telangiectasia
both are AR mode of inheritance

Question 27

ataxia, nystagmus, impaired vibratory/proprioception

presents young adulthood

Answer 27

Freidrech ataxia