Movement disorders [6] Flashcards
What is responsible for unconscious motor control, smoothness of movements, coordination btwn diff muscle groups, muscle tone?
Basal ganglia
Key NT of the extrapyrimidal system. responsible for motor control
DA
Tremor
rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles
Essential tremor
tremor with posture and action (circle drawing)
Antihypertensive med to treat tourettes if its bothersome
clonidine
Dystonia
cocontraction of muscle agonist + antagonist
Red flags for DDX of Parkinsonium
rapid progression
early onset dementia
confusions.hallucinations
early onset of motor instability
Prognosis of parkinsonium syndromes
7-10 years
worst than PD
PD vs ET (essential tremors)
- at rest
- action
PD:
- increased tremor at rest
ET
- Increased tremor with action
PD vs ET (essential tremors)
- with mental concentration
- with walking
PD:
- increased tremor with mental concentration
- increased tremor with walking
ET:
- decreased
- decreased
Symmetry of limb tremor
PD vs Et
PD:
- Assymetric
ET:
- symmetric
Most common movement disorders
- restless leg syndrome
- ET
- PD
Lewy body diseases
- PD vs Diffuse Lewy body disease
PD: movement disorder
DLBD: dementing disease
Substantia nigra damage (parkinsonism)
- PD
- Mult sys atrophy
- PSP
- Picks
- corticobasal deg. disability
Extrapyrimidal signs
abnormal movement, posture, muscular tone
NOT paresis or sensory loss
- basal ganglia disorder
- cerebellar disorder
basal ganglia disorder
- extrapyramidal signs
Resting tremor
Hypokinetic
- rigidity
- bradykinesia
Hyperkinetic
- chorea
- athetosis
- akathisia
cerebellar disorder
- extrapyramidal signs
- Synergy (ataxia)
- Dysmetria (FNF test)
- dysdiadochokinesia
- decomp of movement - Dysequilibrium
- hypotonia
- ACTION tremor (unlike basal gang)
- Nystagmus
pronator drift
-injury is seen in
eyes closed, arm out, palm up
seen in pyramidal tract dysfxn (contralat)
parietal lobe dysfxn (contralat)
parietal lobe dysfxn (ips)
hemiparetic gait
-injury is seen in
unilateral UMN injury (hemispheric stroke)
- ips motor error
Diplegic gate
-injury is seen in
bilateral periventricular lesions (cerebral palsy)
Unilateral Neuropathic gate
-injury is seen in
(foot drop (weakness of foot dorsiflex) )
peroneal nerve palsy
L5 radiculopathy
Bilateral Neuropathic gate
-injury is seen in
ALS
Charcot
uncontrolled diabetes
(foot drop (weakness of foot dorsiflex) )
Myopathic gait
-injury is seen in
“trendelenburg sign*”
Muscular dystrophy
Sensory gait
-injury is seen in
“stomping gait”
dorsal column disorders
- B12
- tabes dorsalis
uncontrolled diabetes
Clinical features of dementing diseases
- impaired memory
- impaired behavior, planning, judgement, emotional control
- impaired language
Clinical features of movement disorders
- choreiform movement disorders
- Parkinsonium features
- ataxia
Tauopathies
- what do taus usually do?
Alz
PSP
CBD
(FTLD, Picks)
- binds to and stabilizes microtubules (hyperphos and aggreg is toxic)
PSP Tau acculm in
at least 3
Substantia nigra
Pallidum
subthal. nuc
Pons
Onset of HD age
40s
Progressive atrophy of neostriatum (ant caudate+dorsal putamen)\
- loss of medium spiney neurons
Freidreich’s Ataxia
b4 20 years old
GAA (TNR)
AR
Ch 9
Loss of neurons in DRG - loss of periphery sensory fibers
