Movement disorders

Question 1

tremor

Answer 1

abnormal involuntary rhythmical oscillation of body part
resting - gravity eliminated
action:
postural - outstretched against gravity
kinetic - while moving
intention - amplitude increases towards target

Question 2

essential tremor

Answer 2

symmetrical onset in upper limbs
mainly postural (but may have a milder resting tremor component)
often a tremor of the head (titubation)

Question 3

parkinsonian tremor

Answer 3

asymmetrical onset
predominantly a resting tremor (often milder postural tremor)
often presents as a coarse pill rolling tremor
titubation rare (although chin tremor common)

Question 4

parkinsonism

Answer 4

syndrome of:
asymmetric resting tremor
rigidity
bradykinesia
postural instability

Question 5

parkinsons disease

Answer 5

idiopathic degeneration of the dopaminergic neurones in the substantia nigra pars compacta
pathologocal hallmark is the presence of abnormal cytoplasmic protein aggregates called lewey bodies

Question 6

causes of parkinsons

Answer 6

idiopathic
drugs
diffuses cerebrovascular disease
structural lesion within basal ganglia
wilsons disease
etc

Question 7

chorea

Answer 7

abnormal, unpredictable, involuntary movements often flowing from one part of the body to another

Question 8

causes of chorea

Answer 8

huntington's
drug induced
SLE and antiphospholipid syndrome
post streptococcal/pregnancy/Oral Contraceptive Pill
cerebrovascular disease
metabolic disease - HONK, thyrotoxicosis

Question 9

HONK

Answer 9

hyperglycaemic hyperosmolar nonketotic coma
metabolic emergency characteristic of uncontrolled type 2 DM
presents with dehydration and stupor or coma (directly linked to how high BMs are)

Question 10

hemiballsism

Answer 10

abrupt high amplitude involuntary movement of a limb
considered a form of chorea
classically associated with a leison in the subthalamic nucleus, but often not that specific

Question 11

dystonia

Answer 11

sustained muscle contractions, freq causing twisting and repetitive motions, or abnormal postures
disorder of neuronal inhibitory mechanisms where cortical activation of one muscle group ‘spills over’ to antagonists and neighbouring muscle groups
can be generalised, focal, segmental, multifocal

Question 12

primary dystonia

Answer 12

has a genetis basis
brain structurally normal but has abnormal function on a cellular level
dystonia is the only neurological abnormality (except for maybe a tremor)

Question 13

secondary dystonia

Answer 13

any structural lesion affecting cortico-basal-thalamic loops

includes a long list of rare heredo-degenerative conditions

Question 14

primary dystonias - generalised

Answer 14

childhood onset
starts in a single limb (usually lower) and then progresses
often severely disabling
most commonly due to mutationin DYT1 locus

Question 15

primary dystonias - focal

Answer 15

onset in middle age
very rare that a definitive genetic diagnosis can be made
usually presents in one of 5 ways:
cervical dystonia
blepharospasm (eye dystonia)
spasmodic dysphonia (difficulty speaking)
jaw opening dysphonia
task specific dystonia

Question 16

tics

Answer 16

involuntary, sudden, rapid, repetitive, nonrhythmic, stereotyped movements or vocalistaions that can be suppressed at the expense of psychological tension
can form part of tourettes

Question 17

myoclonus

Answer 17

involuntary shock like muscular contractions

in routine clinical practice, almost always caused by drugs and systemic illness

Question 18

classification of myoclonus

Answer 18

by anatomy:
cortical
subcortical
spinal/segmental

by aetiology:
physiological
essential (myoclonus dystonia only)
epileptic (cortical myoclonus in context of an epileptic syndrome)
symptomatic (of metabolic/structural brain disease)