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Neurology HK > Movement disorders > Flashcards

Movement disorders Flashcards

1
Q

what are the 4 things to look for in tremors

A

frequency
amplitude
exacerbating factors

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2
Q

defining feature of resting tremor

A

worse at rest

abolished with movement

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3
Q

condition with resting tremor

A

parkinsons

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4
Q

defining features of intention tremor

A

large amplitude

worse at end of purposeful acts (e.g. finger pointing)

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5
Q

defining features of postural tremor

A

absent at rest
presents on maintained posture (hands outstretched)
may persist on movement

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6
Q

causes of postural tremor

A

benign - autosomal dominant (essential tremor)
thyrotoxicosis
B agonists
anxiety

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7
Q

what helps benign postural tremor

A

propranolol (treatment)

alcohol

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8
Q

defining feature of re-emergent tremor

A

postural tremor developing after a delay of approximately 10 seconds

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9
Q

3 features of parkinsonian syndrome

A

bradykinesia
resting tremor
muscle rigidity

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10
Q

what is parkinsons disease

A

progressive neurodegenerative disorder due to loss of dopaminergic neurons from mitochondrial dysfunction

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11
Q

where does neuronal loss occur in parkinsons

A

substantia nigra

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12
Q

what pigment makes substantia nigra black normally

A

neuromelanin

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13
Q

what is the other pathological feature of parkinsons

A

lewy bodies

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14
Q

what are lewy bodies

A

atypically folded alpha synuclein forming eosinophilic intracellular inclusions

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15
Q

how is parkinsons diagnosed

A

onset of motor symptoms

exclusion of other causes - anaemia, hypothyroid

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16
Q

describe the ‘rolling pill’ tremor

A

thumb moves backwards and forwards on palm of hand

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17
Q

signs of increased rigidity and tone

A

flexed, hunched posture

cogwheeling

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18
Q

what is bradykinesia

A

slow to initiate movements

slow and low aplitude of repetitive movements

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19
Q

signs of bradykinesia

A

‘mask like’ expressionless face
dysphagia
slow blink rate
slow, shuffling gait (decreased arm swinging, freeze at doors)

20
Q

what are some non-motor symptoms of parkinsons

A 
depression and hallucinations
dementia
decreased sense of smell
REM sleep disorder 
autonomic features - postural hypotension, constipation
21
Q

tremor dominant/non-tremor dominant parkinsons has the fastest progression

A

non-tremor dominant

22
Q

why might non-motor symptoms of parkinsons be present first

A

presence of lewy bodies in PNS and other areas of CNS

23
Q

parkinsons is typically bilateral/unilateral

A

unilateral

24
Q

what are atypical features of parkinsons

A

early dementia
imbalance
autonomic

25
Q

first line treatment in parkinsons

A

levodopa

26
Q

what does levodopa do and what symptoms does it help

A

increases intracerebral dopamine (dopamine precursor)

particularly helps rigidity and bradykinesia

27
Q

what should be given alongside levodopa and why

A

decarboxylase inhibitor: madopar, sinemet
prevents peripheral breakdown of drug in liver
reduces peripheral side effects

28
Q

what are side effects of levodopa

A 
nausea/vomiting
hypotension
psychosis/hallucinations
daytime solomnence 
dyskinesia (long term use)
29
Q

what can decrease the efficacy of levodopa

A

protein

30
Q

what helps tremor in parkinsons

A

anticholinergics

clozapine

31
Q

what could be added if levodopa resistant disease

A

dopamine agonists

32
Q

SE of dopamine agonists

A

compulsive behaviours
fibrosis
hallucinations + psychosis
erythromyalgia

33
Q

what anti-emetic should be used in Parkinsons

A

domperidone

34
Q

what drug should be used in parkinsons if hypotensive

A

mineralcorticoid - fludrocorticone acetate

35
Q

what medications should be used for depression in parkinsons

A

tricyclics (desipramine)

SSRI (citalopram)

36
Q

what medication should be used for psychosis in parkinsons

A

clozapine

37
Q

what genetic mutations cause young-onset parkinsons

A

synuclein
parkin
LRRK2

38
Q

what can cause secondary parkinsonianism

A 
drug induced (anti-psychotics/anti-emetics)
post traumatic 
vascular disease 
infection (prion disease, HIV)
hydrocephalus
parathyroid 
paraneoplastic
39
Q

clinical features of vascular parkinsons

A

predominantly affects lower limbs

tremor uncommon

40
Q

clinical features of drug induced parkinsons

A

bilateral

coarse postural tremor

41
Q

what conditions may mimic parkinsons

A

multiple system atrophy
progressive supranuclear palsy
dementia with lewy bodies

42
Q

what is chorea

A

involuntary, irregular jerking movements affecting limbs and axial muscle groups
suppressed with difficulty - often incorporated into voluntary gestures (facial grimacing, raising shoulders, flexing extending fingers)

43
Q

what is Sydenham’s chorea

A

complication of a strep pneumoniae infection
develops weeks-months after primary infection
due to necrotising arteritis in striatum and thalamus

44
Q

what is dystonia

A

prolonged muscle contractions causing abnormal posture or repetitive movements (sustained head retraction, sustained inversion of foot)

45
Q

what mutation causes idiopathic generalized dystonia

A

DYT1 - autosomal dominant (reduced penetrance)

46
Q

what group are susceptible to idiopathic generalized dystonia

A

Ashkenazi Jews

47
Q

clinical features of idiopathic generalised dystonia

A

starts in leg affecting gait

spreads to whole body in 5-10 years

Neurology HK (26 decks)

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