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3 Neurology > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

movement disorders are primarily concerned with what part of the brain?

A

basal ganglia (however do concern other parts of the brain too)

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2
Q

main pathophysiology of parkinsons?

A

dopaminergic neuron loss in the pars compacta region of the substantia nigra causing pigment loss and formation of lewy bodies

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3
Q

what is the main aim of parkinsons medication at a cellular level?

A

aim to increase dopamine conc or stimulate dopamine receptors directly

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4
Q

most common age range for parkinsons patients?

A

60s-70s

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5
Q

motor features of parkinsons only appear when most of the neurons in the substantia nigra are lost T or F

A

T

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6
Q

give examples of UMN features; where is the problem?

A

pyramidal weakness
spasticity
corticospinal tract

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7
Q

problems with the basal ganglia will cause what problems?

A

hyperkinetic - dystonia, tics, myoclonus, chorea

hypokinetic- rigidity, bradykinesia

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8
Q

is parkinsons a hyper or hypokinetic disorder?

A

hypokinetic

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9
Q

what is parkinsonism?

A

symptoms compatible with extrapyramidal problems that is not caused by parkinsons disease (can be caused by medication)

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10
Q

ataxia is a result of a problem in which part of the brain?

A

cerebellum

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11
Q

basal ganglia are made up of __ matter

A

grey

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12
Q

how do the basal ganglia control movement?

A

via a positive/negative feedback loop through the thalamus and cerebral cortex

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13
Q

where is dopamine made?

A

in the midbrain by dopaminergic neurons

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14
Q

what structures are the neurohistological hallmark of PD?

A

lewy bodies

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15
Q

most anterior component of the basal ganglia?

A

caudate nucleus

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16
Q

what 2 structures make up the lentiform nucleus component of the basal ganglia, where are they located?

A

putamen
globus pallidus
posterolateral to the thalamus

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17
Q

what is the most lateral component of the lentiform nucleus?

A

putamen

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18
Q

motor symptoms of parkinsons?

A

tremor
bradykinesia
rigidity
postural instability

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19
Q

non-motor symptoms of parkinsons?

A 
sleep disorders
hallucinations
GI dysfunction
depression
dementia
anosmia
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20
Q

bradykinesia is…

A

slow movement

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21
Q

how could you differentiate a postural tremor from a resting tremor?

A

the patient is fine at rest but when you ask them to hold their arms out or do a movement they have a tremor

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22
Q

those with postural tremor usually have a/an ___ tremor

A

action

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23
Q

intention tremor is a hallmark of disease in what part of the brain?

A

cerebellar disease

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24
Q

how would you test for an intention tremor

A

patient touches their nose and touches your finger while you move it to different targets

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25
Q

postural tremor is often __lateral

A

bi

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26
Q

resting tremor in PD is usually __lateral

A

uni

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27
Q

how would you test for rigidity?

A

muscle tone

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28
Q

rigidity affects both sides equally in parkinsons T or F

A

F, usually worse on 1 side

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29
Q

2 main subtypes of PD

A

tremor dominant

non tremor dominant (more gait/postural focused)

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30
Q

what sleep problems can be present in those with PD?

A

restlessness

REM sleep disorder - acting out dreams

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31
Q

pre-emptive symptoms of PD

A 
sleep disorders
constipation
hyposmia
depression
fatigue
32
Q

what is required for a diagnosis of parkinsonism

A

bradykinesia plus:
resting tremor
rigidity
postural instability

33
Q

describe a parkinsonian gait

A

shuffling, short-stepped gait with flexed and stiff trunk and legs

34
Q

late onset symptoms of parkinsons? if a patient presented with these what would be the case?

A

dementia
hallucinations
early onset bulbar problems
eye movement disorder

cant be parkinsons, is most likely lewy body dementia

35
Q

what does a DATSCAN do?

A

looks at the dopamine transporter

36
Q

a PMH of what should prompt you to consider other diagnoses?

A

repeated strokes
repeated head injury
early dementia

37
Q

risk factors for parkinsons

A

advancing age (+++)
positive FH (early age at diagnosis suggests genetics)
male
environmental eg rural living, B blocker use
genetics

38
Q

what genetic mutation can cause PD?

A

point mutation in alpha-synuclein (protein in the brain)

39
Q

Tx for tremor

A

anti-cholinergic agents

40
Q

Tx for PD

A

dopamine agonists for motor symptoms
decarboxylase inhibitors eg levodopa
anticholinergics for tremor

41
Q

side effects of dopamine agonists

A

euphoria
hallucinations
hypersexuality

42
Q

examples of hyperkinetic disorders

A

tremor
tics
chorea
myoclonus dustonia

43
Q

what is a tremor

A

rhythmic sinusoidal oscillation of a body part

44
Q

what are tics?

A

involuntary stereotyped movements of vocalisations

can be suppressible

45
Q

brief irregular purposeless movements which flit and flow from 1 body part to the other is described as…

A

chorea

46
Q

brief electric shock like jerks are referred to as…

A

myoclonus (jerk before bed is a physiological example)

47
Q

abnormal posture of an affected body part can be described as…

A

dystonia

48
Q

primary movement disorders tend to be progressive T ro F

A

F

49
Q

a heredo-degenerative movement disorder has what kind of onset?

A

late onset, progressive

usually as part of a degenerative process

50
Q

a psychogenic movement disorder has what kind of presentation?

A

diverse presentation coupled with unusual physical features

psychological disturbance

51
Q

cause of a tremor?

A

alternate activation of agonist and antagonist muscles

52
Q

how is a tremor classified? how should you explore it in a history?

A 
position - is it at rest? movement?
distribution- where is the tremor
frequency
amplitude- how much it moves
age at onset
drug exposure
53
Q

when do you get a tremor in PD

A

at rest

54
Q

how is tremor investigated?

A

TFTs

copper and coeruloplasmin test in young patients

55
Q

most common movement disorder?

A

essential tremor

56
Q

bilateral action tremor of hands and forearms wth absence of other signs, positive FH that has lasted for a while could suggest….

A

essential tremor

57
Q

what neurological movement problem can partially be stopped by the patient?

A

TICS

58
Q

what conditions present with tics?

A

tourettes

huntingtons disease

59
Q

inheritance for tourettes?

A

AD

60
Q

Tx of tourettes

A

clonidine

CBT

61
Q

a patient with chorea looks…

A

restless and fidgety

62
Q

huntingtons inheritance?

A

AD

63
Q

myoclonus can present in what systemic conditions?

A

liver and renal failure

drug intoxication

64
Q

what gene has the mutation in young onset primary dystonia

A

DYT1

65
Q

is dystonia AD or AR?

A

AD

66
Q

Tx of primary onset dystonias

A

levodopa

67
Q

patients with chorea will be relaxed when they sleep T or F

A

T

68
Q

a shin tremor is a classic symptom of…

A

parkinson’s disease

69
Q

a head tremor (yes-no) is a classic symptom of…

A

essential tremor

70
Q

when will a cerebellar tremor occur?

A

after a movement

71
Q

this tremor increases in times of stress and disappears when distracted; it’s common in people with psychiatric disorders

A

functional tremor

72
Q

what is an extensor plantar response?

A

babinski sign is positive

toes fan out

73
Q

treatable causes of myasthaenia

A

anaemia

hypothyroidism

74
Q

how does the presentation of vascular parkinsonism differ from PD?

A

no rest tremor
tends to affect the lower limb
poor levodopa response

75
Q

what tremor does drug induced parkinson present with if any?

A

coarse postural tremor

76
Q

cause of drug induced parkinsons?

A

dopamine antagonists

3 Neurology (41 decks)

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