Movement Disorders Flashcards
movement disorders are primarily concerned with what part of the brain?
basal ganglia (however do concern other parts of the brain too)
main pathophysiology of parkinsons?
dopaminergic neuron loss in the pars compacta region of the substantia nigra causing pigment loss and formation of lewy bodies
what is the main aim of parkinsons medication at a cellular level?
aim to increase dopamine conc or stimulate dopamine receptors directly
most common age range for parkinsons patients?
60s-70s
motor features of parkinsons only appear when most of the neurons in the substantia nigra are lost T or F
T
give examples of UMN features; where is the problem?
pyramidal weakness
spasticity
corticospinal tract
problems with the basal ganglia will cause what problems?
hyperkinetic - dystonia, tics, myoclonus, chorea
hypokinetic- rigidity, bradykinesia
is parkinsons a hyper or hypokinetic disorder?
hypokinetic
what is parkinsonism?
symptoms compatible with extrapyramidal problems that is not caused by parkinsons disease (can be caused by medication)
ataxia is a result of a problem in which part of the brain?
cerebellum
basal ganglia are made up of __ matter
grey
how do the basal ganglia control movement?
via a positive/negative feedback loop through the thalamus and cerebral cortex
where is dopamine made?
in the midbrain by dopaminergic neurons
what structures are the neurohistological hallmark of PD?
lewy bodies
most anterior component of the basal ganglia?
caudate nucleus
what 2 structures make up the lentiform nucleus component of the basal ganglia, where are they located?
putamen
globus pallidus
posterolateral to the thalamus
what is the most lateral component of the lentiform nucleus?
putamen
motor symptoms of parkinsons?
tremor
bradykinesia
rigidity
postural instability
non-motor symptoms of parkinsons?
sleep disorders hallucinations GI dysfunction depression dementia anosmia
bradykinesia is…
slow movement
how could you differentiate a postural tremor from a resting tremor?
the patient is fine at rest but when you ask them to hold their arms out or do a movement they have a tremor
those with postural tremor usually have a/an ___ tremor
action
intention tremor is a hallmark of disease in what part of the brain?
cerebellar disease
how would you test for an intention tremor
patient touches their nose and touches your finger while you move it to different targets
postural tremor is often __lateral
bi
resting tremor in PD is usually __lateral
uni
how would you test for rigidity?
muscle tone
rigidity affects both sides equally in parkinsons T or F
F, usually worse on 1 side
2 main subtypes of PD
tremor dominant
non tremor dominant (more gait/postural focused)
what sleep problems can be present in those with PD?
restlessness
REM sleep disorder - acting out dreams
pre-emptive symptoms of PD
sleep disorders constipation hyposmia depression fatigue
what is required for a diagnosis of parkinsonism
bradykinesia plus:
resting tremor
rigidity
postural instability
describe a parkinsonian gait
shuffling, short-stepped gait with flexed and stiff trunk and legs
late onset symptoms of parkinsons? if a patient presented with these what would be the case?
dementia
hallucinations
early onset bulbar problems
eye movement disorder
cant be parkinsons, is most likely lewy body dementia
what does a DATSCAN do?
looks at the dopamine transporter
a PMH of what should prompt you to consider other diagnoses?
repeated strokes
repeated head injury
early dementia
risk factors for parkinsons
advancing age (+++)
positive FH (early age at diagnosis suggests genetics)
male
environmental eg rural living, B blocker use
genetics
what genetic mutation can cause PD?
point mutation in alpha-synuclein (protein in the brain)
Tx for tremor
anti-cholinergic agents
Tx for PD
dopamine agonists for motor symptoms
decarboxylase inhibitors eg levodopa
anticholinergics for tremor
side effects of dopamine agonists
euphoria
hallucinations
hypersexuality
examples of hyperkinetic disorders
tremor
tics
chorea
myoclonus dustonia
what is a tremor
rhythmic sinusoidal oscillation of a body part
what are tics?
involuntary stereotyped movements of vocalisations
can be suppressible
brief irregular purposeless movements which flit and flow from 1 body part to the other is described as…
chorea
brief electric shock like jerks are referred to as…
myoclonus (jerk before bed is a physiological example)
abnormal posture of an affected body part can be described as…
dystonia
primary movement disorders tend to be progressive T ro F
F
a heredo-degenerative movement disorder has what kind of onset?
late onset, progressive
usually as part of a degenerative process
a psychogenic movement disorder has what kind of presentation?
diverse presentation coupled with unusual physical features
psychological disturbance
cause of a tremor?
alternate activation of agonist and antagonist muscles
how is a tremor classified? how should you explore it in a history?
position - is it at rest? movement? distribution- where is the tremor frequency amplitude- how much it moves age at onset drug exposure
when do you get a tremor in PD
at rest
how is tremor investigated?
TFTs
copper and coeruloplasmin test in young patients
most common movement disorder?
essential tremor
bilateral action tremor of hands and forearms wth absence of other signs, positive FH that has lasted for a while could suggest….
essential tremor
what neurological movement problem can partially be stopped by the patient?
TICS
what conditions present with tics?
tourettes
huntingtons disease
inheritance for tourettes?
AD
Tx of tourettes
clonidine
CBT
a patient with chorea looks…
restless and fidgety
huntingtons inheritance?
AD
myoclonus can present in what systemic conditions?
liver and renal failure
drug intoxication
what gene has the mutation in young onset primary dystonia
DYT1
is dystonia AD or AR?
AD
Tx of primary onset dystonias
levodopa
patients with chorea will be relaxed when they sleep T or F
T
a shin tremor is a classic symptom of…
parkinson’s disease
a head tremor (yes-no) is a classic symptom of…
essential tremor
when will a cerebellar tremor occur?
after a movement
this tremor increases in times of stress and disappears when distracted; it’s common in people with psychiatric disorders
functional tremor
what is an extensor plantar response?
babinski sign is positive
toes fan out
treatable causes of myasthaenia
anaemia
hypothyroidism
how does the presentation of vascular parkinsonism differ from PD?
no rest tremor
tends to affect the lower limb
poor levodopa response
what tremor does drug induced parkinson present with if any?
coarse postural tremor
cause of drug induced parkinsons?
dopamine antagonists
