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Neurology > Movement disorders > Flashcards

Movement disorders Flashcards

1
Q

The 3 key features of parkinsonism?

A

Akinesia
Tremor
Rigidity

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2
Q

how do you get cogwheel rigidity in someone with parkinson’s?

A

the combo of tremor + rigidity = cogwheeling

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3
Q

pathophysiology behind parkinsons?

A

Neuronal loss + Presence of Lewy bodies

Lewy Bodies target the pars compacta of SUBSTANTIA NIGRA causing a disturbance in the DOPAMINERGIC pathway

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4
Q

Apart from the 3 characteristic features of Parkinson’s, what other symptoms do they show?

A

Shuffling gait
Masked facial expression
Non-motor symptoms such as depression & dementia

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5
Q

Treatment of Parkinson’s Disease

A

Levodopa

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6
Q

S/E of levodopa

A

Hypotension
Nausea
Dyskinesia - rolling of tongue (like jack)

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7
Q

What other types of drugs can be used to treat Parkinson’s?

A

Monoamine oxidase B inhibitors

Dopamine agonists

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8
Q

Why does inhibiting the work of the enzyme monoamine oxidase B help with Parkinson’s?

A

The enzyme is responsible for catabolising dopamine to homovanilic acid

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9
Q

Why would you used dopamine agonists in younger patients (>70) instead of using levodopa?

A

Due to the high risk of dyskinesia

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10
Q

What Parkinson’s drugs cause hypotension and what ones cause hypertension?

A

Levodopa + Dopamine agonists = HYPOtension

Monoamine oxidase B inhibitors = HYPERtension (when you eat cheese)

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11
Q

What drugs may induce parkinsonism?

A

Typical anti-psychotics

  • Haloperidol
  • Chlorpromazine

Mood stabilizer
- Lithium

Anti-epileptics
- Valproic acid

Dopamine receptor antagonist
- Metoclopramide

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12
Q

What drugs can aid in the symptomatic relief of drug induced parkinsonism?

A

Anticholinergics:
Benzotropine
Procyclidine

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13
Q

If dementia starts more than 6 months after the onset of parkinsonism, it is called Parkinson’s disease dementia - T/F?

A

FALSE. It is called Lewy Body Dementia

Dementia starting more than 1 YEAR after the onset of parkinsonism is called Parkinson’s disease dementia

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14
Q

What are the 3 core features of Lewy Body dementia?

A

Progressive disabling cognitive impairment (dementia)
Recurrent VISUAL HALLUCINATIONS
Features of Parkinsonism

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15
Q

What is multiple system atrophy?

A

Nerve cells in MULTIPLE parts of the brain deteriorate over time.
Parkinsonism symptoms
Autonomic dysfunction (hypotension, ED, urinary urge)
Cerebellar dysfunction

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16
Q

what is an MRI ‘hummingbird’ sign seen on the midbrain characteristic of?

A

progressive supranuclear palsy

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17
Q

what are the symptoms of progressive supranuclear palsy?

A 
Axial akinesia 
Rigidity 
Loss of balance 
Unexplained falls 
Forgetfulness
Dysarthria 
Loss of eye movements
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18
Q

what form of imaging can be used to differentiate between vascular parkinsonism and other parkinsonism syndromes?

A

SPECT (single-photon emission computed tomography)

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19
Q

how does vascular parkinsonism compare to that of other parkinsonism syndromes?

A

It progresses slower

Poor response to levodopa

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20
Q

what is a MRI hot cross bun appearance at the pons characteristic of?

A

multiple system atrophy

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21
Q

you get an essential tremor with parkinsonism - T/F?

A

FALSE. You get a RESTING tremor with parkinsonism

Essential (or ‘action/postural’) tremors are commonly inherited

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22
Q

How to treat essential tremor

A

Alcohol

Beta-blockers

23
Q

What are the 2 types of tremor you can get from cerebellar damage

A

Intention tremor - due to a lesion
Holmes (rubral) tremor - ‘‘triple’’ tremor because you get a tremor at rest, postural/essential tremor AND intention tremor

24
Q

How do you test for a intention tremor

A

finger to nose test

25
Q

what is dystonia?

A

involuntary muscle spasms leading to abnormal postures of the affected body part

26
Q

pathophysiology behind dystonia

A

opposing agonists and antagonist muscles working against each other

27
Q

blepharospasm (the thing vorrey has!) is an example of a GENERALIZED dystonia - T/F?

A

F.

It is FOCAL

28
Q

how to treat dystonia?

A 
anticholinergics
botulinum toxin (1st line in focal dystonias)
29
Q

what conditions can dystonia arise in?

A

Parkinson’s
MS
Stroke

30
Q

What is chorea?

A

continuous spontaneous jerky movements

31
Q

genetic association of huntington’s

A

CAG triplet repeat

32
Q

what is genetic anticipation?

A

when the genetic mutation increases from generation to generation causing increased severity and earlier onset

33
Q

early signs of huntingtons?

A 
personality changes 
depression 
apathy 
clumsiness 
dysarthria 
dysphagia 
abnormal eye movements
34
Q

late signs of huntingtons?

A

chorea
rigidity
dementia

35
Q

in huntington’s:
GABA increases - T/F?
ACh increases - T/F?
Dopamine increases - T/F?

A

F - GABA decreases
F - ACh decreases
T - dopamine increases

36
Q

mode of action of tetrabenazine

A

limits dopamine release

37
Q

what is Sydenham’s chorea

A

widespread chorea
behavioural disturbance
OCD symptoms

38
Q

what age group does syndenham chorea often occur in?

A

Young girls

39
Q

what condition often precedes syndenham chorea?

A

rheumatic fever

40
Q

what are tics

A 
rapid 
stereotyped 
intermittent 
involuntary 
movements or sounds
41
Q

difference in tics and chorea

A

tics occur in similar place

chorea - occurs randomly in various locations

42
Q

what is Tourette’s syndrome

A

motor tics + vocal tics lasting longer than a year

43
Q

e. g. of simple tic

e. g. of complex tic

A

simple - sniffing/coughing/throat clearing

complex - barking/strings of words

44
Q

what is the most common psychiatric co-morbidity to tourette’s

A

ADHD

45
Q

pharmacological treatment for solo Tourette’s

pharmacological treatment for Tourette’s + ADHD

A

solo - risperidone (tic control)
**help to remember - risperidone sounds like ‘on my own’ **

combo - clonidine

46
Q

1st line management of Tourette’s

A

counselling
behavioural intervention
habit reversal

47
Q

what is myoclonus?

A

sudden brief shock like involuntary movement caused by muscle contraction or inhibition

48
Q

what conditions can myoclonus occur in?

A

Wilson’s disease
Huntington’s
Multiple system atrophy
Severe hypoxia

49
Q

what is hemiballism?

A

the wild flinging/throwing movements of one arm or leg (lady from church !!)

50
Q

how does hemiballism occur?

A

cerebrovascular lesion to the subthalamic nucleas

51
Q

restless leg syndrome is associated with zinc deficiency - T/F?

A

F
IRON deficiency
it’s also related with uraemia, pregnancy, parkinsons

52
Q

treatment of restless leg syndrome

A

dopamine agonists (pramipexole)

53
Q

pathophysiology of progressive supranuclear palsy?

A

protein called tau which is naturally occurring in brain

in PSP it isn’t broken down properly so high levels in the brain are harmful

Neurology (15 decks)

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