Movement Disorders/Cerebellar Disorders and Ataxia Flashcards
T/F: Parkinson’s Disease is a hypokinetic but also has action tremors and dyskinesia
False. Parkinson’s Disease is a hypokinetic but also has RESTING tremors and dyskinesia
Most common movement disorder
Tremor
Name the type of tremor:
tremor produced during voluntary contraction of muscle
Action
Name the type of tremor:
tremor present while voluntarily maintaining a position against gravity
Postural
Name the type of tremor:
tremor occurring during any voluntary movement
Kinetic
Name the type of tremor:
tremor occurring during target directed movement
Intention. Subtype of kinetic
Name the type of tremor:
tremor that occurs in body part that is not voluntarily activated and completely supported against gravity
Resting tremor
Name the type of tremor:
tremor easily visible, mainly postural with NO underlying neurological disease
Enhanced physiologic
Most common type of tremor
Essential Tremors (ET)
T/F: Essential tremor is characterized by unilateral, mainly postural or kinetic tremor involving feet.
False
BIlateral, mainly SYMMETRIC postural or kinetic tremor involving HANDS and FOREARMS
Pathophysiology of Essential Tremor
Impaired GABA-ergic inhibitory cerebellar output
Increased activity in cerebellothalamocortical circuit
Medication used to treat essential tremor include ALL except: A. Beta blocker B. Anti seizure drugs C. Muscle relaxants D. Benzodiazepines
C
Beta blocker: propranolol
Anti-seizure drugs: primidone, gabapentin, topiramate
Benzodiazepines: clonazepam
4 cardinal features of Parkinson’s Disease
Tremor at rest (asymmetric)
Bradykinesia
Rigidity
Postural instability
BRAAK staging of Parkinson’s
Preclinical presents with ____ in ____
Lewy bodies
Olfactory bulb –> anosmia
Medulla, pons
BRAAK staging of Parkinson’s
Clinical presents with ____ in ____
Lewy bodies
Midbrain (substantia nigra)
Basal forebrain
BRAAK staging of Parkinson’s
Late disease presents with ____ in ____
Lew bodies
Neocortex
T/F: Chorea is characteristic of involuntary, irregular, purposeless, asymmetric, non-rhythmic movements that gets better with activity and usually involves distal lower extremities
False. WORSEN with activity
distal UPPER extremities
Name the type of Chorea:
• Involuntary writhing, dance like movements
• Onset after infection (Group A streptococcus)
• Problems concentration
• Impulsivity
• Resolves over time
Sydenham Chorea
Which of the following is TRUE about the pathophysiology of Huntington Disease?
A. Increased GABA-ergic input to medial globus pallidus
B. Decreased inhibition of subthalamic nucleus
C. Increased tonic activity on lateral globus pallidus and substantia nigra pars reticularis
D. Increased glutaminergic stimulation of cerebral cortex
D
A. Decreased, lateral globus pallidus
B. Increased
C. Reduced, medial globus pallidus
Psychiatric symptoms of Huntington’s Disease possibly due to pathology in ____
medial anterior caudate
Treatment of Huntington's Disease include all of the following EXCEPT: A. Haloperidol B. Tetrabenazine C. Propranolol D. Sertraline E. Buspirone F. Levodopa
F. Levodopa used to treat Parkinsonism features of juvenile onset HD
A. dopamine-blocking drug
B. Dopamine depleting agent
C, D, E: for irritability/aggression
Dystonia results in disorder of ____
basal ganglia function
Dystonia is treated with:
Botox for focal or segmental
Anticholinergic: trihexiphenidyl, benztropine
Muscle relaxant
Deep brain stimulation of globus pallidus interna
Head or truncal oscillation (axial tremor) =
Titubation
Difficulty with target directed movement (finger to nose) (Overshoot or undershoot target) =
Dysmetria
Inability to coordinate single joint movements=
Dysrhythmia
Inability to coordinate multiple joint movements =
Dysdiadochokinesia
Decreased resistance to passive muscle stretch
Hypotonia
Pendular reflexes =
multiple oscillation
Inability to perform the Romberg test with eyes open suggests ___ dysfunction
cerebellar
Inability to perform the Romberg test with eyes closed suggests ___ dysfunction
dorsal column or peripheral nerve
Which of the following is FALSE about sensory ataxia?
A. Impaired feedback of position sense to coordinate movements
B. Romberg: unable to perform when eyes open
C. Dorsal column or peripheral nerve dysfunction
B. when eyes CLOSED
Which of the following is FALSE about vestibular ataxia?
A. Impaired sense of head movement
B. Lack of orientation w/ respect to gravity
C. Gait and balance difficulty
D. Incoordination of limbs or speech
D. NO incoordination of limbs or speech
Name the type of cerebellar ataxia:
o Impaired equilibrium = postural instability/titubation
o Difficulty with eye movements
o Romberg: unable to perform with eyes open
Vestibulocerellum
Flocculonodular lobe
Name the type of cerebellar ataxia:
Truncal ataxia: “drunken sailor gait”
Spinocerebellum
Vermis/midline structures
Name the type of cerebellar ataxia:
Appendicular ataxia: Disruption of fine motor movements and limbs
Dysarthria
Cerebrocerebellum
Lateral hemisphere
Name the disease:
Mutation of FXN gene → decreased frataxin protein production
Friedrich’s Ataxia
Which of the following is FALSE about pathophysiology of Friedrich’s Ataxia?
A. PNS degneration of sensory fibers
B. CNS degeneration of spinal cord and parietal cortex
C. Ataxia due to proprioceptive loss
B. spinal cord and spinocerebellar tract
Which of the following is NOT a symptom of Friedrich's Ataxia? A. Scoliosis B. Lose of ability to walk C. Abnormal ocular movement D. Diabetes E. Cardiomyopathy F. Dysarthria G. Loss of proprioception in feet H. None of the above
H
Multiple System Atrophy shows ___ on MRI
atrophy of cerebellum and brainstem
Multiple System Atrophy is caused by degeneration of (3)
Cerebellum
Pons
Inferior olives
Which of the following is FALSE about Multiple System Atrophy?
A. Weakness
B. Autonomic dysfunctions (incontinence, orthostasis)
C. Parkinsonism
D. Dementia
E. Cerebellar ataxia
F. Visual impairment
F
Drug induced cerebellar syndrome includes all of the following EXCEPT: A. Transient gait ataxia B. Sensory ataxia C. Dysarthria D. Nystagus
B
Vitamin B12 deficiency causes what kind of ataxia?
o Dorsal column degeneration → Sensory ataxia
o Spinocerebellar tract degeneration → cerebellar ataxia
Acute vitamin B1 deficiency causes what kind of ataxia?
Gait ataxia
Wernicke-Korsakoff
Chronic vitamin B1 deficiency causes what kind of ataxia?
Truncal ataxia
Cerebellar cortical degeneration
Vitamin E deficiency causes ____ degeneration
spinocerebellar
anti-Yo =
Anti-Purkinge cell antibodies → loss of Purkinje cells and cerebellar atrophy –> Multiple System Atrophy
In Ovarian/breast cancer
anti-Hu =
Anti-Purkinge cell antibodies → loss of Purkinje cells and cerebellar atrophy –> Multiple System Atrophy
In small cell lung cancer
T/F: Gluten ataxia causes reversible cerebellum damage
False. Irreversible
T/F: Unilateral stroke causes contralateral symptoms
False. Ipsilateral
