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Year 2 neuro exam 2 > Movement Disorders, Cohen I > Flashcards

Movement Disorders, Cohen I Flashcards

1
Q

Parkinsons

A

tremors
weakness
stooped posture
festinating gait!!!!

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2
Q

4 cardinal features PD

A

resting tremor 4-7 Hz
bradykinesia
dysequilibrium
rigidity

should have 3/4 to Dx

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3
Q

physiologic tremor

A

normal tremor usually hands and fingers
excacerbated by fatigue, stress, drugs and age
faster freq than pathological tremors

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4
Q

pathologic tremor

A

disturbs normal functioning

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5
Q

Bradykinesia in PD

A 
slow
look like statues
masked facies
dec blinking
hard to swallow-- drooling!!
walk or speak briefly with greater speed when under stress
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6
Q

what is kinesis paradoxica

A

in PD patient stressed and can for brief time walk/run

overcome slowness

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7
Q

Dysequilibrium in PD

A

not steady on feet, fall backwards, try to catch up with falling
lack of arm swinging!!

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8
Q

dangerous physical sign of PD

A

lack of arm swinging, lack of balance

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9
Q

cogwheeling

A

PD

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10
Q

early Sx of PD (not 4 cardinal)

A 
insomina
loss of sense of smell
impotence, incontinence, hypotension
depression
cramps and pains in back and shoulders
small scribly handwriting
loss of power of voice, monotone
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11
Q

pathology PD

A

loss of cells in substantia nigra– other areas too

loss of dopamanergic neurons in striatum

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12
Q

Lewy Bodies

A

alpha synuclein

eosinophilic in neurons

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13
Q

What is synuclein

A

protein that helps facilitate movement of synaptic vesicles to end of axon

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14
Q

Genes assoc with PD

A

PARK 1 -11

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15
Q

rare familial cases PD

A

young age

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16
Q

peak age incidence PD

A

55-59

range 40-70

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17
Q

M vs F PD

A

M>F

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18
Q

Best Tx for PD

A

L dopa
dopamine does not cross BBB so give L dopa
can combine with carbidopa

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19
Q

most common drug for PD

side effects

A

sinemet which is L dopa and carbidopa
can cause nausea, hypotension and nightmares if advanced too quickly
dyskinesias
psychosis

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20
Q

What are the dopaminergic drugs used in PD and benefits?

A

Mirapex and Requip which bind to D2 R

less wearing off effect and less dyskinesias so good to use in younger patients

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21
Q

prominent side effect of Dopamine agonists

A

psychosis

visual hallucinations

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22
Q

What drug is give to increase dopamine release in PD

A

amantadine
anticholinergic
loses effectiveness in 6 mo

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23
Q

What drugs prolong benefits of L dopa

A

inhibitors of monoamine oxidase and COMT

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24
Q

Psych problems in PD

A

dementia (later onset)
depression
psychosis

25
Q

why careful with antipsychotics in PD

A

some are antidopaminergic so use the atypical ones that are not

26
Q

survival of PD patients

A

50% die in 15 years

27
Q

Surgery for PD

A

cuts or strong stimulation in globus pallidus

deep brain stimulation of subthalmic nuclei

28
Q

Signs of drug induced Parkinsonism

A

no resting tremor

bradykinesia and dysequilibrium

29
Q

what drugs today can cause parkinsonism

A

phenothiazines for nausea, reflux
metocloparmide
promethazine
weeks needed to recover once stop drug

30
Q

Signs Progressive Supranuclear Palsy

A

no tremor
severe dysequlibrium
FALLS!! and CHOKING
loss of speech and moderate dementia
progressive loss EOMI!!!!! vertical then horizontal
extension of neck and confused look on face
blink alot!!

31
Q

fearful expression on patient

A

progressive supranuclear palsy

32
Q

PSP misdiagnosed as

A

PD

33
Q

deaths from PSP

A

aspiration pneumonia or from fall

34
Q

pathology PSP

A

degeneration of entire brainstem

especially midbrain

35
Q

25% PSP patients respond to what drugs used in PD

A

l dopa carbidopa

36
Q

most common movement disorder seen in practive

A

essential tremor

37
Q

essential tremors

A

mostly arms, sometimes head
fast
evident in childhood or in 20s

38
Q

what cause essential tremors

A

disease in thalamus probably

39
Q

Dx essential tremor

A

Hx and lack of other evidence of disease
FMH+++!!
cannot touch to opposing fingers or nose

40
Q

what must you rule out to Dx essential tremor

A

hyperthyroidism
medication effect
cerebellar disease
parkinsonism features

41
Q

Tx for essential tremors

A

weights on wrists, heavier utensils

propanolol and primidone

42
Q

Tx for severe essential tremor

A

surgery via deep brain stimulation

43
Q

Tics

A

rapid movements
sniffing, grunting, blinking, clearing throat, protruding chin, wrinkling face, shrugging shoulders
usually in children and fades away

44
Q

Tourettes

A

both motor and vocal tics
start before age 21
does not fade away
many patients also have OCD

45
Q

pathology tourettes

A

maybe dopamine disorder

46
Q

Tx tourettes

A

haloperidol or other D2 blockers

newer antipsychotics and sometimes clonidine

47
Q

Chorea

A

irregular and variable movement
smooth and continous
writhing

48
Q

Syndenham chorea

A

untreated group A strep infection

49
Q

Huntington

A

inherited
chromosome 4
CAG repeats
chorea, tremors, clumsiness, dementia, psych agitaiton depression and psychosis

50
Q

age onset HD

A

40s 50s

51
Q

area affected in HD

A

basal ganglia

52
Q

HD Dx

A

known +FMH

testing done AFTER counseling!

53
Q

Tx HD

A

dopaminergic blockers or chorea that are also antipsychotics to help agitation
Tetrabenazine!

54
Q

side effects of dopaminergic blockers used in HD

A

sedation, hypotension and tardive dyskinesia when used chronically

55
Q

Prognosis HD

A

rapid downhill course

die in institutions from suicide infections or falls

56
Q

Restless Leg syndrome

A 
cannot stop moving legs
Dx middle aged and elderly
less common in children
painful disturbing creepy crawly sensation
interferes with onset sleep
maybe autosomal recessive
57
Q

MRI restless leg syndrome

A

reductions total iron esp in substantia nigra
reduced dopaminergic activity in brainstem and basal ganglia
reduced activity tyrosine hydroxylase

58
Q

Tx Restless leg syndrome

A

dopaminergic drugs like pramipexole and l dopa carbidopa
iron!!
benzos and gabapentin

59
Q

when are medications taken for those with restless leg syndrome

A

at least 30 minutes before onset of sleep or all time in those with continuous restless leg syndrome

Year 2 neuro exam 2 (23 decks)

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