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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
why careful with antipsychotics in PD
some are antidopaminergic so use the atypical ones that are not
26
survival of PD patients
50% die in 15 years
27
Surgery for PD
cuts or strong stimulation in globus pallidus | deep brain stimulation of subthalmic nuclei
28
Signs of drug induced Parkinsonism
no resting tremor | bradykinesia and dysequilibrium
29
what drugs today can cause parkinsonism
phenothiazines for nausea, reflux metocloparmide promethazine weeks needed to recover once stop drug
30
Signs Progressive Supranuclear Palsy
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
fearful expression on patient
progressive supranuclear palsy
32
PSP misdiagnosed as
PD
33
deaths from PSP
aspiration pneumonia or from fall
34
pathology PSP
degeneration of entire brainstem | especially midbrain
35
25% PSP patients respond to what drugs used in PD
l dopa carbidopa
36
most common movement disorder seen in practive
essential tremor
37
essential tremors
mostly arms, sometimes head fast evident in childhood or in 20s
38
what cause essential tremors
disease in thalamus probably
39
Dx essential tremor
Hx and lack of other evidence of disease FMH+++!! cannot touch to opposing fingers or nose
40
what must you rule out to Dx essential tremor
hyperthyroidism medication effect cerebellar disease parkinsonism features
41
Tx for essential tremors
weights on wrists, heavier utensils | propanolol and primidone
42
Tx for severe essential tremor
surgery via deep brain stimulation
43
Tics
rapid movements sniffing, grunting, blinking, clearing throat, protruding chin, wrinkling face, shrugging shoulders usually in children and fades away
44
Tourettes
both motor and vocal tics start before age 21 does not fade away many patients also have OCD
45
pathology tourettes
maybe dopamine disorder
46
Tx tourettes
haloperidol or other D2 blockers | newer antipsychotics and sometimes clonidine
47
Chorea
irregular and variable movement smooth and continous writhing
48
Syndenham chorea
untreated group A strep infection
49
Huntington
inherited chromosome 4 CAG repeats chorea, tremors, clumsiness, dementia, psych agitaiton depression and psychosis
50
age onset HD
40s 50s
51
area affected in HD
basal ganglia
52
HD Dx
known +FMH | testing done AFTER counseling!
53
Tx HD
dopaminergic blockers or chorea that are also antipsychotics to help agitation Tetrabenazine!
54
side effects of dopaminergic blockers used in HD
sedation, hypotension and tardive dyskinesia when used chronically
55
Prognosis HD
rapid downhill course | die in institutions from suicide infections or falls
56
Restless Leg syndrome
``` 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
MRI restless leg syndrome
reductions total iron esp in substantia nigra reduced dopaminergic activity in brainstem and basal ganglia reduced activity tyrosine hydroxylase
58
Tx Restless leg syndrome
dopaminergic drugs like pramipexole and l dopa carbidopa iron!! benzos and gabapentin
59
when are medications taken for those with restless leg syndrome
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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