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Neuro Block 8 > Movement Disorders: Hemibalismus And Athetosis > Flashcards

Movement Disorders: Hemibalismus And Athetosis Flashcards

1
Q

This type of movement disorder is characterized by writhing, twisting movements

A

Athetosis

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2
Q

What are some important causes of athetosis

A
  • medications: levodopa

- other- perinatal hypoxia, Huntingtons disease, antipsychotic meds

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3
Q

This type of movement disorder is characterized by continuous involuntary movements that have a fluid or jerky, constantly varying quality

A

Chorea

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4
Q

What do Mild cases of chorea commonly get mistaken for

A

Low amplitude chorea may be mistaken for fidgeting

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5
Q

Severe cases of chorea

A

Larger amplitude movements resemble frantic break dancing

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6
Q

Consists of uncontrolled flinging (ballistic) movements of an upper or lower extremity but is most characteristically seen in the upper extremity

A

Ballismus (hemiballismus)

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7
Q

Is basllismus usually unilateral or contralateral?

A

Unilateral

-seen as hemiballismus

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8
Q

Ballismus (hemiballismus) is most commonly seen in patients with vascular lesions localized to the ______________________

A

Contralteral subthalamic nucleus

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9
Q

What is hemiballismus caused by

A

Damage to the subthalamic nucleus or to the subthalamic projections to GPi (lenticular fasciculus) caused by stroke

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10
Q

Onset of hemiballismus following stroke

A

May be acute but more often delayed and insidious onset

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11
Q

What are some other focal pathologies other than stroke that can cause hemiballismus

A
  • abscess (infection)
  • demyelinating disease (MS)
  • neoplasm (tumor)
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12
Q

Where is athetosis usually seen

A

Usually distally in limbs: affects wrist, hand, fingers more than rest of the arm

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13
Q

What is athetosis usually due to

A

Stroke (ischemic) and white matter (axonal) damage

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14
Q

What disease can athetosis be seen in

A

Huntingtons disease

-along with hemiballismus

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15
Q

What is it called when athetosis and hemiballismus are seen together in huntingtons disease

A

Choreoathetotic movement

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16
Q

What causes athetosis

A
  • disruption of the direct pathway
  • stroke involving the internal capsule
  • NOT neurodegenerative disease
  • due to partial damage to GPi projections to thalamus via the ansa lenticularis or lenticular fasciculus
  • can occur due to a small lesion (infarct, demyelinating plaque, etc)
  • can also emerge as a delayed, residual deficit after an internal capsule infarct, as with hemiballismus
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17
Q

What are the two kinds of strokes you will see involving the internal capsule

A

Mixed sensorimotor stroke

Pure motor stroke

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18
Q

Mixed sensorimotor stroke involving the internal capsule

A

Since both motor and sensory fibers are carried in the internal capsule, a stroke to the posterior limb of the internal capsule can lead to contralateral weakness and contralateral sensory loss

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19
Q

Pure motor stroke involving the internal capsule

A
  • like a UMN lesion
  • lacunar infarct, result of an infarct affecting the posterior limb of internal capsule
  • weakness of face, arm, and/or leg
  • caused by infarct in the internal capsule is the most common lacunar syndrome
  • UMN signs: hyperreflexia, babinski, spasticity
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20
Q

What kind of infarct could give you a hemiplegic gait

A

Right internal capsule infarct

21
Q

Hemiplegic gait following right internal capsule infarct

A
  • stabilizes posture by favoring intact side
  • pt swings body to passively shift leg forward
  • flexed posture of affected arm
  • lower face weakness
  • head tilt
22
Q

If a patient comes in with arm/leg weakness, how do you tell if it is internal capsule stroke or a cortical stroke

A

The presence of the following signs along with the weakness will be indicative of a cortical stroke

  • gaze preference or deviation
  • expressive or receptive aphasia
  • VF deficits
  • visual or spatial neglect
23
Q

Blood supply to the striatum and globus pallidus

A

Lenticulostriate branches of the MCA

24
Q

What are some other possibilities of blood supply to the globus pallidus other than the lenticulostriate branch of the MCA

A

Anterior choroidal artery

25
Q

What are some other possibilities of blood supply to the caudate nucleus other than the lenticulostriate branch of the MCA

A

Recurrent artery or Heubner (branch of ACA)

26
Q

Why is it hard to tell what arteries are affected in a stroke near the basal nuclei

A

There is a lot of variability in blood supply to the area

27
Q

Blood supply to the internal capsule anterior limb

A

Lenticulostriate branches of MCA

-less often branches of ACA

28
Q

Blood supply to genu of the internal capsule

A

Lenticulostriate branches of MCA

29
Q

Blood supply to posterior limb of internal capsule

A
  • lenticulostriate branches of MCA

- anterior choroidal artery of ICA

30
Q

What is the blood supply to the subthalamic nucleus

A

Anterior choroidal artery

31
Q

What structures does the anterior choroidal artery supply

A
  • subthalamic nucleus
  • small inferior portion of the globus pallidus
  • inferior portion of the internal capsule
32
Q

What do the more superior aspects of the internal capsule receive blood supply from

A

Lateral striate artery branches

33
Q

Blood supply to basal nuclei

A

Medial and lateral striate arteries

34
Q

Vascular territories for caudate nucleus, putamen, globus pallidus

A

No clearly defined vascular territory

  • significant overlap or anastomoses among branches of the medial and lateral traits arteries
  • occlusion in any given branch leads to variable infarcts within the basal nuclei
35
Q

Hemorrhage and basal nuclei

A

Hemorrhages can involve all of the basal nuclei and if unchecked, can becomes fatal

36
Q

What disease is associated with low dopamine levels

A

Parkinson’s

37
Q

What is associated with too much dopamine levels

A

Psychiatric problems such as schizo

38
Q

System from the ventral tegmental area to prefrontal cortex, limbic regions, and ventral striatum

A

Mesocorticolimbic system

39
Q

System from substantia nigra to caudate nucleus and putamen

A

Nigrostriatal

40
Q

What happens when there are problems in the mesocorticolimbic system

A
  • psychiatric problems (schizo)

- explains depression during Parkinson’s too

41
Q

What is a major target of the mesocorticolimbic dopamine pathway from the ventral tegmental area

A

Nucleus accumbens

42
Q

What underlies behavioral side effects L-Dopa treatment: impulsive/risky behavior, manic/psychotic episodes

A

Excessive activation of the mesocorticolimbic system

43
Q

Diverse functions of the caudate nucleus

A

Not only projects to motor nuclei of the thalamus, but also to centromedian (part of the reticular activating center) and medodorsal nuclei (connects with prefrontal cortex), which are involved in promoting optimal alertness and executive functions of the prefrontal cortex (cognition, behavioral regulation)

44
Q

In huntingtons disease, degeneration in ___________likely contributes to emotional disturbances: volatile emotions

A

Caudate nucleus

45
Q

A basal nuclear disorder that is iatrogenic in nature, that is , caused by medical intervention for treatment for another disease. It is caused by chronic treatment with neuroleptic meds

A

Tardive dyskinesia

46
Q

What is the manifestation of tardive dyskinesia

A

Uncontrolled involuntary movements, particularly of the face, mouth, and tongue, and cogwheel rigidity, may be temporary or permanent

47
Q

What is the action of neuroleptic drugs

A

Block dopaminergic transmission throughout the brain. The primary target cells are those in the ventral tegmental area that form the mesolimbic dopaminergic pathway.

48
Q

Prolonged treatment with neuroleptic drugs

A

May lead to blockage of the D2 dopamine receptors, which causes imbalance in the nigrostriatal influence on the basal nuclear motor loop and ultimately results in overestimate disorders

49
Q

Why is treatment for tardive dyskinesia compacted

A

By the fact that withdrawal of the causative medication may result in exacerbation of the underlying psychotic state.

Neuro Block 8 (11 decks)

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