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Clin Med- Neuro > Movement Disorders Lecture > Flashcards

Movement Disorders Lecture Flashcards

1
Q

Seen when there is NO muscle engagement/activity

(must hold up the pts affected body part to really determine)

A

Resting tremor

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2
Q

Tremor that is produced by voluntary muscle contraction

A

Action tremor

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3
Q

Tremor that is present during visually guided, target directed motion

ie..going to pick up a water bottle

A

Intention tremor

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4
Q

“normal” finding
high frequency, low amplitude postural tremor
enhanced by hyper-adrenergic states

fine, fast tremor. low amplitude. worse with anxiety

A

Physiologic tremor

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5
Q

MC movement disorder wordwide

aka benign familial tremor

generally seen in elderly (60+)

A

Benign essential tremor

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6
Q

Insidious development, slow progression
95% start with postural distal arm tremor

*unilateral, progresses to bilateral
almost ALWAYS upper extremity!!!

A

Benign essential tremor

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7
Q

Elder pt, slow progression, upper extremity (starts unilateral, moves bilateral)

..think of?

A

Benign essential tremor

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8
Q

Worsens with:
Stress, fatigue, CNS stimulants, voluntary activity

Better with:
ETOH, beta blockers, rest

A

Benign essential tremor

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9
Q

Treatment for benign essential tremor

contraindicated in asthma

SE: sedation, dizziness, nausea, mood changes

barbiurate, anticonvulsant

A

Primidone

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10
Q

Do you use beta blockers to treat benign essential tremor?

A

YES.

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11
Q

What will the neurological exam look like in a benign essential tremor?

A

Normal

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12
Q

Neurodegenerative disorder resulting from decreased dopaminergic transmission in basal ganglia

A

Parkinsons

(think dopamine when you hear Parkinsons)

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13
Q

4 cardinal signs:

  1. tremor
  2. rigidity
  3. bradykinesia
  4. postural impairment
A

Parkinsons

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14
Q

Tremor is present in 85% of cases
“pill rolling” 4-6 Hz resting tremor
one limb or one side of body for months to years
spares head

A

Parkinsons

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15
Q

Rigid gait
Flat affect/facial expressions
Tremor with rest and action

A

Parkinsons

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16
Q

Increased resistance to passive movements
“cogwheel rigidity”

NO weakness (5/5 in all extremities)
NO change in DTRs

A

Parkinsons

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17
Q

Bradykinesia (slowness of movements)
Effects voluntary movements and speech

*start hesitation..trouble taking that first step

A

Parkinsons

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18
Q

Parksinson pts have difficulty with balance and gait

..at what point in the disease process do you see this?

A

later in disease course

(worrisome if seen early. normally this takes long time)

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19
Q

What is “festinating gait” referring to?

A

The way a Parkinson’s pt walks…

short fast steps, trying to keep up with center of gravity. shuffling

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20
Q

What does turn “en bloc” refer to?

A

The way a Parkinson’s patient turns

freezing with direction change or when entering small space

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21
Q

“mask like” face
decreased blinking
dementia 6x normal
micrographia
hypophonia
depression
akinesia

A

Parkinsons

(non specific, just other findings)

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22
Q

Peak onset 60 (35-85)
Course 10-25 years
Males>Females
Some genetic predisposition

A

Parkinsons

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23
Q

Loss of melanin-containing, dopaminergic neurons in substantia nigra

Lewy bodies***- Pathological hallmark of PD when in basal ganglia (not specific)

A

Pathophysiology of Parkinsons

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24
Q

At the time Parkinsons symptoms appear, what levels might be depleted by 70%?

A

Dopamine

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25
Q

Gold standard tx of Parkinsons?

A

Levodopa

(converted to dopamine in the brain. dopamine itself cant cross BBB)

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26
Q

When do you start treating Parkinsons?

A

When functional disability starts

*medication benefit only works for a few years

27
Q

What is a surgical tx option for Parkinsons?

A

Surgically implanted deep brain stimulation

blocks abnormal signals that cause PD symptoms

28
Q

Autosomal dominant neurodegenerative disorder

Classic triad: motor, cognitive and psychiatric symptoms

insidious onset, no cure
age of onset: 30-50
Fatal in 15-20 years*

A

Huntington’s disease

29
Q

Primary involuntary movement in Huntington’s Disease
“the dance”

A

Chorea

30
Q

What is athetosis? (seen in Huntington’s)

A

Proximal limb writhing

31
Q

Involuntary, irregular, rapid, uncontrolled, excessive movement

*often not noticed by, nor disturbing to, the patient

A

Chorea

32
Q

Abnormal eye movements
Slow or uncoordinated fine motor control
Dyarthria
Dysphagia
Gait disturbance
Bradykinesia and rigidity late in course (as chorea peaks and wanes)

A

Huntington’s

33
Q

Psychiatric symptoms:

Depression
Mania
OCD
Apathy
Anxiety

A

Huntington’s disease

34
Q

Cognitive symptoms:

Dysfunction of executive functions
Problems with plannig, judgement, emotion, regulation, learning, attention, etc.
Cant follow instructions
Temper outbursts
Difficulty with spatial perception

A

Huntington’s

35
Q

decreased GABA

decreased Ach

increased dopamine

A

Huntingtons

36
Q

Excessive number of “CAG” sequence repeats

A

Huntingtons

37
Q

How do you treat Huntingtons?

A

Symptomatically

(Neuroleptics, Benzos, Dopamine depleting agents)

38
Q

MAJOR potential complication of Huntingtons?

A

Rhabdomyolysis

(breakdown of muscle tissue that releases damaging protein into blood)

39
Q

Inherited neurobehavioral disorder characterized by sudden involuntary, repetitive muscle movements and vocalizations

A

Tourette’s

40
Q

For a diagnosis of Tourette’s…
Tic episodes several times a day, almost every day, or periodically during period longer than….

A

1 year

41
Q

Where does Tourette’s start/originate?

A

Head and face

(ie blinking, face twitch, head jerk, shrug, neck stretch, sniffing)

42
Q

Meaningless repitition or imitation of movements

*seen in Tourette’s patients

A

Echopraxia

43
Q

Palilalia

A

repeating one’s own words

44
Q

Repeating heard words-last words spoken by someone else

A

Echolalia

45
Q

Coprolalia

A

the involuntary and repetitive use of obscene language

46
Q

movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures or both

diagnosed in the young!

A

Cerebral palsy

47
Q

Non-traumatic fractures can occur due to extreme hyper flexion or hyper extension

A

Cerebral Palsy (CP)

48
Q

“burning” sensation
generally starts in distal extremities (MC feet) and moves proximally

A

Neuropathy

49
Q

Hallmark= VERY painful with light touch
Hypersensitive

pain out of proportion

A

Neuropathy

50
Q

Compression at the superior thoracic outlet resulting from excess pressure places on a neurovascular bundle passing between the anterior scalene and middle scalene muscles

A

Thoracis outlet syndrome

51
Q

Positive Adson’s sign
Costoclavicular movement

seen in…

A

Thoracis Outlet Syndrome

52
Q

Intermittent, progressive chronic disorder involving aberrant firing of trigeminal nerve-
usually 2nd and 3rd branches

Unilateral lancing paroxysmal facial pain

A

Trigeminal neuralgia

53
Q

Triggers= light touch!!

but NOT firm pressure

A

Neuropathy

54
Q

What will a neuro exam look like in trigeminal neuralgia?

A

NORMAL! except for illicit pain with light touch

55
Q

Drug class for treatment of trigeminal neuralgia?

A

Anti-convulsants

56
Q

Highest risk location of shingles?

A

Trigeminal (especially ophthalmic division..can cause blindess)
Brachial plexus

57
Q

A term applied to a number of genetic disorders that produce progressive degeneration and necrosis of skeletal muscle fibers and eventual replacement with fat and connective tissue

A

Muscular dystrophy

58
Q

Does muscular dystrophy involve the nervous system?

A

NO..disease of muscle tissue!

59
Q

A disorder of the neuromuscular junction that affects impulse transmission between the motor neuron and the innervated muscle cell

A

Myasthenia Gravis

60
Q

An acute life threatening polyneuropathy
rapid progressive limb weakness and LOSS of tendon reflexes

MC cause of acute, flaccid paralysis in developed countries

A

Guillain-Barre syndrome

61
Q

An acute onset immune-mediated demyelinating neurpathy

progressive ascending muscle weakness of limbs, producing a symmetric flaccid paralysis

Symptoms: parasthesia and numbness, often accompany the loss of motor function

A

Guillain-Barre syndrome

62
Q

What is the Myerson Sign and what disorder is it seen in?

A

Sustained eye blinking in response to taping above nasal bridge

seen in Parkinson’s

63
Q

Can you tx trigeminal neuralgia with Carbamazepine?

A

YES

Clin Med- Neuro (10 decks)

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