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Neurology > Movement Disorders & Parkinsons > Flashcards

Movement Disorders & Parkinsons Flashcards

1
Q

Name the parts of the brain involved in voluntary movement

A
  • pyramidal tracts
  • basal ganglia
  • cerebellum
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2
Q

What is the word used to describe too little movement?

A

Hypokinetic

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3
Q

What is the word used to describe too much movement?

A

Hyperkinetic

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4
Q

State three important factors to include in a history of suspected movement disorder

A

Birth
Family History
Drug and toxin history

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5
Q

What does the pneumonic TRAP stand for?

A

Tremor
Rigidity
Akinesia/bradykinesia
Postural disturbances

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6
Q

Describe rigidity

A

Increased muscle tone that is felt on passive movement, resistance is felt throughout full range of movement

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7
Q

What is the difference between rigidity and spasticity?

A

No increase with higher mobilising speed, which distinguishes rigidity from spasticity owing to UMN lesions

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8
Q

What is the name for the combination of rigidity and tremor?

A

Cog wheel felt at the wrist

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9
Q

What maneuver can be used to test for rigidity?

A

Froment’s - rigidity increases in examined body segment by voluntary movement of other body parts

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10
Q

What is akinesia?

A

Loss of movement

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11
Q

What is bradykinesia?

A

Slowed movement

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12
Q

State the features of hyperkinetic disorders

A 
Tremor 
Dystonia 
Chorea 
Ballism 
Myoclonus 
Tics
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13
Q

Define camptoconia

A

Extreme anterior truncal flexion

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14
Q

Define festination

A

Lots of small steps, change of centre of gravity

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15
Q

What is the test for postural instability?

A

Pull test

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16
Q

What is a tremor?

A

Rhythmic sinusoidal oscillation of a body part

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17
Q

Name four types of tremor

A
  • rest
  • postural (when arms outstretched)
  • kinetic
  • cerebellar (when you approach a target)
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18
Q

Describe dystonia

A

Sustained, intermittent muscle contractions causing abnormal repetitive movements, postures or both

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19
Q

What makes a dystonia worse?

A

Voluntary action

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20
Q

Describe chorea

A

Irregular purposeless movement that flit and flaws from one body part to another - restless and fidgety

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21
Q

What causes chorea?

A 
Basal ganglia lesions
APLS 
Huntington's 
Neuroacanthocytosis 
Oral contraception
22
Q

Name a variant of chorea

A

Ballism - involves proximal joints resulting in large amplitude flinging movements with a hemi-body distribution

23
Q

What causes ballism?

A

Contralateral lesion invloving striatum or subthalamic nucleus

24
Q

Describe myoclonus

A

Brief electric shock like jerks, hiccups and hypnic jerks

25
Q

Give an example of negative myoclonus

A

Asterixis in liver flap

26
Q

What are tics?

A

Un-voluntary repetitive stereotyped movements or vocalisations - suppressible by the patient for a short period of time

27
Q

Describe motor and vocal tics

A

Motor - eye blinking, jerks, complex sequence

Vocal - sniffing, grunting, snorting, phrases

28
Q

What disease often has a onset of persistent multiple motor and vocal tics?

A

Gilles de la Tourette Syndrome

29
Q

Describe the most common type of tremor

A

Essential tremor - seen when hands are outstretched, runs in families autosomal dominant slow progression made worse by alcohol

30
Q

What can cause a tremor?

A
  • Wilson’s disease
  • Physiological tremor
  • Hepatic encephalopathy
  • Titubation (oscillation of the head in anteroposterior/verticle position)
31
Q

What are the non-motor clinical features of Parkinson’s disease?

A 
Sleep disorders 
Hallucinations 
GI dysfunction 
Depression 
Cognitive impairment 
Anosmia
32
Q

What causes parkinsons disease?

A

Loss of dopaminergic neurons from the pars compacta region of substantia nigra

33
Q

What percentage of neurons need to be lost to give parkinsons symptoms?

A

60%

34
Q

What staging can be used in Parkinson’s?

A

Braak - early non-motor symptoms, areas subsequently affected as disease progresses through motor and non-motor phases

35
Q

State the three sub-types of parkinson’s disease

A
  • tremor dominant (relative absence of other motor symptoms)
  • non-tremor dominant (akinetic rigid syndrome, postural instability)
  • mixed
36
Q

Which subtype has the slower progression rate?

A

Tremor dominant

37
Q

What are the stages of Parkinson’s disease?

A

Prodromal phase
Early Stage
Unstable
Advanced and palliative

38
Q

Describe the prodromal phase of Parkinson’s

A

Up to 20 years, constipation, psychiatric problems, hyposomia, EDS, RBS

39
Q

How is Parkinson’s diagnosed?

A
  • Bradykinesia and one or more - resting tremor, rigidity, postural instability
  • Presence of parkinsonism with no alternative diagnosis and dopamine responsiveness
40
Q

What form of imaging can be useful in Parkinson’s?

A

DatSCAN - radioiodine solution will result in a period shaped

41
Q

State the factors that increase your risk of Parkinson’s

A

Pesticides, head injury, rural living, beta blockers, agriculture, well water drinking

42
Q

State the factors that decrease your risk of Parkinson’s

A

Tobacco, coffee, NSAIDs, CCB, Alcohol

43
Q

What are motor flucutations?

A

Alterations between periods of good motor symptom control and reduced control

44
Q

What are non-motor flucutations?

A

Alterations between periods of good and bad non-motor symptoms control

45
Q

What is dyskinesisa?

A

Involuntary choreiform or dystonic movements which occur most frequently when levodopa concentrations are at their maximum

46
Q

Describe the pathophysiology of Parkinson’s

A
  • Lewy body formation in the cells that remain due to accumulation of aggregations
  • Reactive gliosis, immune pathways can move in blood to outside of the brain
47
Q

What drugs are used in the treatment of Parkinson’s?

A 
Levodopa + beserazide = madopar 
Dopamine agonist - ropinirole 
MAO-B inhibitors - selegiline
COM inhibitors - entacapone
Muscarinic ACh receptor antagonist
48
Q

What drug treats the tremor?

A

Anticholinergic agents

49
Q

What drug has the greatest symptomatic benefit?

A

Levodopa

50
Q

Name the surgical treatment available for Parkinsons

A

Deep brain stimulation - targets the subthalamic nucleus and globus pallidus

Neurology (29 decks)

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