Movement disorders (Pg.489)

Question 1

Akathisia

Answer 1

Pres: Restlessness and intense urge to move

Can be seen with neuroleptic use or in Parkinson disease.

Question 2

Asterixis

Answer 2

Pres: Extension of wrists causes “flapping” motion

Associated with hepatic encephalopathy, Wilson disease, and other metabolic derangements.

Question 3

Athetosis

Answer 3

Pres: Slow, snake-like, writhing movements; especially seen in the fingers

Char lesion: Basal ganglia

Question 4

Chorea

Answer 4

Pres: Sudden, jerky, purposeless movements

Char lesion: Basal Ganglia

Chorea = dancing.
Sydenham chorea seen in acute
rheumatic fever.

Question 5

Dystonia

Answer 5

Pres: Sustained, involuntary muscle contractions

Writer’s cramp, blepharospasm, torticollis.

Question 6

Essential tremor

Answer 6

Pres: High-frequency tremor
with sustained posture
(eg, outstretched arms), worsened with movement or when anxious

Often familial. Patients often self-medicate with alcohol, which tremor amplitude. Treatment: nonselective β-blockers (eg, propranolol), primidone.

Question 7

Hemibalismus

Answer 7

Pres: Sudden, wild ailing of 1 arm +/− ipsilateral leg

Char lesion: Contralateral subthalamic nucleus (eg, lacunar stroke)

Pronounce “Half-of-body ballistic.”
Contralateral lesion.

Question 8

Intention tremor

Answer 8

Pres: Slow, zigzag motion when pointing/extending toward a target

Char lesion: Cerebellar dysfunction

Question 9

Myoclonus

Answer 9

Pres: Sudden, brief, uncontrolled muscle contraction

Jerks; hiccups; common in metabolic abnormalities such as renal and liver failure.

Question 10

Resting tremor

Answer 10

Pres: Uncontrolled movement of distal appendages (most noticeable in hands); tremor alleviated by intentional movement

Char lesion: Substantia nigra (Parkinson disease)

Occurs at rest; “pill-rolling tremor” of Parkinson disease.
When you park your car, it is at rest.