Movement/ Tic disorders Flashcards
a 42 yo M with gradually progressive cognitive deficit also develops jerking movements of the extremities, head, trunk. Imaging shows atrophy of caudate nuclei bilaterally. Father with similar illness that started at 50. Which of the following tests is more likely to confirm?
DNA analysis for CAG repeats
79 yo pt with decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG sharp waves.
Subacute spongiform encephalopathy
Parkinson’s Disease treated with levodopa. Visual hallucinations. Recommendations?
Reduce dose of levodopa.
What MRI finding would most specifically indicate a dx of Huntingtons
Caudate head atrophy
65 yo with history of asthma presents for tx of essential tremor. Which for first line?
Primidone
Medication useful in management of orthostatic hypotension in Parkinson?
Fludrocortisone
98 yo M, unconscious after choking, had progressive neurological condition presented in his early 30’s with involuntary irregular movements of all extremities and face but after 15 yr course evolved into rigid, akinetic condition with difficulty swallowing, speaking. Also progressive dementia and full time care. After obstruction was relieved pt remained unconscious, had cardiac arrest and died. Generalized brain atrophy. Dx
Huntingtons
Tx of Huntington’s chorea
Haloperidol
Gait consisting of postural instability, destination, and truncal rigidity. Lewy bodies visualized. Also with involuntary acceleration is seen in what condition?
Parkinsons
32 yo patient with hx of cognitive deterioration, difficulty at work, and irritability. Exam: restless with slow, writhing movements in most muscle groups and frequent blinking. Pts father and paternal grandpa had similar symptoms and died in their 50s. Dx
Huntingtons
Patient with depression, 3 yr hx of change in personality, irritability, impulsive outbursts, and eccentric or inappropriate social interactions. He subsequently lost his job and is now withdrawn and fidgety. Pt has increased eye blinking, marked tongue impersistence, mild bradykinesia, akinesia, and mild hyperreflexia without clonus. The pt’s dad died of severe dementia at 55. Dx
Huntingtons
Typical of idiopathic Parkinson’s disease, rather than another parkinsonian syndrome
Asymmetrical onset and progressive motor symptoms
First line tx of restless leg syndrome
Pramipexole
Multifocal myoclonus in a comatose pt indicates
Metabolic encephalopathy
Most effective tx for “writer’s cramp” (focal dystonia associated with writing)
Botulinum toxin
