Neuralgias

Question 1

Body part affects is supported against gravity, no muscle contraction

Answer 1

Resting tremor

Question 2

Produced by voluntary muscle contraction

Answer 2

Action tremor

Question 3

Present during visually-guided, target-directed motion

Answer 3

Intention tremor

Question 4

aka benign familial tremor

Answer 4

Benign essential tremor

Question 5

MC movement disorder worldwide* ; insidious development, SLOW progression; unilateral progresses to bilateral; usually starts with postural distal arm tremor; Neuro exam NORMAL!

Answer 5

Benign essential tremor

Question 6

Amplitude increases with stress, fatigue, CNS stimulants, voluntary activity; DECREASES with ETOH, beta-blockade, reset

Answer 6

Benign essential tremor

Question 7

Tx of Benign essential tremor

Answer 7

Primidone or Propranolol (better tolerated)

Question 8

Neurodegenerative disorder resulting form DECREASE in dopaminergic transmission in basal ganglia

Answer 8

Parkinson’s Disease

Question 9

4 Cardinal Signs= Tremor, Rigidity, Bradykinesia, Postural impairment

Answer 9

Parkinson’s Disease

Question 10

Tremor that is worse at REST; Resting tremor MC sign; One limb or one side of body for months to years; spares head

Answer 10

Parkinson’s disease

Question 11

Rigidity (increased resistance to passive movements)–> flexed posture; “cogwheel rigidity”; NO weakness; NO change in DTRs

Answer 11

Parkinson’s disease

Question 12

Slowness of movements; effects voluntary movements and speech; seen in Parkinson’s

Answer 12

Bradykinesia

Question 13

Classic “festinating gait”; short fast steps (trying to keep up with the forward center of gravity); freezing w/ direction change or when entering small space

Answer 13

Parkinson’s disease

Question 14

“mask-like” face, decreased blinking, dementia 6x normal rate, micrographic (small handwriting), hypophonia, depression, akinesia

Answer 14

Parkinson’s disease

Question 15

Loss of melanin-containing dopaminergic neurons in substantial nigra; LEWY BODIES in basal ganglia

Answer 15

Parkinson’s Disease

Question 16

GOLD STANDARD in tx of Parkinson’s; converted to dopamine in the brain–> Dopamine itself cannot cross BBB!

Answer 16

Levodopa

Question 17

SE include nausea, dyskinesias (sudden, uncontrollable, jerky movements of extremities)

Answer 17

Levodopa

Question 18

Includes Ropinirole; used in Parkinson’; possibly neuroprotective; stimulate dopamine receptor directly (D3); can add-on to dopamine when levodopa alone no longer effective (or SEs intolerable)

Answer 18

Dopamine agonists

Question 19

Includes Benzotropine; used in Parkinson’s primarily to alleviate tremor; Decreases the imbalance between dopamine and acetylcholine, increasing dopamine levels.

Answer 19

Anticholinergics

Question 20

Antiviral flu drug, also anti-dyskinetic for mild symptoms; NMDA receptor antagonist–>increases presynaptic dopamine release; may also help with chorea in Huntington’s!

Answer 20

Amantidine

Question 21

Includes Selegiline; used in Parkinson’s; decreases dopamine breakdown and increases dopamine in the striatum; may be neuroprotective

Answer 21

MAO-B Inhibitors

Question 22

Surgically implanted neurostimulator in subthalamic nucleus; blocks abnormal signs that cause PD symptoms; only for pts whose symptoms are UNCONTROLLED BY MEDS!

Answer 22

Deep Brain Stimulation

Question 23

AUTOSOMAL DOMINANT neurodegenerative disorder; Disease of the YOUNG; Triad= motor, cognitive, and psychiatric symptoms; insidious onset, no cure; fatal in 15-20yrs!

Answer 23

Huntington’s disease

Question 24

“the dance”-primarily involuntary movement in HD; involuntary, irregular, rapid, uncontrolled, excessive movement

Answer 24

Chorea

Question 25

Abnormal eye movements, slow or uncoordinated fine motor control, dysarthria, dysphagia, gait disturbance

Answer 25

Huntington's disease

Question 26

Psychiatric symptoms include depression, mania, OCD, apathy, anxiety

Answer 26

Huntington's disease

Question 27

Decrease in GABA (GABA is inhibitory), decrease in Ach, increase in dopamine

Answer 27

Huntington's disease

Question 28

Defective gene on 4th chromosome-> has excess repeats of glutamine "CAG" sequence (40+ repeats= will have HD; 70+ repeats- will have juvenile HD)

Answer 28

Huntington's disease

Question 29

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

Answer 29

Tourettes

Question 30

Dx: multiple motor and one or more vocal tics at some time during the disorder that are NOT explained by another medical condition and directly observed or recorded; Tic episodes several times a day, almost every day >1 year

Answer 30

Tourettes

Question 31

Initially in head and face; includes blinking, face twice, head jerk, shrug, neck stretch, sniffing

Answer 31

Motor tics

Question 32

Sudden, involuntary, recurrent, and often loud; include grunt, throat clearing, sign, bark, hiss, snort, sniff; advanced includes repeating words or phrases out of context

Answer 32

Vocal tics

Question 33

Used in the tx of tourettes to decrease behavior problems; include Haloperidol, fluphenazine, risperidone

Answer 33

Dopamine antagonists/antipsychotics

Question 34

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

Answer 34

Cerebral palsy

Question 35

Associated conditions include epilepsy, developmental delay, behavioral issues/learning disabilities, and fxs

Answer 35

Cerebral palsy

Question 36

Compression at the superior thoracic outlet resulting from excess pressure place on a neurovascular bundle passing between the anterior scalene and middle scalene muscles; Adson's sign (loss of radial pulse in arm when rotating head to ipsilateral side), costoclavicular maneuver (shoulders drawn downward and back)

Answer 36

Thoracic outlet syndrome

Question 37

Intermittent, progressive chronic disorder involving aberrant firing of the trigeminal nerve (CN V)--> usually 2nd and 3rd branches; UNILATERAL lancing paroxysmal facial pain

Answer 37

Trigeminal Neuralgia

Question 38

Found in those >50; in younger pts, should make you think of MS*

Answer 38

Trigeminal Neuralgia

Question 39

Symptoms include stabbing, shocking, 'live wire'; pain can be severe and cause muscle spasm (tic); episodes last a day to several weeks

Answer 39

Trigeminal neuralgia

Question 40

Pain triggered by LIGHT touch and vibration, but NOT firm pressure; Pts will hold face VERY still to avoid triggering

Answer 40

Trigeminal neuralgia

Question 41

Tx of trigeminal neuralgia; Decreases hyperactivity of trigeminal nerve nucleus

Answer 41

Carbamazepine (1st line) & Phenytoin

Question 42

Experience of pain from a NON-PAINFUL stimulus, such as light touch; May be present in Post-herpetic neuralgia

Answer 42

Allodynia