Neuralgias Flashcards
Body part affects is supported against gravity, no muscle contraction
Resting tremor
Produced by voluntary muscle contraction
Action tremor
Present during visually-guided, target-directed motion
Intention tremor
aka benign familial tremor
Benign essential tremor
MC movement disorder worldwide* ; insidious development, SLOW progression; unilateral progresses to bilateral; usually starts with postural distal arm tremor; Neuro exam NORMAL!
Benign essential tremor
Amplitude increases with stress, fatigue, CNS stimulants, voluntary activity; DECREASES with ETOH, beta-blockade, reset
Benign essential tremor
Tx of Benign essential tremor
Primidone or Propranolol (better tolerated)
Neurodegenerative disorder resulting form DECREASE in dopaminergic transmission in basal ganglia
Parkinson’s Disease
4 Cardinal Signs= Tremor, Rigidity, Bradykinesia, Postural impairment
Parkinson’s Disease
Tremor that is worse at REST; Resting tremor MC sign; One limb or one side of body for months to years; spares head
Parkinson’s disease
Rigidity (increased resistance to passive movements)–> flexed posture; “cogwheel rigidity”; NO weakness; NO change in DTRs
Parkinson’s disease
Slowness of movements; effects voluntary movements and speech; seen in Parkinson’s
Bradykinesia
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
Parkinson’s disease
“mask-like” face, decreased blinking, dementia 6x normal rate, micrographic (small handwriting), hypophonia, depression, akinesia
Parkinson’s disease
Loss of melanin-containing dopaminergic neurons in substantial nigra; LEWY BODIES in basal ganglia
Parkinson’s Disease
GOLD STANDARD in tx of Parkinson’s; converted to dopamine in the brain–> Dopamine itself cannot cross BBB!
Levodopa
SE include nausea, dyskinesias (sudden, uncontrollable, jerky movements of extremities)
Levodopa
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)
Dopamine agonists
Includes Benzotropine; used in Parkinson’s primarily to alleviate tremor; Decreases the imbalance between dopamine and acetylcholine, increasing dopamine levels.
Anticholinergics
Antiviral flu drug, also anti-dyskinetic for mild symptoms; NMDA receptor antagonist–>increases presynaptic dopamine release; may also help with chorea in Huntington’s!
Amantidine
Includes Selegiline; used in Parkinson’s; decreases dopamine breakdown and increases dopamine in the striatum; may be neuroprotective
MAO-B Inhibitors
Surgically implanted neurostimulator in subthalamic nucleus; blocks abnormal signs that cause PD symptoms; only for pts whose symptoms are UNCONTROLLED BY MEDS!
Deep Brain Stimulation
AUTOSOMAL DOMINANT neurodegenerative disorder; Disease of the YOUNG; Triad= motor, cognitive, and psychiatric symptoms; insidious onset, no cure; fatal in 15-20yrs!
Huntington’s disease
“the dance”-primarily involuntary movement in HD; involuntary, irregular, rapid, uncontrolled, excessive movement
Chorea
Abnormal eye movements, slow or uncoordinated fine motor control, dysarthria, dysphagia, gait disturbance
Huntington’s disease
Psychiatric symptoms include depression, mania, OCD, apathy, anxiety
Huntington’s disease
Decrease in GABA (GABA is inhibitory), decrease in Ach, increase in dopamine
Huntington’s disease
Defective gene on 4th chromosome-> has excess repeats of glutamine “CAG” sequence (40+ repeats= will have HD; 70+ repeats- will have juvenile HD)
Huntington’s disease
Inherited neurobehavioral disorder characterized by sudden involuntary, repetitive muscle movements and vocalizations
Tourettes
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
Tourettes
Initially in head and face; includes blinking, face twice, head jerk, shrug, neck stretch, sniffing
Motor tics
Sudden, involuntary, recurrent, and often loud; include grunt, throat clearing, sign, bark, hiss, snort, sniff; advanced includes repeating words or phrases out of context
Vocal tics
Used in the tx of tourettes to decrease behavior problems; include Haloperidol, fluphenazine, risperidone
Dopamine antagonists/antipsychotics
Movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
Cerebral palsy
Associated conditions include epilepsy, developmental delay, behavioral issues/learning disabilities, and fxs
Cerebral palsy
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)
Thoracic outlet syndrome
Intermittent, progressive chronic disorder involving aberrant firing of the trigeminal nerve (CN V)–> usually 2nd and 3rd branches; UNILATERAL lancing paroxysmal facial pain
Trigeminal Neuralgia
Found in those >50; in younger pts, should make you think of MS*
Trigeminal Neuralgia
Symptoms include stabbing, shocking, ‘live wire’; pain can be severe and cause muscle spasm (tic); episodes last a day to several weeks
Trigeminal neuralgia
Pain triggered by LIGHT touch and vibration, but NOT firm pressure; Pts will hold face VERY still to avoid triggering
Trigeminal neuralgia
Tx of trigeminal neuralgia; Decreases hyperactivity of trigeminal nerve nucleus
Carbamazepine (1st line) & Phenytoin
Experience of pain from a NON-PAINFUL stimulus, such as light touch; May be present in Post-herpetic neuralgia
Allodynia
