Neuro Cases 2

Question 1

What is a resting tremor?

Answer 1

Occurs in body part that is relaxed and completely supported against
gravity
Enhanced by mental stress or movement of another body part (walking)
Diminished by voluntary movement of that body part

Question 2

What is an action tremor?

Answer 2

Postural tremor – maintaining a position against gravity (i.e. arm elevation) • Isometric tremor – muscle contraction against a rigid stationary object (i.e.
making fist)
Kinetic tremor associated with voluntary movement and includes intention
tremor, which is produced with target-directed movement (i.e. reaching
for a pen)

Question 3

What is an enhanced physiological tremor?

Answer 3

Everybody has an asymptomatic physiologic tremor • Low amplitude, high frequency at rest and during activity • Enhanced by anxiety, stress, certain medications and metabolic conditions • If patients have tremors that come and go with anxiety, med use, caffeine
intake or fatigue, they don’t need further testing

Question 4

What is an essential tremor?

Answer 4

• Most common pathological tremor • 95% of patients have primarily kinetic rather than postural • Most common in hands and wrists, can also affect head, LEs and voice • Usually bilateral, is present with different tasks and interferes with
activities • Can be inherited, tends to progress with age • 25% of those affected retire early or modify career path, can cause social
embarrassment • Caffeine and fatigue exacerbate these tremors, alcohol can help symptoms

Question 5

What is an Parkinsonism tremor?

Answer 5

-medicine CAN CAUSE THIS (by blocking or depleting dopamine)
-Parkinsons Disease: 70% hare RESTING TREMOR, pill rolling motion
Bradykinesia: difficulty rising from a seated position, reduced arm swing, microgrpahia

Question 6

What is an Cerebellar tremor?

Answer 6

Low-frequency, slow-intension or postural tremor, and is
typically caused by multile sclerosis with cerebellar plaques, stroke, or
brainstem tumors.

Question 7

What is an Psychogenic tremor?

Answer 7

abrupt onset, spontaneous
remission, changing tremor characteristics (including locaton and
frequency), increase with attention and extinction with distraction.
More frequently seen in patients employed in allied health professions,
those involved in litigation

Question 8

Symptoms of PD (Parkinson’s Disease

Answer 8

Resting tremor is often first sign • Subtle decrease in dexterity • Decreased arm swing on the first-
involved side • Soft voice • Sleep disturbances • Decreased sense of smell
Subtle decrease in dexterity • Decreased facial expression • A general feeling of weakness,
malaise, or lassitude • Depression or anhedonia • Slowness in thinking • Shuffling gait • Symptoms of autonomic
dysfunction (eg, constipation,
sweating abnormalities, sexual
dysfunction, seborrheic dermatitis
)

Question 9

Differences between Parkinson’s tremor and essential tremor

Answer 9

PD: AT REST, assymtrical, improved with levodopa, progressively worse, affects hands and legs, writing is small and illegible
ET: Posture holding, symmetrical, improve and tremulous (large loops)

Question 10

What is dementia?

Answer 10

loss of cognitive functioning—thinking, remembering, and reasoning— and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. These functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention

Question 11

For who and when is dementia most prevalent?

Answer 11

anyone > 80

ESPECIALLY WOMEN

Question 12

Etiologies of dementia

Answer 12

Alzheimer disease • Delirium • Frontotemporal dementia • HIV infection related • Hypoperfusion from heart failure • Intracranial tumor • Medicatin adverse effects • Neurocognitive disorder with Lewy
body dementia • Vascular dementia

Question 13

Alzheimers disease

Answer 13

non-reversible, B-amyloid plague buildup

Question 14

Cognitive domains affected by dementia and associated symptoms

Answer 14

1) Complex attention
2) Executive funcion
3) Language
4) Learning and memory
5) Perceptual-motor
6) Social cognition

Question 15

DSM-5 Major and Minor Neurocog Disorder criteria

Answer 15

Major Neurocognitive Disorder – Significant cognitive decline in at least one domain interfering with activities of daily living
Minor Neurocognitive Disorder – Modest cognitive decline that does not interfere in daily living

Question 16

What parts of history to focus on in dementia patients?

Answer 16

Education
Medication
Recent hospitalziations

Question 17

What are reversible causes of dementia?

Answer 17

Hypothyroidism
– Vitamin deficiencies
– Intracranial tumors
– Normal Pressure hydrocephalus
– Depression
– Hypoperfusion from heart failure

Question 18

What is a mini-cog test?

Answer 18

Patient asked to repeat three unrelated words, perform a clock drawing test then recall the three words.

Question 19

How do you score a mini cog test?

Answer 19

One point for each word remembered. 2 points for good clock (numbers correct,
clock hands have arrow marks, arm length doesn’t matter)
Score of 3, 4 or 5 indicates lower likelihood of dementia but doesn’t. exclude some element of cognitive impairment

Question 20

What is the ASCERTAIN 8-Item Informant Questionary

Answer 20

Screens for major and minor
neurocognitive disorders. 
Sensitivity of 85%, specificity of 86%. 
Count the “Yes” answers:
– 0-1: Normal cognition – 2 or more: Cognitive impairment likely to be
present

Question 21

If ASCERTAIN test is positive, and next you want to screen for DEGREE of cognitive impairment, what tests are done?

Answer 21

1) MMSE: Mini-mental state examination: score from 0-30 (normal is 30)
2) MOCA: Montreal cognitive assessment )accurate in patients with parkinsons disease (designed for persons scoring 24 or higher on MMSE
3) SLU Mental Status exam