Neuro - Weakness

Question 1

What is Dystonia?

Answer 1

Sustained contractions that may be either 1.) rapid and repetitive 2.) focal or generalized, 3.)idiopathic or symptomatic

Question 2

What is Kernicterus caused by?

Answer 2

Too much bilirubin in babies

Question 3

What medications commonly cause dystonia?

Answer 3

Haloperidol, levodopa. phetothiazines (perphenazine) used in Parkinson and Huntington disease

Question 4

Young child of 5 years present with spasms that contort the body. Mother say it started with a little oot inversion and then spread. The child has facial grimacing. Mother says these contractions end with sleep. What is the disease called? What is the etiology? What is the treatment?

Answer 4

Idiopathic Torsion Dystonia

Unknown maybe AD, AR or x-linked recessive.

Treatment: Diazepam, anticholinergic meds, baclofen, and carbamazepine. Surgical option is to perform a thalomotomy

Question 5

What are the possible causes of torticollis?

Answer 5

hyperthyroidism, antipschotics; ocular imblance, cervical spone disease or fragment of Idiopathic Torsions Dystonia.

Question 6

Treatment for Torticollis?

Answer 6

Botox which degrades SNAP-25

Question 7

Patient comes in complaining of being unable to drive because she blinks constantly. What does she have and what treatment can you give her?

Answer 7

Blepharospasms and she could use Botox

Question 8

The most common movement disorder?

Answer 8

Essential tremor Essential tremor generally presents as a rhythmic tremor (8–10 Hz) that is present only when the affected muscle is exerting effort (in other words, it is not present at rest)

Can also occur in the head and voice

Question 9

What is the treatment for essential tremor?

Answer 9

Alcohol is small amounts

Beta Blockers - propranolol
Anti-seizure - topiramate, primidone

Benzodiazapines - clonazepam, alprazolam, diazepam, lorazepam

Question 10

What can you use for kidney stones and essential tremors?

Answer 10

Probenicid

Question 11

Patient comes in with persistent, repetitive involuntary movements of the face and mouth. MHx is consistant with schizophrenia and phenothiazines. The patient is marching in place and keeps sticking his tongue at your. What does the patient have that is causing the tremors and what is the treatment plan?

Answer 11

Typical antipsychotic causes Tardive Dyskinesia.

Trying to switch the patient onto and second generation and Reserpine (tetrabenzaine or trihexyphenidyl, Haloperidol last resort)

Question 12

A 23 year old patient is experiencing parkinsonian symptoms and was just recently put on a new drug. What types of drug could be causing the condition?

Answer 12

Anti-psychotic meds (Haloperidol, phenothiazine, reserpine, or tetrabenzaine), alpha methyl dopa, and metoclopraminde (anti-emetic)

Question 13

A presents with an inner sense of restlessness, inability to sit still. Acute conditions as this can be referred to as.

Answer 13

Acute akathisia

Question 14

18 year old patient presents with inversion of ankle, and inability to get tongue back in mouth. He is acute Dystonic Reaction. What treatment would be applied?

Answer 14

Benedryl (diphenhrydamine)

Also could treat with IV benztropine and diazepam

Question 15

Patient recently on anti-psychotics is diagnosed with Neurolepic Malignant Syndrome. This is always a fear when prescribing anti-psychotics. What condition can develop and what is often the long term disability? What treatment?

Answer 15

Neuroleptic Malignant Syndrome can develop into a myoglobinuria that can progress to kidney failure.

To treat you want to immediately withdraw the offending drug and treat with bromocriptine or dantrolene

Question 16

An 8 year old comes into the office with constant dance like movements. He tells his dad he cannot stop so they brought him in the doctors office. The child’s previous medical history is significant for a recent bacterial infection. On physical exam physician notes the child is always sticking his tongue out. What does the child have? What was the etiology? How do you treat it?

Answer 16

Syndenham Chorea caused by the recent streptococcal infection that developing into Rheumatic fever.

Treat with sedatives, antipsychotics, valproic acid. If recurrent can treat with IV IgG

Question 17

Patient is coming into the office with jerky involuntary movements, extraoccular movement difficulties and a dancing gait. What genetic testing abnormalitity would the patient most likely have?

Answer 17

An autosomal dominant Chromosome 4 trinucleated repeat with a gain of function of the huntingtin gene. Cause GABAnergic neuron loss as well as decreased Ach. Treatment will only sustain the patient. Reserpine, tetrabenzaine, ect.

Question 18

Where is the lesion for hemiballism and what is the treatment?

Answer 18

Hemiballism is violent form of chorea of a single side. The single side indicates that the contralateral subthalamic nucleus has been lesioned. The common causes are hemorrhage, tumor, ischemic (lacunar infarct), or iatrogenic.

Treatment is same as Huntington’s Chorea. Reserpine, Haloperidol, Tetrabenzaine, Phenothiazine

Question 19

What are tics and how do they differ from Tourett’s?

Answer 19

Habitual movements that are highly personalized and idiosyncratic. They could be anything but are usually controllable and self-limiting. For adults you can use psychotherapy or sedatives and for kids it usually is self-limiting as said before.

Tourett's combines multiple tics with vocalizations.  The treatment for this is more intensive and may include:
Clonidine
Haloperidol
Pimozide
Naltrexone
Marinol (marijuana)
Deep brain stimulation

Question 20

What antibodies are associated with Tourett’s?

Answer 20

Anti-DNAase B antibodies

Question 21

What is coprolalia?

Answer 21

Copro means dung and lalia means vocalizations. Means swearing.