Parkinson's and Movement Disorders

Question 1

what are the two main groups of movement disorders?

Answer 1

hypokinetic - too little movement i.e. parkinson’s

hyperkinetic - too much movement i.e. tics

Question 2

what mnemonic can be used to remember the main presentation of parkinsonism and what does this stand for?

Answer 2

TRAP

tremor
rigidity
akinesia/bradykinesia
postural disturbances

Question 3

what postural disturbances can be seen in parkinsonism?

Answer 3

flexed posture

postural instability

Question 4

what is rigidity?

Answer 4

increased muscle tone

felt by passive movements

Question 5

what are the two types of rigidity?

Answer 5

lead pipe = consistent throughout the movement

cogwheel = has a superimposed tremor

Question 6

how is rigidity distinguished from spasticity?

Answer 6

felt throughout the whole range of movement

no increase with higher mobilising speed

Question 7

what type of motor neurone lesion is associated with spasticity?

Answer 7

upper motor neuron lesions

Question 8

what is a positive froment’s maneouvre?

Answer 8

rigidity increases in the examined body segment by voluntary movement of other body parts

Question 9

how do you test for akinesia or bradykinesia?

Answer 9

ask the patient to perform rapid repetitive and alternating movements such as finger/toe tapping, opening and closing the fist + pronating and supinating the wrist

Question 10

why do patients with parkinsonism have stooped posture?

Answer 10

impaired postural reflexes

Question 11

what is camptocormia?

Answer 11

postural impairment where patients have extreme anterior truncal flexion

seen in parkinsonism

Question 12

describe the gait associated with parkinsonism

Answer 12

slow
narrow base
short, shuffling steps

Question 13

what is the hallmark of the gait impairment in parkinsonism and how can this be visualised?

Answer 13

freezing

seen on turning, may also have start hesitation

Question 14

what can be used to test for postural instability in parkinsonism?

Answer 14

pull test

stand behind the patient, hold their shoulders and pull them backwards

Question 15

what is a tremor?

Answer 15

a rhythmic sinusoidal oscillation of a body part

Question 16

when does a rest tremor occur?

Answer 16

when the affected body part is at rest

Question 17

when does a postural tremor occur?

Answer 17

when the arms are outstretched

Question 18

when does a kinetic tremor occur?

Answer 18

during the movement of a body part

Question 19

describe the appearance of a physiological tremor

Answer 19

symmetrical
fast
small amplitude

Question 20

name two liver conditions associated with a postural tremor

Answer 20

wilson’s disease

hepatic encephalopathy

Question 21

what is dystonia?

Answer 21

a movement disorder characterised by sustained/intermittent muscle contractions causing abnormal movements, postures or both

Question 22

what are dystonic movements like?

Answer 22

patterned
twisting
may be tremulous

Question 23

what can initiate dystonia?

Answer 23

voluntary movement

Question 24

name some possible causes of chorea

Answer 24

drugs
basal ganglia lesions
anti phospholipid syndrome
huntington’s

Question 25

what is ballism?

Answer 25

extreme variant of chorea

Question 26

how does ballism present?

Answer 26

large amplitude flinging movements usually affecting proximal joints

usually in a hemi-body distribution

Question 27

what does ballism suggest?

Answer 27

a contralateral lesion typically involving the striatum of the subthalamic nucleus

Question 28

what is myoclonus?

Answer 28

brief electric shock like jerks

Question 29

what are two common, normal forms of myoclonus?

Answer 29

hiccups

hypnic jerks when falling asleep

Question 30

what causes myoclonus?

Answer 30

brief activation of a group of muscles

Question 31

what causes negative myoclonus?

Answer 31

temporary cessation of muscle activity

Question 32

name an example of negative myoclonus

Answer 32

asterixis (aka liver flap) in patients with liver failure

Question 33

what are tics?

Answer 33

involuntary, repetitive movements or vocalisations

Question 34

when do tics tend to start?

Answer 34

almost always in childhood

Question 35

what i sthe most common type of postural tremor?

Answer 35

essential tremor

Question 36

what is the inheritance pattern of essential tremor that runs in families?

Answer 36

autosomal dominant

high penetrance

Question 37

what can make an essential tremor better?

Answer 37

alcohol intake

Question 38

what is a histological hallmark of parkinson’s?

Answer 38

lewy bodies

Question 39

what are the motor symptoms of parkinson’s?

Answer 39

tremor
rigidity
akinesia/bradykinesia
postural instability

(TRAP)

Question 40

what non motor symptoms can be seen in parkinson’s?

Answer 40

sleep disorders 
hallucinations
GI problems 
depression 
dementia 
anosmia

Question 41

what are the essential features for a diagnosis of parkinson’s?

Answer 41

bradykinesia and 1+ of:

• resting tremor
• rigidity
• postural instability

Question 42

who is more likely to get parkinson’s - males or females?

Answer 42

males