Parkinson's and Movement Disorders Flashcards
what are the two main groups of movement disorders?
hypokinetic - too little movement i.e. parkinson’s
hyperkinetic - too much movement i.e. tics
what mnemonic can be used to remember the main presentation of parkinsonism and what does this stand for?
TRAP
tremor
rigidity
akinesia/bradykinesia
postural disturbances
what postural disturbances can be seen in parkinsonism?
flexed posture
postural instability
what is rigidity?
increased muscle tone
felt by passive movements
what are the two types of rigidity?
lead pipe = consistent throughout the movement
cogwheel = has a superimposed tremor
how is rigidity distinguished from spasticity?
felt throughout the whole range of movement
no increase with higher mobilising speed
what type of motor neurone lesion is associated with spasticity?
upper motor neuron lesions
what is a positive froment’s maneouvre?
rigidity increases in the examined body segment by voluntary movement of other body parts
how do you test for akinesia or bradykinesia?
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
why do patients with parkinsonism have stooped posture?
impaired postural reflexes
what is camptocormia?
postural impairment where patients have extreme anterior truncal flexion
seen in parkinsonism
describe the gait associated with parkinsonism
slow
narrow base
short, shuffling steps
what is the hallmark of the gait impairment in parkinsonism and how can this be visualised?
freezing
seen on turning, may also have start hesitation
what can be used to test for postural instability in parkinsonism?
pull test
stand behind the patient, hold their shoulders and pull them backwards
what is a tremor?
a rhythmic sinusoidal oscillation of a body part
when does a rest tremor occur?
when the affected body part is at rest
when does a postural tremor occur?
when the arms are outstretched
when does a kinetic tremor occur?
during the movement of a body part
describe the appearance of a physiological tremor
symmetrical
fast
small amplitude
name two liver conditions associated with a postural tremor
wilson’s disease
hepatic encephalopathy
what is dystonia?
a movement disorder characterised by sustained/intermittent muscle contractions causing abnormal movements, postures or both
what are dystonic movements like?
patterned
twisting
may be tremulous
what can initiate dystonia?
voluntary movement
name some possible causes of chorea
drugs
basal ganglia lesions
anti phospholipid syndrome
huntington’s
what is ballism?
extreme variant of chorea
how does ballism present?
large amplitude flinging movements usually affecting proximal joints
usually in a hemi-body distribution
what does ballism suggest?
a contralateral lesion typically involving the striatum of the subthalamic nucleus
what is myoclonus?
brief electric shock like jerks
what are two common, normal forms of myoclonus?
hiccups
hypnic jerks when falling asleep
what causes myoclonus?
brief activation of a group of muscles
what causes negative myoclonus?
temporary cessation of muscle activity
name an example of negative myoclonus
asterixis (aka liver flap) in patients with liver failure
what are tics?
involuntary, repetitive movements or vocalisations
when do tics tend to start?
almost always in childhood
what i sthe most common type of postural tremor?
essential tremor
what is the inheritance pattern of essential tremor that runs in families?
autosomal dominant
high penetrance
what can make an essential tremor better?
alcohol intake
what is a histological hallmark of parkinson’s?
lewy bodies
what are the motor symptoms of parkinson’s?
tremor
rigidity
akinesia/bradykinesia
postural instability
(TRAP)
what non motor symptoms can be seen in parkinson’s?
sleep disorders hallucinations GI problems depression dementia anosmia
what are the essential features for a diagnosis of parkinson’s?
bradykinesia and 1+ of:
- resting tremor
- rigidity
- postural instability
who is more likely to get parkinson’s - males or females?
males
