Trans 043 Movement Disorders

Question 1

o physical sign of abnormal movement in absence of
weakness
o the syndrome that causes such motor abnormalities

Answer 1

Movement Disorder

Question 2

where is the pathology in movmnt disorders?

Answer 2

basal ganglia

Question 3

along lateral side of each lateral ventricle

Answer 3

Caudate nucleus

Question 4

what comprises the basal ganglia?

Answer 4

Caudate nucleus
putamen
GP
Subthalamic nucleus
Substantia nigra

Question 5

small structure on border between brain stem &

cerebrum, lateral & inferior to hypothalamus

Answer 5

Subthalamic nucleus

Question 6

BG do not connect directly to spinal neurons. T or F?

Answer 6

T

Question 7

major receiving area

o Input from all areas of cortex

Answer 7

Striatum

Question 8

the main output stations of the basal ganglia

Answer 8

GPe + SNr

Question 9

Hypokinetic movement disorders are usually called

Answer 9

Akinetic-

rigid syndromes

Question 10

progressive neuro-degenerative
disorder that is associated with the loss of dopaminergic
neurons in the substantia nigra pars compacta.

Answer 10

PD

Question 11

Hallmarks of PD?

Answer 11

o resting tremor
o rigidity
o akinesia/bradykinesia
• Gait and postural disturbances also characterize the disease.
 Usually in the latter part of the disease

Question 12

Direct vs Indirect pathway

Answer 12

o Direct Pathway
▪ Facilitates movement
o Indirect Pathway
▪ Inhibits movement

Question 13

how does dopamine facilitate movement?

Answer 13

Dopamine Facilitates movement through the activation of
the direct pathway and the inhibition of the indirect
pathway

Question 14

Resting, static, or non-intention tremor
• slow, coarse, and compound in type
• Onset is usually in one hand; it may later involve the
contralateral upper limb or ipsilateral lower limb.
• The rate vary from 2 to 6 Hz, averaging 4 to 5 Hz

Answer 14

Parkinsonian Tremor

Question 15

parkinsonian rigidity complicated by parkinsonian tremor

Answer 15

Cogwheel rigidity

Question 16

most disabling component in PD?

Answer 16

Bradykinesia - slowness of voluntary movements and poverty of normal
associated movements

Question 17

eye movement that has less than the magnitude that would be required to gain fixation of the object.

Answer 17

saccadic hypometria

Question 18

early PD, the posture may show

Answer 18

early PD, the posture may show
o slight flexion of the neck or trunk
o slight lean to one side

Question 19

Abnormalities of gait in PD include

Answer 19

Abnormalities of gait include
o asymmetrIcally reduced arm swing,
o overall slowing of gait and early fatigue,
o shortened stride length
o Intermittent shuffle, or tripping over objects,
o Sometimes with ankle dystonia
o Inability to turn quIckly`

Question 20

examples of parkinsonian syndromes?

Answer 20

• Progressive supranuclear palsy
 Associated with gaze abnormality
• Multisystem atrophy
• Olivopontocerebellar degeneration (sporadic form)
 Associated with some cerebellar signs
• Striatonigral degeneration
• Shy-Drager syndrome
 Associated with autonomic dysfunction
• Diffuse Lewy body disease
• Corticobasal degeneration
 Associated with dementia
• Drug-induced parkinsonism
• Dopa responsive dystonia
VII. TREMOR

Question 21

• series of involuntary, relatively rhythmic purposeless,
oscillatory movements due to intermittent muscle
contractions

Answer 21

Tremor

Question 22

simple vs compound tremor?

Answer 22

• Simple tremor
o involves only a single muscle group
• Compound tremor
o involves several muscle groups
o several elements in combination
o resulting in a series of complex movements

Question 23

Tremors are accentuated by emotional excitement
o Many normal individuals develop tremor with anxiety,
apprehension, and fatigue

T or F?

Answer 23

T

Question 24

present in normal individuals
▪ frequency varies from 8 to 12 Hz
▪ Can occur in normal persons by anxiety, fright, fatigue
(rock climber’s tremor)
▪ In conditions with increased adrenergic activity

Answer 24

Physiologic tumor

Question 25

is characterized by involuntary, irregular, purposeless, random, non-rhythmic hyperkinesias • movements are spontaneous, abrupt, brief, rapid, jerky, and unsustained • movements are actually random and aimless • They are present at rest but Increased by activity, tension, emotional stress and self-consciousness • patient may be able to temporarily and partially suppress the movements • disappear in sleep

Answer 25

Chorea

Question 26

CAUSES OF CHOREA

Answer 26

``` • Drugs: o levodopa in Parkinson's patients o oral contraceptive pill o many psychiatric drugs • Vascular disease of the basal ganglia: o atheroma o systemic lupus erythematosus • Degenerative diseases: o Huntington's disease • Post-Infectious: o Sydenham's chorea • Other causes: o Thyrotoxicosis ```

Question 27

Most common cuase of chorea in the PH?

Answer 27

Rheumatic fever

Question 28

(milkmaid grip)

Answer 28

patient holds the examiner's finger in her fist, there are | constant twitches of individual fingers

Question 29

means "without fixed position" • Involuntary, irregular, coarse, somewhat rhythmic, and writhing or squirming in character (twisting) • Hyperkinesias are slower, more sustained, and larger in amplitude than those in chorea • May involve the extremities, face, neck, and trunk • In the extremities they affect mainly the distal portions, the fingers, hands, and toes • movements are characterized by any combination of flexion, extension, abduction, pronation, and supination, often alternating and in varying degrees

Answer 29

Athethosis

Question 30

Causes of athetosis

Answer 30

May be congenital due to perinatal injury to the basal ganglia • May be present in association with other neurological deficits (athetotic cerebral palsy) • It may be either unilateral or bilateral • The predominant pathologic changes are in the caudate and putamen, there may also be cortical involvement • Many patients have features of athetosis plus chorea

Question 31

refers to movements that lie between chorea and athetosis in rate and rhythmicity, and may represent a transitional form

Answer 31

Choreoathetosis

Question 32

Dramatic neurologic syndrome of wild, flinging (forceful), incessant (uninterrupted or continuous) movements that occur on one side of the body • Due to infarction or hemorrhage in the region of the contralateral subthalamic nucleus • Results in disinhibition of the motor thalamus and the cortex, resulting in contralateral hyperkinetic movements

Answer 32

hemiballismus

Question 33

Hemiballismus is difficult to treat, incredibly disabling, and sometimes fatal because of exhaustion and inanition. T or F?

Answer 33

T

Question 34

Single or repetitive, abrupt, brief, rapid, lightning-like, jerky, arrhythmic, asynergic, involuntary contractions involving portions of muscles, entire muscles, or groups of muscles • Movements are quicker than chorea • Seen principally in the muscles of the extremities and trunk, but the involvement is often multifocal, diffuse, or widespread • May involve the facial muscles, jaws, tongue, pharynx, and larynx • May be successive or simultaneous Involvement of many muscles

Answer 34

myoclonus

Question 35

Myoclonus may appear symmetrically on both sides • Such synchrony may be an attribute unique to myoclonus T or F?

Answer 35

T

Question 36

are myoclonic jerks that appear during the process of falling asleep, but disappear during sleep  Minsan you will see them nahuhulog sa kama

Answer 36

Hypnic Jerks

Question 37

Myoclonus occurs without prominent seizures in a number of | other conditions, including

Answer 37

``` Myoclonus occurs without prominent seizures in a number of other conditions, including o Metabolic disorders (especially uremic and anoxic encephalopathy) o Subacute sclerosing panencephalitis o Hallervorden-Spatz syndrome o Creutzfeldt-Jakob disease o Alzheimer's disease o Wilson's disease o Huntington's disease o Corticobasal degeneration o Viral encephalitis o General paresis o Hashimoto's encephalopathy o lipidoses ```

Question 38

Negative vs Postive motor symptoms?

Answer 38

slow movements vs excessive involuntary movements

Question 39

postural vs kinetic vs intention vs resting tremor?

Answer 39

postural pag hinold against gravity kinetic any voluntary movement intention tuwing ggagalaw