Trans 043 Movement Disorders Flashcards
o physical sign of abnormal movement in absence of
weakness
o the syndrome that causes such motor abnormalities
Movement Disorder
where is the pathology in movmnt disorders?
basal ganglia
along lateral side of each lateral ventricle
Caudate nucleus
what comprises the basal ganglia?
Caudate nucleus putamen GP Subthalamic nucleus Substantia nigra
small structure on border between brain stem &
cerebrum, lateral & inferior to hypothalamus
Subthalamic nucleus
BG do not connect directly to spinal neurons. T or F?
T
major receiving area
o Input from all areas of cortex
Striatum
the main output stations of the basal ganglia
GPe + SNr
Hypokinetic movement disorders are usually called
Akinetic-
rigid syndromes
progressive neuro-degenerative
disorder that is associated with the loss of dopaminergic
neurons in the substantia nigra pars compacta.
PD
Hallmarks of PD?
o resting tremor
o rigidity
o akinesia/bradykinesia
• Gait and postural disturbances also characterize the disease.
Usually in the latter part of the disease
Direct vs Indirect pathway
o Direct Pathway
▪ Facilitates movement
o Indirect Pathway
▪ Inhibits movement
how does dopamine facilitate movement?
Dopamine Facilitates movement through the activation of
the direct pathway and the inhibition of the indirect
pathway
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
Parkinsonian Tremor
parkinsonian rigidity complicated by parkinsonian tremor
Cogwheel rigidity
most disabling component in PD?
Bradykinesia - slowness of voluntary movements and poverty of normal
associated movements
eye movement that has less than the magnitude that would be required to gain fixation of the object.
saccadic hypometria
early PD, the posture may show
early PD, the posture may show
o slight flexion of the neck or trunk
o slight lean to one side
Abnormalities of gait in PD include
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`
examples of parkinsonian syndromes?
• 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
• series of involuntary, relatively rhythmic purposeless,
oscillatory movements due to intermittent muscle
contractions
Tremor
simple vs compound tremor?
• 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
Tremors are accentuated by emotional excitement
o Many normal individuals develop tremor with anxiety,
apprehension, and fatigue
T or F?
T
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
Physiologic tumor
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
Chorea
CAUSES OF CHOREA
• 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
Most common cuase of chorea in the PH?
Rheumatic fever
(milkmaid grip)
patient holds the examiner’s finger in her fist, there are
constant twitches of individual fingers
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
Athethosis
Causes of athetosis
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
refers to movements that lie between
chorea and athetosis in rate and rhythmicity, and may
represent a transitional form
Choreoathetosis
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
hemiballismus
Hemiballismus is difficult to treat, incredibly disabling, and
sometimes fatal because of exhaustion and inanition. T or F?
T
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
myoclonus
Myoclonus may appear symmetrically on both sides
• Such synchrony may be an attribute unique to myoclonus
T or F?
T
are myoclonic jerks that appear during the
process of falling asleep, but disappear during sleep
Minsan you will see them nahuhulog sa kama
Hypnic Jerks
Myoclonus occurs without prominent seizures in a number of
other conditions, including
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
Negative vs Postive motor symptoms?
slow movements vs excessive involuntary movements
postural vs kinetic vs intention vs resting tremor?
postural pag hinold against gravity
kinetic any voluntary movement
intention tuwing ggagalaw
