Tremor and Hyperkinetic Disorders Flashcards
Name 5 types of hyperkinetic movement disorder.
Tremor. Tics. Chorea. Myoclonus. Dystonia
Define tremor.
Rhythmic sinusoidal oscillation of a body part
Define tics.
Involuntary stereotyped movements or vocalizations
Define chorea.
Brief irregular purposeless movements which flit and flow from one body part to another
Define myoclonus.
Brief electric-shock like jerks
Define dystonia.
Abnormal posture of the affected body part
Describe tremor.
Rhythmic sinusoidal oscillation of a body part, usually due to alternate activation of agonist and antagonist muscles
Outline the 4 ways in which tremor can be classified.
Position: at rest, on posture, during movement (kinetic tremor).
Distribution: body part affected.
Frequency: measured in Hertz.
Amplitude: ‘fine’ or ‘coarse.’
What should you ALWAYS ask a patient who presents with a tremor?
When they notice the tremor most
Name the 6 main types of tremor.
- Resting
- Postural
- Kinetic
- Head
- Jaw
- Palatal
Name the 3 causes of a resting tremor.
- Parkinson’s disease.
- Drug-induced parkinsonism.
- Psychogenic tremor
Name the 3 causes of a postural tremor.
- Essential tremor.
- Enhanced physiological tremor.
- Tremor associated with neuropathy.
Name the 2 causes of a kinetic tremor.
- Cerebellar disease (demyelination, haemorrhage, degenerative, toxic).
- Wilson’s disease.
Name the 2 causes of a head tremor.
- Dystonia.
* Cerebellar disease.
Name the 2 causes of a jaw tremor.
- Dystonia.
* Parkinson’s disease.
Outline the key things which must be discussed when taking a history from a patient with a tremor.
- Age at onset
- Body part(s) affected
- Any precipitating factors at onset?
- Drug / toxin exposure
- Exacerbating and relieving factors
- Associated neurological symptoms
- Associated systemic symptoms
- Family history
What are the important features which should be included in the examination of a patient with a tremor?
- Examine at rest, on posture and during movement.
- Ask patient to write something and copy a spiral.
- Complete physical and neurological examination.
What tests looks at cerebellar function?
Get pt to touch their nose, then touch your finger
Tremor due to stress is usually symmetrical
TRUE
An asymmetrical tremor suggests a problem with the brain
TRUE
What investigations should be done in a patient who presents with a tremor?
- Guided by presentation.
- TFT’s.
- Copper and coeruloplasmin in young patients, <45.
Describe the treatment for a patient with a tremor.
Usually symptomatic, if at all.
in selected cases, deep brain stimulation
What is a tremor associated with dystonia?
A tremor in a body part that is not dynamic, but there is dystonia elsewhere
A dystonic tremor can occur at…….
Rest, in sustained postures and in voluntary movement
Focal and task specific
Describe an essential tremor.
- Abnormal tremor in bilateral upper limbs, with absence of neurological signs elsewhere
Essential tremors are _________
BILATERAL
What is the duration of an essential tremor like?
Long
An essential tremor is not what?
A diagnosis, but a syndrome of many different types of tremor – dystonia predominates