tremor and movement

Question 1

rest tremor ddx

Answer 1

parkinsons disease

otehr akinetic rigid syndromes

Question 2

postural (action ) tremor ddx

Answer 2

(maximal with maintained posture)

Essential tremor
physiological: anxiety, hyperthyroid, beta agonists

Question 3

kinetic (intention) tremor ddx

Answer 3

(maximal during movement)

cerebellar diseases: MS, hereditary ataxias, tumours, strokes

Question 4

features of essential tremor:

Answer 4

progressive
mainly symmetrical
usually absent at rest and present during posture and intentional movements (worsens with movement eg writing)
can also involve head, ajw, voice

Question 5

is essential tremor absent at rest?

Answer 5

yes

Question 6

what is dystonia

Answer 6

movement disorder characterised by sustained involuntary contractions of agonist and antagonist muscles, often leading to repetitive twisting movements and abnormal postures of the trunk, extremities etc

Question 7

aetiology of dystonias

Answer 7

genetic (primary)
Spinocerebellar degenerations, HUntingtons
WIlson’s disease

Secondary
lesions in basal ganglia
drugs: antipsychotics, dopamine antagonists
post-truama

Question 8

neurological findings in cerebellar disorders`

Answer 8

General: Intention tremor

Neurological:  
Ataxic gait, 
truncal ataxia, 
hypotonia, 
pendular reflexes, 
dysmetria, 
dysdiadochokinesis, 
nystagmus, 
dysarthria, 
heel-shin ataxia

Question 9

causes of unilateral cerebellar syndrome

Answer 9

1. SOL
2. vertebrobasilar ischaemia
3. MS
4. Trauma

Question 10

causes of bilateral cerbellar syndrome

Answer 10

1. Alcoholic cerebellar degeneration
2. Posterior fossa space-occupying lesion
3. Multiple sclerosis
4. Brainstem vascular lesion
5. Inherited ataxias (Friedreich’s)
6. Paraneoplastic syndromes
7. Drugs (phenytoin)
8. Hypothyroidism
9. Arnold-Chiari malformation (NPHC)

Question 11

unilateral cerebellar lesions will affect what part of the body?

Answer 11

ipsilateral limbs with relative truncal sparing

Question 12

vermian cerebellar lesions will affect what part of the body

Answer 12

truncal, with relatively spared limbs

Question 13

additional findings in alcoholic cerebellar degeneration

Answer 13

stigmata of liver disease

peripheral neuropathy

Question 14

additional findings in Friedereich’s ataxia

Answer 14

pes cavus
pyramidal and dorsal column signs in the legs
DEPRESSED ANKLE JERKS WITH EXTENSOR PLANTARS

Question 15

what primary tumours can affect cerebellum

Answer 15

astrocytomas

medulloblastomas

Question 16

friedreichs ataxia aetiology

Answer 16

Autosomal recessive

chr9 &raquo_space; trinucleotide expansion&raquo_space; protein frataxin deficiency

Question 17

friedreichs ataxia Sx

Answer 17

BILATERAL cerebellar syndrome
sensorineural deafness (?hearing aids)
Diabetes (?finger pricks, fundi fro retinopathy)
optica atrophy (fundi&raquo_space; pale optic disc)
Hypertrophic cardiomyopathy (jerky pulse, double apex beat, systolic murmur)
High arched palate

losss of dorsal columns (ROMBERGS POSITIVE)
Pyramidal weakness

Mentation normal

Question 18

ddx for absent knee & ankle jerks BUT EXTENSOR PLANTARS

Answer 18

Combination:
a) peripherl neuropathy 6 stroke
b) peripheral neuropathy + cervical spondylosis
c) cervical and lumbar spondylosis
Subacute combined spinal cord degeneration
tebes dorsalis
conus medullaris lesion
friedreichs ataxia
MND

Question 19

DDx for high arched palate

Answer 19

Marfans
Turners
Friedreichs
tuberous sclerosis

Question 20

DDx for spastic and ataxic paraparesis (UMN + cerebellar signs)

Answer 20

Spinocerebellar degeneration
Arnol Chiari malforamtion
MS
syringomyelia
infarction in upper pons or internal capsule)