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Medicine 2 > Week 3 - Movement disorders > Flashcards

Week 3 - Movement disorders Flashcards

1
Q

What symptoms are associated with upper motor neuron damage?

A

Muscle weakness / stiffness

+ muscle tone

+ stretch reflexes

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2
Q

What symptoms are associated with lower motor neuron damage?

A

Muscle weakness

Decreased muscle tone

Inhibited stretch reflexes

Spontaneous firing

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3
Q

What is aphasia?

What are the two types?

A

Disruption of speech

Broca’s = failure to formulate

Wernicke’s = failure to comprehend

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4
Q

What are the 4 stages of motor neuron disease?

What occurs in each?

A

Amyotrophic lateral sclerosis - degeneration of MNs

Primary lateral sclerosis - slow corticospinal tract degeneration

Pseudobulbar palsy - corticobulbar tract degeneration (facial paralysis)

Progressive muscular atrophy - degeneration of LMNs

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5
Q

What is multiple sclerosis and what are the symptoms?

A

Autoimmunity against myelin

Leg tingling, fatigue, balance issues, blurred vision, dysphagia

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6
Q

What are 4 ways of measuring sleep?

A
  • Polysomogram
  • Electro-encephalogram
  • Electro-myogram
  • Electro-oculogram
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7
Q

What are the stages of sleep?

A
  • REM
  • Non-REM 1
  • Non-REM 2
  • Non-REM 3
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8
Q

Why do we sleep?

A
  • Reset body
  • Tau accumulates in brain during day and is cleared during sleep
  • Tau forms tangles if it accumulates
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9
Q

What happens to the body during sleep deprivation?

A
  • Increased sleep propensity
  • Decreased glucose metabolism
  • Increased tau
  • Mood changes
  • High level cognitive functioning
  • Perceptual changes
  • Increase in risky behaviours
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10
Q

What are the 3 types of insomnia?

A

Transient = 2-3 days

Short-term = < 1 month

Long-term = undewrlying psychiatric illness

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11
Q

What is the circadian rhythm?

A
  • Controlled by suprachiasmatic nucleus in hypothalamus
  • Melatonin produced when its dark, inducing tiredness
  • SCN releases cortisol in daylight, causing wakefulness
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12
Q

What is the role of ACh in sleep?

A

Active during wakefulness and REM

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13
Q

What is the role of NA in sleep?

A

Generates arousal

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14
Q

What is the role of histamine in sleep?

A

Promotes wakefulness

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15
Q

What is the role of 5HT in sleep?

A

Promotes wakefulness and supresses REM

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16
Q

What is the role of DA in sleep?

A

Exerts potent wake promoting effects

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17
Q

What causes restless leg syndrome?

A
  • Dopamine dysfunction
  • Genetics
  • Medications
  • Chronic illness
  • Vitamin deficiency
  • Pregnancy
  • Sleep deprivation
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18
Q

What drugs are used to treat sleep disorders?

A
  • Benzodiazepines
  • Antihistamines
  • Sedative antidepressants
  • Valerian
  • Melatonin receptor antagonists
  • Z drugs (bind to benzodiazepine binding sites)
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19
Q

WHat is executive function?

A

Description of psychological processes underlying flexible goal directed behaviour

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20
Q

What are the causes of Huntington’s disease?

A
  • Genetics
    • Autosomal dominant on chromosome 4
    • Trinucleotide repeat disorder
    • HD gene codes for Huntingtin protein (HTT)
21
Q

What are the clinical features of Huntington’s disease?

A
  • Chorea, dystonia, dysarthria, dysphagia
  • Dementia of frontal lobe, loss of empathy, lack of insight, loss of verbal fluency
  • Depression, anxiety, psychosis
  • High metabolic rate, weight loss
22
Q

How is Huntington’s managed?

A
  • Dopamine blockers for chorea
  • Psychiatric medications
  • Speech and swallowing assessments
  • Fortified diet
  • Feeding tube?
23
Q

What triplet repeat causes Huntington’s?

A

CAG

24
Q

What is anticipation in regards to triplet repeats?

A

When triplet repeats become unstable

Therefore more likely to expand

Therefore increased chance of developing condition

25
Q

What is the parent of origin effect for maternal transmission?

A
  • Larger CTG expansion occurs only on maternal transmission
  • Female carriers more likely to have children with expanded gene
26
Q

What is the parent of origin effect for paternal transmission?

A
  • Large CAG expansion repeats occur almost only on paternal transmission
  • Male carriers more likely to have children with expanded gene
27
Q

What is incomplete penetrance?

A

When not everyone who inherits the mutation develops the disease

28
Q

WHat are the 2 types of stroke and their subtypes?

A
  • Ischaemic
    • Thrombotic
    • EMbolic
    • Lacunar occlusion
    • Large vessel occlusion
  • Haemorrhagic
    • Intracerebral
    • Subarachnoid
29
Q

What are the symptoms of a haemorrhagic stroke?

A
  • Thunderclao headache
  • Seizures
  • Nausea
  • Unilateral weakness
30
Q

What are the symptoms of a anterior circulatory stroke?

A
  • Hemiplegia
  • Hemisensory loss
  • Hemianopia
  • Dysphasia
  • Aphasia
31
Q

What are the symptoms of a posterior circulatory stroke?

A
  • Bilateral sensory deficits
  • Dis-conjugate eye movement
  • Cerebellar dysfunction
  • Isolated hemianopia
32
Q

What happens in a lacunar infarction?

A
  • Small stroke in penetrating arteries
  • Clinically silent
  • Motor hemiplegia syndrome
33
Q

How do you treat a haemorrhagic stroke?

A
  • Pain management
  • Surgery
  • Lower BP
34
Q

How do you treat an ischaemic stroke?

A
  • Thrombolysis with alteplase within 3 hours
  • Thrombectomy within 6 hours
35
Q

What are the penumbra and core of a stroke?

A

Penumbra = area of potentially salvageable tissue

Core = irreversibly damaged tissue

36
Q

What happens during excitotoxicity stage of stroke?

A
  • Failure of ion pumps
  • Cell depolarisation
  • Na+, Ca2+, H2O influxe
  • K+ efflux
  • GLutamate release and receptor activation
37
Q

What happens in the later stages of a stroke cellularly?

A
  • Microglia, astrocytes, blood vessels
  • BBB breakdown
  • Influx of leukocytes
38
Q

When do strokes lead to dementia?

A

When there is major vascular cognitive impairment

39
Q

How do the basal ganglia and cerebellum assist one another for movement?

A

Basal ganglia:

  • Receives sensory and motor cortical information
  • Plans movement

Cerebellum:

  • Assists with dynamic coordination of movement, balance, and posture
40
Q

What is the basal ganglia?

A
  • Group of subcortical greay matter structures
  • Plan movement to cortex via thalamus
  • Prevents unwanted movement
    • Injury = involuntary movements
  • Caudate nucleus, lentiform nucleus (putamen + globus pallidus), substantia nigra, subthalamic nucleus
41
Q

What is the role of the striatum?

A
  • Receives input from glutamatergic afferents and dopaminergic afferents
  • Composed of 90% inhibitory GABAergic medium spiny neurons
42
Q

What are upper motor neurone disorders?

A
  • Stroke
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis
43
Q

What are lower motor neuron disorders?

A
  • Peripheral neuropathy
  • Myasthenia gravis
44
Q

What is Parkinson’s disease?

A
  • Neurodegeneration of extrapyramidal system
  • Poor movement, rigidity, mask like expression, tremor
  • Depression, dementia, endocrine dysfunction in late stages
  • Loss of striatal dopamine
  • Loss of pigmented neurons in substantia nigra
45
Q

How do you treat Parkinson’s disease?

A
  • Dopamine replacement therapy
  • Dopamine agonists
  • Drugs preventing dopamine metabolism
  • Muscarinic receptor antagonists
46
Q

What are the causes of Parkinson’s disease?

A
  • Oxidative stress
  • Immediate relative with disease
  • Genetic
  • Drug-induced neurodegeneration
  • Drug-induced
  • Viral encephalitis
47
Q

What is Huntington’s disease?

A

Disorder affecting basal ganglia

Loss of GABA but not dopamine

ENlarged lateral ventricles

Reduced putamen and caudate nucleus

48
Q

What is tourettes and how is it treated?

A
  • Altered basal ganglia function
  • Dopamine receptor antagonists = treatment

Medicine 2 (29 decks)

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