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Neuro Part 2 > Week 6.2 > Flashcards

Week 6.2 Flashcards

1
Q

What are the features of parkinsonism?

A
  • bradykinesia/akinesia
  • rigidity
  • postural instability
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2
Q

The most common cause of parkinsonism is what?

A

Parkinson’s disease

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3
Q

Parkinson’s disease affects which neuron population?

A

dopaminergic neurons in the substantia nigra

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4
Q

What are the clinical features of Parkinson’s disease?

A
  • resting tremor
  • parkinsonism
  • autonomic dysfunction
  • neuropsychiatric disturbances
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5
Q

What are some examples of autonomic dysfunction experienced by those with Parkinson’s disease?

A
  • orthostatic hypotension
  • constipation
  • drooling
  • excessive sweating
  • sexual dysfunction
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6
Q

What are some types of neuropsychiatric disturbances experienced by those with Parkinson’s disease?

A
  • depression
  • dementia
  • psychosis
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7
Q

The average age of onset for Parkinson’s disease is what?

A

60 years old

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8
Q

What clinical findings may suggest a non-Parkinson’s disease cause of parkinsonism?

A
  • symmetry at onset
  • early dementia
  • abrupt onset or rapid progression
  • early or severe autonomic dysfunction
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9
Q

What are the features of Shy-Drager Syndrome?

A
  • autonomic failure
  • parkinsonism
  • pyramidal tract signs
  • peripheral neuropathy
  • cerebellar signs
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10
Q

What sort of damage leads to Shy-Drager syndrome?

A

damage to both the substantia nigra and striatum

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11
Q

What sort of drugs can cause drug-induced parkinsonism?

A

those that block dopamine signaling

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12
Q

What is the primary cause of vascular parkinsonism?

A

ischemic damage to the striatum

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13
Q

What are the risk factors for vascular parkinsonism?

A

anything that increases one’s risk to striatal ischemia

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14
Q

What is MPTP?

A

a drug that induces parkinsonism

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15
Q

Name four pharmacologic therapies for Parkinson’s disease.

A
  • levodopa
  • COMT inhibitors
  • MAO-B inhibitors
  • dopamine agonists
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16
Q

How does carbidopa enhance the effect of levodopa?

A

it inhibits COMT in the periphery, increasing the amount of levodopa that makes it into the CNS

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17
Q

What are the three primary complications of levodopa in the long-term?

A
  • motor fluctuations
  • dyskinesias
  • mental status change
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18
Q

What is MAO-B?

A

an enzyme that metabolizes dopamine in the synaptic cleft

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19
Q

What are selegiline and rasagiline?

A

MAO-B inhibitors

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20
Q

What are entacapone and tolcapone?

A

COMT inhibitors

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21
Q

Deep brain stimulation for Parkinson’s disease targets what structure?

A

the sub-thalamic nucleus

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22
Q

What is a tremor?

A

a rhythmic involuntary movement

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23
Q

What is a tic?

A

a suppressible involuntary movement

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24
Q

What is a dystonia?

A

a sustained involuntary movement

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25
Q

What is a chorea?

A

a ballistic involuntary movement

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26
Q

What is a myoclonus?

A

a non-rhythmic, non-sustained, non-ballistic, non-suppressible involuntary movement

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27
Q

What are three common causes of tremor?

A
  • Parkinson’s disease
  • essential tremor
  • familial tremor
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28
Q

Tics are a common feature of which diseases?

A
  • Tourett’e syndrome

- adult onset tic disorder

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29
Q

How do we treat tics?

A

by blocking DA

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30
Q

What is athetosis?

A

a type of dystonia that appears as a writhing movement

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31
Q

What is the underlying problem that leads to dystonia?

A

a lack of reciprocal inhibition

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32
Q

How do we treat focal dystonia?

A

botulinum toxin

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33
Q

What is a ballistic movement?

A

an agonist, antagonist, agonist sequence

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34
Q

What is tardive dyskinesia?

A

involuntary movements seen after the use of dopamine blocking agents

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35
Q

What are three common etiologies for myoclonus?

A
  • idiopathic
  • primary generalized epilepsy
  • post-anoxic
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36
Q

How do we prevent tardive dyskinesia?

A

with anticholinergics

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37
Q

The most common cause of parkinsonism is what?

A

Parkinson’s disease

38
Q

Parkinson’s disease affects which neuron population?

A

dopaminergic neurons in the substantia nigra

39
Q

What are the clinical features of Parkinson’s disease?

A
  • resting tremor
  • parkinsonism
  • autonomic dysfunction
  • neuropsychiatric disturbances
40
Q

What are some examples of autonomic dysfunction experienced by those with Parkinson’s disease?

A
  • orthostatic hypotension
  • constipation
  • drooling
  • excessive sweating
  • sexual dysfunction
41
Q

What are some types of neuropsychiatric disturbances experienced by those with Parkinson’s disease?

A
  • depression
  • dementia
  • psychosis
42
Q

The average age of onset for Parkinson’s disease is what?

A

60 years old

43
Q

What clinical findings may suggest a non-Parkinson’s disease cause of parkinsonism?

A
  • symmetry at onset
  • early dementia
  • abrupt onset or rapid progression
  • early or severe autonomic dysfunction
44
Q

What are the features of Shy-Drager Syndrome?

A
  • autonomic failure
  • parkinsonism
  • pyramidal tract signs
  • peripheral neuropathy
  • cerebellar signs
45
Q

What sort of drugs can cause drug-induced parkinsonism?

A

those that block dopamine signaling

46
Q

What are three common causes of tremor?

A
  • Parkinson’s disease
  • essential tremor
  • familial tremor
47
Q

How do we treat tics?

A

by blocking DA

48
Q

What is tardive dyskinesia?

A

involuntary movements seen after the use of dopamine blocking agents

49
Q

The most common cause of parkinsonism is what?

A

Parkinson’s disease

50
Q

Parkinson’s disease affects which neuron population?

A

dopaminergic neurons in the substantia nigra

51
Q

What are the clinical features of Parkinson’s disease?

A
  • resting tremor
  • parkinsonism
  • autonomic dysfunction
  • neuropsychiatric disturbances
52
Q

What are some examples of autonomic dysfunction experienced by those with Parkinson’s disease?

A
  • orthostatic hypotension
  • constipation
  • drooling
  • excessive sweating
  • sexual dysfunction
53
Q

What are some types of neuropsychiatric disturbances experienced by those with Parkinson’s disease?

A
  • depression
  • dementia
  • psychosis
54
Q

What clinical findings may suggest a non-Parkinson’s disease cause of parkinsonism?

A
  • symmetry at onset
  • early dementia
  • abrupt onset or rapid progression
  • early or severe autonomic dysfunction
55
Q

What are the features of Shy-Drager Syndrome?

A
  • autonomic failure
  • parkinsonism
  • pyramidal tract signs
  • peripheral neuropathy
  • cerebellar signs
56
Q

What sort of drugs can cause drug-induced parkinsonism?

A

those that block dopamine signaling

57
Q

What are three common causes of tremor?

A
  • Parkinson’s disease
  • essential tremor
  • familial tremor
58
Q

How do we treat tics?

A

by blocking DA

59
Q

How do we generally treat hyper-kinetic movement disorders?

A

dopaminergic and cholinergic antagonists

60
Q

What is tardive dyskinesia?

A

involuntary movements seen after the use of dopamine blocking agents

61
Q

Tardive dyskinesia is most likely to involve which kinds of involuntary movement?

A

oral, lingual, or buccal chorea or dystonia

62
Q

What is the most common CNS demyelinating disease?

A

multiple sclerosis

63
Q

Which populations are most affected by MS?

A

women between 15 and 45 years of age

64
Q

What course of MS is most common?

A

chronic relapsing-remitting

65
Q

What CSF findings are consistent with MS?

A

elevated protein, lymphocytes, and oligoclonal bands

66
Q

What MRI findings are consistent with MS?

A

periventricular T2-hyperintense lesions

67
Q

Describe the pathogenesis of MS.

A
  • CD4 cells react against self-myelin and secrete cytokines

- cytokines activate macrophages and other inflammatory mediators

68
Q

Which genes are linked to multiple sclerosis?

A
  • HLA-DR15 allele

- IL-2RA and IL-7RA

69
Q

MS preferentially affects which white matter tracts?

A
  • periventricular
  • optic nerve and chiasm
  • superficial pons and spinal cord
70
Q

How does an acute MS lesion differ from an inactive one?

A
  • there is no white mater in an inactive one

- macrophages are only part of acute lesions

71
Q

How can we differentiate a stroke lesion from an MS lesion?

A

MS lesions will stain for neurofilament since the white mater has been destroyed by the axons have not

72
Q

What is the Marburg MS variant?

A

an acute form of MS with an earlier age of onset and rapid course unresponsive to treatment

73
Q

What is neuromyelitis optica?

A

an aggressive demyelinating disorder that preferentially affects the optic nerve and spinal cord

74
Q

Creutzfeldt cells are a feature of which demyelinating disease?

A

neuromyelitis optica

75
Q

Neuromyelitis optics is mediated by what pathogenesis?

A

antibodies directed against aquaporin-4

76
Q

What is aquaporin-4?

A

an astrocytic water channel targeted by antibodies in neuromyelitis optica

77
Q

What is acute disseminated encephalomyelitis?

A

an acute demyelinating disease that affects younger people in the setting of viral infection and characterized by lesions of the same age

78
Q

How do we treat encephalomyelitis?

A
  • IVIG
  • plasmapheresis
  • steroids
79
Q

What are the symptoms of acute hemorrhagic encephalomyelitis?

A
  • rapid progression
  • fever
  • neck stiffness
  • seizures
  • recent upper respiratory infection
80
Q

What is the characteristic feature of central pontine myelinolysis?

A

a basis pontis lesions

81
Q

Central pontine myelinosis most commonly follows what?

A

rapid sodium correction

82
Q

How does central pontine myelinolysis present?

A

with rapid onset quadriplegia

83
Q

What is progressive multifocal leukoencephalopathy?

A

a demyelinating disease due to viral reactivation of JC virus in an immunosuppressed or compromised host

84
Q

JC virus infects what cell type?

A

oligodendrocytes

85
Q

What are the symptoms of progressive multifocal leukoencephalopathy?

A

progressive visual, motor, dementia, and sensory disturbances

86
Q

What are leukodystrophies?

A

inherited, progressive disorders of abnormal synthesis of myelin due to lysosomal or peroxisomal enzyme deficiencies

87
Q

Most leukodystrophies have what mode of genetic transmission?

A

autosomal recessive

88
Q

The characteristic feature of Alexander’s disease is what?

A

the presence of rosenthal fibers

89
Q

What is Alexander’s disease?

A

an autosomal dominant leukodystrophy caused by a mutation in GFAP

90
Q

Adrenoleukodystrophy has what mode of genetic transmission?

A

X-linked recessive

91
Q

What causes adrenoleukodystrophy?

A

a mutation in ABCD1, a peroxisomal membrane transporter, that cause defects in VLCFA metabolism

92
Q

What are the symptoms of adrenoleukodystrophy?

A
  • progressive intellectual and behavior problems

- often preceded by adrenal dysfunction

Neuro Part 2 (18 decks)

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