Ch. 121 Cecils
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| Difficulty with coordination, balance, and rapid movements is associated with | CNS disorders. Muscle strength is frequently normal, and muscle atrophy is usually lacking.
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| Muscle tone increase associated with spasticity and rigidity is associated with | CNS disorder
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| Weakness rising from a chair or climbing stairs or lifting heavy objects overhead is associated with | PNS disorders with proximal weakness
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| PNS with distal weakness sounds like | patients complains of stumbling and tripping or having problems fastening buttons or opening locks or doors with the hands.
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| Corticospinal diseases from system degeneration are uncommon and are characterized by upper motor neuron signs (spasticity and hyperreflexia). The most common is: | Amyotrophic Lateral Sclerosis (ALS) which differs from other CNS motor diseases by the prominent involvement of both the CNS and PNS
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| Lesions of the ______ system cause motor weakness (paresis), spasticity, and hyperreflexia. Although lesions of this system disturb motor function, they are not considered movement disorders | Pyramidal system
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| Movement Disorders are caused by | extrapyramidal or cerebellar dysfunction.
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| Extrapyramidal refers to | the basal ganglia and their projections
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| The _________ modulate not only motor cortical activity but also the activity of association cortex, particularly in the frontal lobes. | Basal ganglia. Many movement disorders therefore involve complex neurobehavioral sx (eg. demention in Huntington's, depression in Parkinson's, and OCD in Tourette's)
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| Cogwheel rigidity is | the superimposition of tremor on underlying rigidity (rigidity is increased muscular tone throughout the range of motion).
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| What kind of kinesia do you find in Parkinson's dz? | hypokinesia.
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| What kind of kinesia do you find in Huntington's dz? | Hyperkinesia
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| Chorea in successive generations is most likely caused by | Huntington's disease. Hereditary Chorea
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| Resting tremor in an older patient with rigidity and bradykinesia is most likely | Parkinson's
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| Some signs of cerebellar system impariment | ataxia (poorly coordinated, broad-based, lurching gait), Ataxic dysarthria (abnormal modulation of speech velocity and volume), Dysdiadochokinesis (breakdown in precision and completeness of RAMs), Intention tremor, titubation=rocking tremor: trunk &head
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| Four diagnostic criteria for Parkinson's dz (AKA Primary features) | tremor, bradykinesia, postural instability, and muscle rigidity
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| What is the leading cause of neurologic disease in inidividuals older than 65 years of age | Parkinson's. Affects 750,000 to 1 million people in the US
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| What is the current knowledge of the pathophysiology of Parkinson's Disease? | Premature death of pigmented dopaminergic neurons in the pars compacta of the substantia nigra, with characteristic Lewy bodies.
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| Secondary Features of Parkinson's Disease | Masked facies, dysphagia, start hesitation, orthostatic hypotension, urinary incontinence, dementia, sleep disorders, depression, aching, numbness, tingling
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| The majority of Parkinson's pts present bilaterally or unilaterallly? | Unilateral sx: characteristic hand tremor, decreased arm swing, foot dragging, micrographia
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| Micrographia is | small, cramped handwriting
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| What is the mainstay of tx for Parkinson pts? | Sinemet: carbidopa-levodopa
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| ________ is an enzyme that breaks down dopamine | MOA type B
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| How does Selegiline work? | inhibits MOAB. Selegiline delays the need for levodopa tx in pts with early Parkinson's dz
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| ______ is the newest FDA approved drug for PD and may be better tolerated than selegiline b/c it is not metabolized to amphetamine | Rasagiline
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| Dopaminergic AEs | nausea, orthostatic hypotension, hallucinations, psychosis, and dyskinesia (hyperkinetic movements: chorea and dystonia)
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| What do COMT inhibitors do? | catalyze the catabolism of levodopa.
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| The most common cause of drug-induced parkinsonism is treatment with | neuroleptic medication (antipsychotics)
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| The most common cause of tremor is | essential tremor. This condition is inherited and ranges in severity from cosmetic to disabling.
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| Characteristics of essential tremor | Unlike the tremor of PD, essential tremor affects both sides of the body symmetrically and is more prominent with action than rest. alcohol often relieves essential tremor
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| Most useful meds for essential tremor | propranolol (Inderal), primidone (Mysoline) and topiramate (topamax)
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| _____ almost never develops after age 50, and is a systemic disorder of copper metabolism | Wilson's Disease. Autosomal Recessive, Rare, psychosis common, hepatic dysfunction, neurologic signs and sx.
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| What does slit lamp examination reveal in Wilson Disease patients? | Kayser-Fleischer rings (deposition of copper pigment in the limbus of the iris)
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| What is indicated in dx a Wilson patient? | 24-hour urine collection for copper, determination of serum copper level, and hepatic biopsy
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| Mean onset of Huntington's dz | 40 years old. Autosomal dominant. Mean duration of illness is 20 years.
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| Copralalia | Foul language
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| Tourette's disorder definition | defined as the hx of both motor and vocal tics (for more than 1 year) with onset before the age 18 years. Not progressive or fatal.
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