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DU PA Movemente dis
Duke PA Movement Disorders
| Question | Answer |
|---|---|
| the three constituents of the central motor system | pyramidal, extrapyramidal, and cerebellar |
| the major outflow from the motor cortex to the spinal cord | pyramidal system |
| lesions of the pyramidal system cause | motor weakness (paresis), spasticity, and hyperreflexia |
| movement disorders are caused by __ dysfunction | extrapyramidal and cerebellar function |
| what neurobehavioral symptom is associated with Huntington's disease | dementia |
| what neurobehavioral symptom is associated with Tourette's disorder | obsessive-compulsive, and attention deficit |
| what neurobehavioral symptom is associated with Parkinson's disease | depression |
| increased muscular tone throughout the range of motion | rigidity |
| the superimposition of tremor on underlying rigidity | cogwheel rigidity |
| velocity-dependant resistance to passive movement. resistance increases as the speed of passive limb displacement increases | paratonic rigidity |
| inability to fully relax a limb for passive rang of motion testing | gegenhalten |
| tendency to help out as the examiner attempts to move the limb passively | mitgehen |
| true rigidity always implies __ on the contralateral side | basal ganglia dysfunction |
| most likely cause of resting tremor in an older patient with rigidity and bradykinesia | Parkinson's disese |
| most likely cause of action tremor in a patient without rigidity or bradykinesia | essential tremor |
| disorders of proprioceptive function may result in __ caused by impairment of the spinocerebellar inputs | sensory ataxia |
| transitory loss of motor tone resulting in rapid movement of a joint | asterixis |
| slow writhing movement | athetosis |
| flailing movement | ballism |
| irregular flicking, dancelike movement | chorea |
| the combination of chorea and athetosis | choreoathetosis |
| the combination of irregular flicking, dancelike movement and slow writhing movement | choreoathetosis |
| sustained contortion resulting from excess muscular activity across a joint | dystonia |
| nonspecific term for hyperkinesia | dyskinesia |
| rapid jerking muscular movement | myoclonus |
| semi-suppressible motor or vocal gestural movement | tic |
| rhythmic oscillating movement | tremor |
| diagnostic criteria for Parkinson's disease | tremor, bradykinesia, postural instability, and rigidity |
| leading cause of neurologic disease in individuals older than 65 | Parkinson's disease |
| Lewy bodies are found in what disease | Parkinson's disease |
| mainstay of treatment for advanced Parkinson's disease | carbidopa-levodopa (Sinemet) |
| __ delays the need for levodopa treatment in patients with early Parkinson's disease | selegiline |
| one surgical treatment for Parkinson's disease is deep brain stimulation of the __ | subthalamic nuclei |
| the most common cause of drug-induced parkinsonism is treatment with __ | neuroleptic medication |
| poorly coordinated, broad-based, lurching gate | ataxia |
| abnormal modulation of speech velocity and volume | ataxic dysarthria |
| irregular placement of voluntary limb or ocular movement | dysmetria |
| movement falling short of the intended target | hypometria |
| movement overshooting the intended target | hypermetria |
| breakdown in precision and completeness of rapid alternating movements | dysdiadochokinesis |
| irregularity of the rhythm of rapid alternating movements or planned movement sequences | dysrhythmokinesis |
| inability to perform movement as a coordinated temporal sequence | dyssynergia |
| decreased resistance to passive muscular extension (seen immediately after injury to the lateral cerebellum) | hypotonia |
| tremor orthogonal to the direction of intended movement (tends to increase in amplitude as the target is approached) | intention tremor |
| rhythmic rocking tremor of the trunk and head | titubation |
| medications for Parkinson's disease | anticholinergics, dopamine precursors, dopamine agonists, monoamine oxidase type B, catechol-o-methyltransferase inhibitors |
| drugs causing bradykinesia or rigidity (established) | neuroleptics, metoclopramide, reserpine |
| drugs causing bradykinesia or rigidity (reported) | lithium, phenytoin, ACE inhibitors |
| the most common cause of tremor | essential tremor |
| unlike in Parkinson's disease this is bilateral and is more prominent with action | essential tremor |
| most useful medications for essential tremor | propranolol (Inderal), primidone (Mysoline), and topiramate (Topamax) |
| Parkinson's disease tremor responds better to __ rather than medications used for essential tremor | anticholinergics |
| rare disease that should be in the differential for new-onset hyperkinesia or parkinsonism in the young adult | Wilson's disease |
| inexorably progressive autosomal dominant neurodegenerative disorder affecting motor function, cognition, and behavior | Huntington's disease |
| movement abnormalities associated with Huntington's disease | dystonia, rigidity, postural instability, myoclonus and chorea |
| involuntary contractions of neck musculature resulting in various combinations of twisting, tilting, extension, or flexion | spasmodic torticollis |
| foul language | coprolalia |
| a substantial proportion of children with learning disorders have __ | Tourette's disorder |
| defined as the history of both motor and vocal tics (for more than one year) with onset before the age of 18 | Tourette's disorder |
| __ is not progressive or fatal | Tourette's disorder |
| rhythmic oscillation of a part of the body around a fixed point | tremor |
| most common. arise when attempting to maintain a fixed position | action tremor |
| seen in normal people in movements requiring a high degree of precision or power. Can be caused by fatigue, anxiety, hypoglycemia, hyperthyroidism, drug withdrawal, caffeine, amphetamines, theophylline, lithium, valproate | physiologic action tremor |
| slower frequency than physiologic tremor | essential action tremor |
| first line treatment for essential tremor | beta-blockers (propranolol) |
| effective but sedating treatment for essential tremor | primidone |
| can be used for anxiety induced tremor. | tranquilizers/benzodiazepines (diazepam) |
| absent at rest and at the start of a movement. Increases when fine adjustments are required | ataxic (intention) tremor |
| caused by disease of the cerebellum or its connections | ataxic (intention) tremor |
| treatment for tics (limited by side effects) | haloperidol or pimozide |
| violent flinging movements | hemiballismus |
| usually the result of an infarct in the contralateral subthalamic nucleus of Luys | unilateral hemiballismus |
| shock like contraction of a group of muscles. irregular in rhythm and amplitude. It may involve a restricted group of muscles or be generalized | myoclonus |
| treatment for myoclonus (both have limited efficacy) | clonazepam, valproate |
| may result from anoxic damage, spinal cord injury, uremia, hepatic encephalopathy | myoclonus |
| torticollis, writer's cramp, blepharospasm are examples of | focal dystonias |
| increasingly common and helpful treatment of dystonia | botulinum toxin |
| rest tremor, cogwheeling, rigidity, bradykinesia, difficulty initiating movements, masked facies, stooped posture and shuffling gait, disturbance of postural reflexes | Parkinson's disease |
| pathophysiology of Parkinson's disease | degeneration of the nigrostriatal pathway (connecting the substantia nigra and the striatum). There is a dramatic loss of dopamine containing neurons. |
| side effects of L-dopa/carbidopa | nausea, vomiting, confusion, peak dose dyskinesias and on-off phenomenon |
| act like dopamine at the dopamine receptor. May allow for reduction in the dose of Sinemet required and may decrease on-off problems | dopamine agonists (bromocriptine, pergolide, ropinirole and pramipexole) |
| may increase dopamine release from nerve terminals. weakly effective | amantidine (symmetrel) |
| may be more effective for the treatment of tremor. Side effects include confusion, constipation, dry mouth, urinary retention | anticholinergic drugs |
| autosomal dominant, varying age of onset. Symptoms often begin with psychiatric disorder (immaturity, impulsivity, and depression). Later apathy and dementia. Chorea, athetosis | Huntington's disease |
| __ can be thought of as a dopamine excess state | chorea |
| treatment for Huntington's disease | dopamine receptor blockers such as neuroleptics (haloperidol, chlorpromazine) |
| iatrogenic disorder from long-term treatment with neuroleptics. | tardive dyskinesia |
| signs of __ are abnormal buccal-lingual movements (tongue thrusting and chewing). Head movements including head turning and bobbing can also occur. | tardive dyskinesia |
Created by:
bwyche
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