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Flashcards in Dyskinetic disorders Deck (47):
1

 

 

What are dyskinetic disorders charcterised by?

 

 

Characterised by impaired planning, control or execution of movement

2

 

 

What is a resting tremor?

https://www.youtube.com/watch?v=AYPzyOK2H2E

 

Tremor which is abolished with on voluntary movement

3

 

 

What is the cause of a resting tremor?

 

 

Parkinsonism

4

 

 

What is an intention tremor?

https://www.youtube.com/watch?v=4Sf-TuXMK64

 

Intention tremor is a slow (2–4 Hz) tremor during voluntary movement that develops as the limb approaches the target.

5

 

 

What tests would you do to assess for an intention tremor?

 

  • Finger-to-nose test
  • Heel-shin sign

6

 

 

Why does an intention tremor occur?

 

 

Delays in motor initiation and movement termination, and abnormalities of movement force and acceleration, contribute to intention tremor

7

 

 

What can cause an intention tremor?

Cerebellar problems

  • Intoxication – alcohol, benzodiazepine
  • Cerebellar infarction
  • Multiple sclerosis
  • Vertebral artery dissection
  • Cerebellar mass lesion – tumour, abscess, AVM
  • HSV cerebellitis
  • Hereditary cerebellar degeneration (Freidreich’s ataxia)
  • Paraneoplastic cerebellar degeneration

Remember mnemonic mavis - MS, Alcohol, Vascular problems, Inherited ataxia/Infection, Space occupying lesions

8

 

 

What is a postural tremor?

https://www.youtube.com/watch?v=ZHUXI6OGdjo

 

A tremor which is absent at rest, but present on maintained posture (e.g. outstretched arms) and may persist on movement

9

 

 

What are causes of postural tremor?

 

  • Benign essential tremor
  • Thyrotoxicosis
  • Anxiety
  • B-agonists

10

 

 

What is chorea?

https://www.youtube.com/watch?v=1hKtmtu2pCw

 

Non-rhythmic, jerky, purposeless movements flitting from one place to another e.g. facial grimacing, raising the shoulders, flexing/extending fingers

11

 

 

What can cause choreic movements?

 

  • Systemic disease - thyrotoxicosis, SLE, antiphospholipid syndrome, primary polycythaemia
  • Genetic diseaseb - Huntingtons disease, neuroacanthocytosis
  • Drugs - levodopa, OCP
  • Post infection - Syndenham's chorea
  • Pregnancy

12

 

 

What is syndenham's chorea?

https://www.youtube.com/watch?v=wTCnbga3sqg

 

A rare atuoimmune complication of group A strep infection, characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. It is caused by destruction of cells in the corpus striatum of the basal ganglia

13

 

 

What drug can worsen chorea symptoms?

 

 

Levodopa

14

 

 

What is hemiballismus?

https://www.youtube.com/watch?v=1iSnmwXfN5o

 

Large-amplitude, flinging hemichorea (affecting proximal muscles) conttralateral to a vacular lesion of the subthalamic nucleus - often elderly diabetics

15

 

 

What is athetosis?

https://www.youtube.com/watch?v=J_wIDm1_ax4

 

Slow, sinuous, confluent, puposeless movements (esp. digits, hands, face, tongue) which are often difficult to distinguish from chorea

16

 

 

What are causes of atheotosis?

 

 

Most common cerebral palsy

17

 

 

What is pseudoathetosis?

 

 

Athetosis caused by severe proprioceptive loss

18

 

 

What are tics?

https://www.youtube.com/watch?v=M0CBmmxufAk

 

Brief, repeated, sterotyped movements which patients may suppress for a while

19

 

 

What is myoclonus?

https://www.youtube.com/watch?v=bHG3GdvZOps

 

Sudden involuntary focal o general jerks arising from cord, brainstem or cerebral cortex

20

 

 

What are causes of myoclonus?

 

  • Physiological myoclonus
  • Myoclonic Epilepsy
  • Variant CJD
  • Metabolic disorders - hepatic/renal failure, dementia/neurodegenrative disorders
  • Encephalitis

 

 

21

 

 

What is myoclonus caused by hepatic/renal failure called?

https://www.youtube.com/watch?v=-R3lRmu7dbk

 

Asterixis (metabolic flap) - jerking (1-2 per sec) of outstretched hands, worse with wrists exteded, from loss of etensor tone (type of negative myoclonus caused by imbalance between flexors and extensors)

22

 

 

What can cause asterixis?

 

  • Liver failure
  • Kidney failure
  • Hyponatraemia
  • Hypercapnia
  • Gabapentin
  • Thalamic stroke - if unilateral

23

 

 

What are tardive syndromes caused by?

 

 

Irreversible tardive symptoms caused by chronic exposure to dopamine antagonists

24

 

 

What are the different types of tardive syndromes?

 

  • Tardive dyskinesia
  • Tardive dystonia
  • Tardive akasthesia
  • Tardive myoclonus
  • Tardive tremor
  • Tardive tourettism

25

 

 

What are features of tardive dyskinesia?

Orobuccolingual, trunal or choreiform movements:

  • Vacuous chewing
  • Lip smacking/pouting
  • Grimacing facial movements

 

https://www.youtube.com/watch?v=FUr8ltXh1Pc&t=19s

26

 

 

What are features of tardive dystonia?

https://www.youtube.com/watch?v=M6haSEEuxZw

 

Sustained, sterotyped muscle spasms of a twisting or turning character e.g. retrocollis and back arching/opisthotonic posturing

27

 

 

What is tardive akasthisia?

https://www.youtube.com/watch?v=-xiG4R7AWdc

 

Sense of restlessness or unease +/- repetative, puposeless movements (e.g. pacing)

28

 

 

How would you treat tardive dyskinesia?

 

 

Gradually withdraw neuroleptics and wait 3-6 months

29

 

 

What is the defintion of dystonia?

 

 

Prolonged muscle contraction causing abnormal posturing or repetitive movements

30

 

 

What is a primary dystonia?

 

 

Where dystonia is the only/main clinical manifestation

31

 

 

What is secondary dystonia?

 

 

Dystonia caused by a disease process e.g. brain injury, cerebral palsy or drugs

32

 

 

What is torticollis?

https://www.youtube.com/watch?v=45bWI1xKemM

Dystonic spasms gradually develop in neck muscles causing the head to turn (torticollis) or to be drawn backwards (retrocollis). There may also be a jerky head tremor. A gentle touch with a finger tip at a specific site may relieve the spasm temporarily (sensory trick or ‘geste’).

33

 

 

What is blephorospasm?

https://www.youtube.com/watch?v=hGesxOGNdfY

 

These consist of spasms of forced blinking or involuntary movement of the mouth and tongue (e.g. lip-smacking and protrusion of the tongue and jaw).

 

34

 

 

What is writer's cramp?

 

A specific inability to perform a previously highly developed repetitive skilled movement, e.g. writing. The movement provokes dystonic posturing. Other functions of the hand remain normal. Overuse may lead to task-specific dystonias in certain occupations, e.g. musicians, typists and even golfers.

35

 

 

What are examples of focal dystonias?

 

  • Spasmodic torticollis
  • Writer's cramp
  • Blepharospasm

36

 

 

What are acute dystonic reactions?

Reactions which can occur on starting new medicaitons. Following features present:

  • Torticollis
  • Trismus
  • Oculogyric crisis

37

 

 

What is trismus?

 

 

Oromandibular spasm

38

 

 

What is oculogyric crisis?

https://www.youtube.com/watch?v=U5c0WaPvr8s

Bilateral elevation of the visual gaze, but several other responses are associated with the crisis

39

 

 

What drugs can cause acute dystonic reactions?

 

  • Antipsychotics
  • Antiemetics —  e.g. metaclopramide, proclorperazine
  • Antidepressants and serotonin receptor agonists — e.g. SSRIs, buspirone, sumitriptan
  • Antibiotics — e.g. erythromycin
  • Antimalarials — e.g. chloroquine
  • Anticonvulsants — e.g. carbamazepine, vigabatrin
  • H2 receptor antagonists — e.g. ranitadine, cimetidine
  • Recreational drugs — e.g. cocaine

 

40

 

 

How would you manage an acute dystonic reaction?

 

 

Anticholinergic

 

41

 

 

What is huntington's disease?

https://www.youtube.com/watch?v=IuSaXiRVqg0

 

A dominantly inherited neurodegenerative condition that produces progressive movement disorder and dementia

42

 

 

What is the cause of huntington's chorea?

 

 

Genetic mutation of huntingtin gene, with extra triplet repeates of glutamine - trinucleotide repeat expansion disease. This produces an expanded polygluatmine protein. The mutated protein aggregates in the caudate and putamen, which causes neuronal cell death. This stops inhibition of movements, leading to chorea and other movement disorders

43

 

 

How is huntington's disease inherited?

 

 

Autosomal dominant

44

 

 

What is the relationship between number of repeat sequences in huntingtin gene and age of onset?

 

 

More repeats, earlier onset of disease

45

 

 

What is the phenomenon of anticipation seen in huntington's disease?

 

A tendency for successive generations to have earlier onset and more severe disease due to unstable CAG repeat expansion during meiosis (particularly when inherited from the father)

46

 

 

What are the main features of huntington's chorea?

 

  • Personality changes
  • Movement disorder - chorea, athetosis
  • Bizarre gait
  • Abnormal eye movements
  • Poor coordination
  • Dementia
  • Depression

 

 

47

 

 

What neurotransmitters are affected in huntington's chorea?

 

  • Decreased GABA
  • Decreased Acetylcholine
  • Increased Dopamine