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Flashcards in Movement disorders Deck (36):
1

Hypokinetic movement disorders

Bradykinesia; PD

2

Hyperkinetic disorder

Dyskinesia;
tremor
tics
chorea
myoclonus
dystonia

3

What is a tremor?

Rhythmic sinusoidal oscillation of a body part

4

What are the different classifications of a tremor?

Rest; occurs when body at rest (5Hz)
Postural; occurs when the arms are outstretched
Kinetic; occurs during movement of a body part

5

What is an essential tremor?

Seen in hands at 5Hz when hold arms outstretched
Continues through moto execution
Familial
Slow progression
Ameliorated by alcohol intake
Asymmetric

6

Describe a physiological tremor

Symmetrical
Fast
Small amplitude

7

Describe a wilson's disease tremor

Early stage postural
Wing beating

8

Describe a hepatic encephalopathy tremor

Asterixis
Repetitive drops of extended hands

9

What is chorea?

Brief irregular purposeless movement that flit and flow from one body part to another
Constantly restless or fidgety
Often generalised but can be focal

10

What can cause chorea?

Drugs/ OCP
Basal ganglia lesions
Sydenham's chorea
Antiphospholipid syndrome
HD
Neurocanathocytosis

11

What is myoclonus?

Brief electric shock like jerks
Hiccups o hypnic jerks are common and normal forms of myoclonus
Arises from cortex, subcortical structures, spinal cord or nerve root and plexus

12

What is a tic?

Unvoluntary repetitive, stereotyped movements of vocalizations
They can be suppressed but there will be a growing feeling of anxiety and discomfort during tic suppression and when allowed to relax there will be a flurry of tics

13

What is a motor tic?

Eye blinking
Head jerks
Arm/leg jerks
Complex sequence

14

What is a vocal tic?

Sniffing
Grunting
Snorting

15

What is gilles de la tourette syndrome?

Typically onset of persistent multiple motor and vocal tics, often with assoc psych disturbance (ADHA, OCD, copropraxia, coprolalia)

16

What is dystonia?

Movement disorder characterized by sustained or intermittent muscle contractions causing abnormal often repetitive movements or posture
Tend to be patterned, twisting and may be tremulous
Often initiated o worsened by voluntary action and assoc with overflow muscle activation

17

Motor sy of PD

Tremor
Bradykinesia
Rigidity
Postural and gait impairement

18

Non motor sy of PD

Depression
Dementia
Constipation
Anosmia
Parasomnias

19

What tremor is assoc with PD?

Pill rolling
3-6 Hz

20

Tx for dementia in PD?

Acetylcholinesterase inhibitor; rivastigmine

21

Tx for depression in PD?

Dopamine agonist
SSRI
Tricyclic

22

Tx for REM sleep behavior disorder in PS?

Benz; clonazepam
Hormone; melatonin

23

Tx for constipation in PD?

Osmotic laxative

24

Tx for GI motility in PD?

Domperidone

25

Tx for orthostatic hypotension in PD?

Domperidone
Fludrocortisone

26

Tx for sialorrhoea in PD?

Atronic drops
Glycopyrrolate
Botulism

27

Tx for fatigue in PD?

Modanifil

28

What encomapsses bradykinesia?

Slowness of movement with progressive loss of amplitude or speed during rapid alternating movements
Hypomimia
Hypophonia
Micrographia

29

Which rigidity is felt in PD?

Cog wheel
Lead pipe
Positive froment's maneouvre

30

How is posture and gait affected in PD?

Stooped
Impaired postural reflexes
Gait; slow, shuffling
Decreased arm swing
Slow turning
Freezing
Festination
Pull test

31

Red flags in PD?

Absence of asymmetry
Severe axial or lower limb
Frequent falls
Fast disease progression
Eye movement; supranuclear palsy, dysmetric or slow saccades
Tics, myoclonus or choea
Pyramidal or cerebellar dysfunction
Bulbar or pseudobulbar features
Parietal assoc sensory disturbances
Apraxia

32

What is vascular parkinsonism?

Affects lower limbs
Rest tremor uncommon
Other neurological signs; spasticity, hemiparesis, pseudobulbar palsy
Poor levodopa response

33

What is drug induces parkinsonism?

Symmetrical
Coarse postural tremor
Emergence of symptoms after drug exposure, and subsequent improvement after drug withdrawal

34

What is the triad of symptoms in multi system atrophy?

Dysautonomia
Cerebellar features
Parkinsonism

35

What is progressive supranuclear palsy?

Symmetric akinetic rigid syndrome with predominantly axial involvement
Gait and balance impairment
Vertical gaze supranuclear palsy
Pseudobulbar symptoms
Retrocollis
Continuous frontalis action
NO response to levodopa

36

How is psychosis in PD managed?

Clozapine; beware of idiosyncratic adverse drug reactions and agranulocytosis