Extrapyrimidal Signs

Question 1

Chorea

Answer 1

Involuntary, non repetitive, Jerky movement involving proximal muscles

Question 2

Athetosis

Answer 2

Involuntary, slow, writhing movements involving distal extremities

Question 3

Dystonia

Answer 3

Variable tone
Signs:
•  Opisthotonus/ peculiar posture
•  Variable tone
•  Delay development
•  Reflex - Persistent primitive reflex
•  Symmetrical tonic neck reflex
•  Extend LL --> Fanning toes & upgoing bigtoe
Manifestation of abnormal posture is elicited by asking pt to move

Question 4

Causes of Choreo-athetosis

Answer 4

1. Hereditary
   • Ataxic telangiectasia, Huntington Chorea
2. Traumatic
   • Asphyxia
3. Infectious
   • Subacute sclerosing panencephalitis (SSPE), Rheumatic fever, Congenital infection
4. Inflammatory condition
   • SLE
5. Toxic
   • Kernicterus
   • Poisoning - CO, Wilson’s
   • Drugs e.g. Phenothiazine

Question 5

Steps in examination for Choreo-athetosis

Answer 5

1. Demonstrate choreoathetosis
   • Hand x reaching out & grip object
2. Neurological examination of limbs
   • Dystonia
   • Shuffling gait; Peculiar/ Clumsy gait
3. Look at the face
   • Eye - KF ring, Telangiectasia; Defective upward gaze (Kernicterus)
   • Ear - Deafness & requires hearing aid
   • Teeth - Brown discoloration (drugs)
   • Facial grimace
4. Abdomen
   • Evidence of portal hypertension
   • Splenomegaly + Choreoathetosis –> Wilson’s disease/ Kernicterus