Moevment Disorders

Question 1

Asterixis

Answer 1

Uncontrolled Extension of the wrists which results in a “flapping of the wrists”

Seen in:

• hepatic encephalopathy
• Wilson disease
• metabolic disorders

Question 2

Athetosis

Answer 2

Slow undulating snake-like movements usually in the fingers and hands

Seen in:

• lesions of the basal ganglia
• degenerative disorders

Question 3

Blepharospasm

Answer 3

A type of dystonia that affects only the eyes
- uncontrolled blinking or eyelid movement

Seen in:

• some medications
• OD of medications
• genetic defects

Question 4

Chorea

Answer 4

Uncontrolled sudden jerking or dance-like movements

Seen in:

• lesions to the basal ganglia
• Huntington’s
• rheumatic fever
• Wilson’s disease

Question 5

Dystonia

Answer 5

Sustained muscle contractions that are uncontrolled

Question 6

Hemiballsmus

Answer 6

Uncontrolled flailing/flinging motions of the extremities

Seen in:

• lesions to the contralateral STN
• lacunar strokes

Question 7

Tardive dyskinesia

Answer 7

Controlled repetitive Orofacial movements (usually smacking of lips or abnormal tongue movements)

Seen in:

• dopamine antagonist uses
• absence seizures

Question 8

Torticolis

Answer 8

Sustained muscle contractions of the neck similar to dystonia

Question 9

Huntington’s disease

Answer 9

A type of hyperkinetic movement disorder

Is a autosomal dominant w/ complete penetrance disease that results in a CAG triplet on chromosome 4 and repeat expansions of HTT genes on chromosome 4

Results in corpus striatum atrophy which lowers number of GABA neurons in the corpus striatum and reduced inhibitory output from the striatum

Question 10

Clinical features of Huntington’s

Answer 10

Doesn’t show until 30-50s usually

Clinical features:

• chorea
• dysarthria
• dysphagia
• abnormal eye movements
• neurobehavioral disorders
• dementia

*(Is autosomal dominant)

Diagnosis:

• family history/ genetic testing
• symptoms
• CT/MRI

Treatment:

• D2 antagonists
• mood medications

Question 11

Restless leg syndrome

Answer 11

Hyperkinetic disorder

Etiology

• genetics
• iron deficiencies
• diabetic neuropathy
• uremia
• OSA
• pregnancy

Symptoms

• leg sensations (akathisa) that worsen at night
• symptoms are present only at rest, movement makes it better

Diagnosis

• polysomnography
• history
• labs

Treatment
- treat underlying cause

Question 12

Types of tremors

Answer 12

Postural:
- occurs when the body part is voluntarily maintained against gravity

Action:
- occurs with voluntary contraction of muscles

Kinetic:
- occurs with any form of voluntary movement

Intention:

• subtype of kinetic tremor amplified as the target is reached
• always implies direct or pathway lesions of the cerebellum

Rest:

• occurs in a body part that is relaxed and completely supported against gravity
• usually implies Parkinsonism

Question 13

Essential tremor (familial)

Answer 13

Hyperkinetic disorder

Most common type of tremor

50% of the time is autosomal dominant genetic caused

High frequency quick tremors that usually affects only the upper extremities (Can affect face and voice however)

Clinical features:

• bimodal distribution that results in bilateral, postural or kinetic tremors.
• usually one hand is worse (although this isnt usually clinically relevant)
• alcohol actually fixes these tremors

Treatments:

• life style modifications
• BBs
• anti-epileptics
• thalamic surgery (severe cases only)

Question 14

Wilson’s disease

Answer 14

hyperkinetic disorder

Autosomal recessive disorder of copper metabolism
- excessive build up of copper since it cannot bind to ceruloplasmin (its transfer protein)

Clinical features

• people under 40 yrs
• hepatic issues
• action tremors
• asterixis
• *presence of kayser-flesicher rings (brown ring on the outside edge of the iris)
• hemolytic anemia
• behavioral disturbances

Diagnosis

• elevated urinary copper
• low ceruloplasmin
• genetic testing

Treatment:
- penicillamine (chelating agent that binds to coppe)

Question 15

Parkinson’s disease

Answer 15

Hypokinetic disorder that is the 2nd most common movement disorder

Degeneration of the substantia Nigra and respective dopamine neurons
- results in inability to inhibit GABA output from the striatum (net negative for movement)

Causes

• genetic neurodegenerative
• therapeutic drugs in high doses
• toxins
• post traumatic stress and trauma

Symptoms:

• unilateral/slow frequency resting tremors
• cogwheel rigidity*
• akinesia/ bradykinesia
• mask-like faces
• hypotonia
• dysphagia
• micrograph is
• postural instability w/ shuffling gate
• autonomic dysfunction
• cognative and behavioral dysfunctions

Question 16

What is a DaT scan?

Answer 16

Shows areas of the brain that are “hotspots” for dopamine uptake

Used to diagnose Parkinson’s
- will show decreased DaT activity over time and in areas where it should be high