Movement disorders 2

Question 1

Nature of movement in “Flapping Tremor” asterixis

Answer 1

1. Hold arms up with palms forward and tell patient to “stop”: see tics of hands.
2. Not frequent, seen mostly in young people

Question 2

“Flapping Tremor” asterixis: associated disease

Answer 2

Wilson’s Disease, liver failure, uremia / kidney failure (only Wilson’s results in copper problems, the others involve other toxins)

Question 3

cause of “Flapping Tremor” asterixis

Answer 3

Copper accumulation in the lentiform nucleus causing basal ganglia degeneration

Question 4

treatment for “Flapping Tremor” asterixis

Answer 4

chelating agents such as penicillamine

Question 5

nature of movement of tics

Answer 5

1. Brief, intermittent movements or sounds
2. Sudden, abrupt, transient
3. Repetitive, coordinated
4. Vary in intensity
5. Repeated at irregular intervals
6. May resemble gestures, normal behavior
7. Sometimes suppressible
8. May look like a voluntary movement

Question 6

associated diseases with tics

Answer 6

tourettes

Question 7

cause of tics

Answer 7

1. SLITRK1 Gene on chromosome 13 (one patient only)
2. AD in other cases
3. Otherwise idiopathic

Question 8

meds to treat tics

Answer 8

1. Clonidine (anti-HTN)
2. SSRIs (for OCD)
3. Neuroleptics
4. Tetrabenazine
5. Clonazepam

Question 9

chorea nature of movement

Answer 9

Irregular, brief, dancing-like, jerky movements

Move from one body part to another

Question 10

chorea associated disease

Answer 10

1. Huntington’s
2. Sydenham chorea (most common type of chorea in kids)
3. Chorea Gravidarum
4. Lupus: 3rd most common neurologic presentation of lupus

Question 11

causes of chorea

Answer 11

1. HD: CAG repeat

2. Sydenham: post streptococcal immune reaction

Question 12

dystonia nature of movement

Answer 12

Contraction of muscle agonists and antagonists

Sustained muscle contractions cause twisting, abnormal postures

Can be associated with tremor

Question 13

cause of primary dystonia

Answer 13

DYT 1-12

Question 14

cause of secondary dystonia

Answer 14

1. Neuro-degenerative disorders
2. Ischemic brain injury
3. Posttraumatic
4. Meds, toxins

Question 15

Tourette Syndrome is

Answer 15

Motor and vocal tics that are suppressible and last more than 1 year

Question 16

Tourette syndrome is associated with

Answer 16

ADHD, OCD, poor impulse control

Question 17

Tourette syndrome: motor

Answer 17

1. grimacing
2. blinking
3. nose twitching
4. lip pouting
5. hopping
6. clapping
7. touching
8. throwing
9. head banging

Question 18

Tourette Syndrome: vocal

Answer 18

1. fronts
2. throat clearing
3. barks
4. sniffling
5. shouting obscenities
6. utterations

Question 19

list hypokinesias

Answer 19

1. parkinson’s
2. progressive supranuclear palsy
3. multiple systems atrophy

Question 20

Parkinson’s disease signs

Answer 20

1. resting tremor
2. bradykinesia or akinesia
3. rigidity
4. non-motor symptoms: autonomic instability, sleep disturbances

Question 21

Progressive supranuclear palsy:

signs

Answer 21

1. impaired eye movements: can’t look down
2. reptilian or scared look
3. falls within the first year

Question 22

Multiple systems atrophy: signs

Answer 22

1. Parkinsonism
2. cerebellar symptoms
3. gait ataxia
4. autonomic symptoms