Movement Disorder Ii From Pneu Year 3

Front 1

How are movement disorders broadly classified?

Back 1

1. akinetic disorder - too little
2. hyperkinetic disorder - too much

Front 2

Definition of Parkinsonism

Back 2

Bradykinesia

Plus any of the followings:
1. rigidity
2. resting tremor
3. postural instability

Front 3

Clinical classification of Parkinsonian disorders

Back 3

1. Idiopathic Parkinson's disease
2. Parkinsonism- plus
3. Heredo-degenerative
4. Secondary

Front 4

Parkinson's disease is a clinical diagnosis, what are the 3 steps in the Queen Square Brain Bank Criteria?

Back 4

Step 1: parkinsonism
Step 2: exlusion criteria
Step 3: supportive criteria

Front 5

Parkinson's disease is not just a motor disease, give some non-motor symptoms

Back 5

1. anosmia
2. bradyphrenia (slow thinking)
3. dementia
4. autonomic dysfunction (late)

Front 6

Give pathology of Parkinson's disease Give the pathological hallmark of this disease and the types of the hallmark

Back 6

Pathology:
1. Dopaminergic neurons in substantia nigra pars compacta (SNpc) degenerate

2. exponential neuron loss

3. neuronal loss start at lat. part of ventral tier of SNpc

Pathological hallmark: Lewy bodies
1. brainstem type
2. cortical type

Front 7

Pathogenesis of Parkinson's disease
and the underlying chemical mechanism causing it

Back 7

1. Most sporadic
2. If age < 50, then significant enetic

Central mechanism:
1. toxic proteins
2. oxidative stress

Front 8

Give some possible environmental factors of Parkinson's disease

Back 8

1. Neurotoxin
2. Diet (high fat, high calories)

Caffein, alcohol, smoking: inverse association

Front 9

When should we delay the use of levodopa and why?

Back 9

Delay if age < 60

dyskinesia more easily to develop.

Front 10

Medical treatmnet for Parkinson's disease

Back 10

+ve:
Dopamine agonists, levodopa

-ve:
MAO-B inhib, anticholinergic, NMDA inhib, COMT inhib, adenosine (2a) antagonist

Front 11

Give some Parkinsonism- Plus disorders

Back 11

1. Multiple system atrophy
2. Progressive supranuclear palsy
3. Cortico-basal degeneration

Front 12

Give some Heredo-degenerative disorders

Back 12

1. Wilson's disease
2. Huntington's disease

Front 13

Give some secondary parkinsonian disorder

Back 13

1. Infection
2. Trauma
3. Vascular disease

Front 14

Give 3 clinical features of Multiple System Atrophy

Back 14

1. autonomic dysfunction
2. parkinsonism
3. cerebellar dysfunction

Nocturnal stridor: late feature

Front 15

Imaging of MSA

Back 15

CT: infratentorial atrophy
MRI: putamen slit sign, hot-cross bun sign

Front 16

Pathology of MSA

Back 16

Glial cytoplasmic inclusions

Front 17

Medical Mx of MSA

Back 17

Levodopa ( parkinsonism, but unsustaned response)

Oxybutinin ( bladder urgency)

Treat orthostatic hypotension

Front 18

Clinial features of Progressive Supranuclear Palsy

Back 18

1. axial feature
-fall backwards
-loss of postural reflex
-axial regidity

2. bradykinesia
3. reptilian stare
4. imparied downgaze
5. swallowing difficulty

Front 19

Pathology of Progressive Supranuclear Palsy

Back 19

Nuerofibrillary tangles

Front 20

Imaging of Progressive Supranuclear Palsy

Back 20

MRI: dorsal midbrain atrophy

Front 21

Medical Mx of Progressive Supranuclear palsy

Back 21

Levodopa
Botulinum toxin (x retrocollis)

Front 22

Concerning Cortico - basal degeneration.

Back 22

Highly assymmetrical - progressive - akinetic-rigid syndrome

Front 23

Give some basal ganglia signs of cortico-basal degeneration

Back 23

1. Akinesia
2. Alien limb phenomenon

Front 24

Imaging of cortico-basal degeneration

Back 24

Asymmetrical frontal-parietal atrophy

Front 25

Medical Mx for cortico-basl degeneration

Back 25

Levodopa (x parkinsonism)
Clonazepam (x myoclonus , action tremor)

Baclofen (x rigidity)

Botulinum toxin (x painful dystonia)

Front 26

Give some hyperkinetic disorders

Back 26

1. tremor ( rhythmic)
2. myoclonus ( sudden brief jerky, involuntary)
+ve: contraction -ve: cessation of contraction
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3. ballismus (violent flinging of entire limb)

4. chorea (rapid irreggular jerks)

5. athetosis (slow, flowing, twisting movement, distally)

6. dystonia (co-contraction)
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7. tics (recurrent, stereotyped)
-simple: 1 muscle group
-complex: cooridnated, sequenced

8. psychogenic movement disorder

Front 27

Tx of psychogenic movement disorder

Back 27

1. avoid confrontation
2. psychotherapy