Movement Disorders

Front 1

What is the basal ganglia?

Back 1

A collection of gray matter nuclei located deep within the white matter of the cerebral hemispheres.

Front 2

What are the 6 sections of the basal ganglia?

Back 2

Caudate, Putamen, Subthalamic nucleus, globus pallidus, and substania nigra

Front 3

What comprises the striatum?

Back 3

Caudate and Putamen

Front 4

What is the striatum's role?

Back 4

The major input nuclei to the basal ganglia

Front 5

What is the role of the globus pallidus and substantia nigra?

Back 5

They are the major output nuclei of the basal ganglia.

Front 6

What makes up the lentiform nucleus?

Back 6

Putamen and globus pallidus

Front 7

What does the basal ganglia do?

Back 7

It controls and regulates activities of the motor and premotor cortex via various circuits so that voluntary movements may be performed smoothly.

Front 8

What are the two predominant pathways that form input to output nuclei through the basal ganglia?

Back 8

The direct and indirect pathways.

Front 9

What two structures have similar embryologic origin?

Back 9

Globus pallidus interna and substantia nigra reticulata

Front 10

What is the pathway of the direct pathway?

Back 10

cortex -> striatum -> GPi/SNr -> thalamus -> motor cortex

Front 11

What is the pathway of the indirect pathway?

Back 11

cortex -> striatum -> GPe -> STN -> GPi/SNr -> thalamus -> motor cortex

Front 12

When does movement result?

Back 12

Movement results when thalamic cells are released from tonic inhibition.

Front 13

What is the role of dopamine in the direct and indirect pathways?

Back 13

Dopamine inhibits in the indirect pathway and facilitates the direct pathway.

Front 14

What is thought to be responsible for the disorder in movement?

Back 14

The shift in degree of inhibitory influence flowing from the basal ganglia to the thalamus.

Front 15

What are the 4 major features of basal ganglia disease?

Back 15

Hyperkinesia, hypokinesia, rigidity, and loss of automatic associated movements.

Front 16

In a unilateral movement disorder caused by a focal basal ganglia lesion, the movement disorder is ______________ to the basal ganglia lesion.

Back 16

Contralateral

Front 17

What are the subtypes of hypokinesis?

Back 17

bradykinesia and akinesia

Front 18

What causes bradykinesia and akinesia?

Back 18

Increased inhibitory basal ganglia outflow to the thalamus.

Front 19

What are the 8 types of hyperkinesis?

Back 19

tremor, dystonia, tics, chorea, athetosis, myoclonus, hemiballismus and tardive dyskinesia.

Front 20

What is hemiballismus?

Back 20

Large amplitude choreiform movements of PROXIMAL limbs resulting in flailing of the limb.

Front 21

What is the typical cause of tardive dyskinesia?

Back 21

Dopamine receptor blocking drugs.

Front 22

What is rigidity?

Back 22

Resistance to passive movement

Front 23

Is rigidity velocity independent or dependent?

Back 23

INdependent

Front 24

What are the 2 types of rigidity?

Back 24

Cogwheel rigidity and Lead pipe rigidity.

Front 25

When is cogwheel rigidity seen?

Back 25

In Parkinsonian disorders.

Front 26

What is the cause of Parkinson's disease?

Back 26

caused by a loss of dopaminergic neurons in the SUBSTANTIA NIGRA PARS COMPACTA.

Front 27

What are some causes of Parkinsonism?

Back 27

drug induced (neuroleptics, antiemetics), toxins (MPTP, manganese), tumor, vascular, infection

Front 28

What is the pathophysiology of Parkinson's?

Back 28

The balance between dopamine and acetylcholine is disrupted secondary to the depletion of dopamine within the nigrostriatal system. The net effect is to increase inhibition of the thalamus, through both the direct and indirect pathways, resulting in the paucity of movement seen in PD.

Front 29

Parkinson's disease occurs when what percentage of the neurons have lost synthesizing capacity?

Back 29

70%

Front 30

What is the average age of onset of PD?

Back 30

60

Front 31

What percentage of the population of people over 50% have PD?

Back 31

1%

Front 32

What are the 4 clinical features of PD?

Back 32

bradykinesia, resting tremor, rigidity, and postural instability

Front 33

Other than the main 4 features, what else is common in PD?

Back 33

Dementia in 30%, depression and dysautonomia

Front 34

What are the treatments for PD?

Back 34

L-dopa/carbidopa, dopamine agonists, anticholinergics, amantadine, COMT inhibitors and MAOIs.

Front 35

What surgery is available for PD and describe a candidate?

Back 35

Deep Brain stimulation; relatively young, clear diagnosis of PD, w/o dementia/depression, few medical comorbidities.

Front 36

What are the types of tremors?

Back 36

Resting, postural tremor and intention (kinetic).

Front 37

Describe a resting tremor.

Back 37

3-5 Hz, occurs at rest - treated with standard PD therapies

Front 38

What are the subtypes of Postural tremors?

Back 38

Physiologic, enhanced physiologic and essential

Front 39

What is a postrual tremor most prominent?

Back 39

When body part is voluntarily maintained against gravity, as when holding arms out in front of body.

Front 40

Describe an essential tremor.

Back 40

Frequency 5 - 8 Hz, autosomal dominant, slowly progressive, kinetic component, worsens with stress, stimulants, improves with alcohol

Front 41

What are the treatments for an essential tremor?

Back 41

Propanolol and Primidone

Front 42

What is an intention tremor?

Back 42

It is worst during guided voluntary movement (as with finger to nose testing)

Front 43

What are some causes of intention tremors?

Back 43

Cerebellar, brainstem, wilson's disease, drug toxicity, it is very resistant to medical therapy

Front 44

What is dystonia?

Back 44

Prlonged contraction of axial and/or limb musculature resulting in distortion of posture.

Front 45

What is torticollis?

Back 45

Dystonia in the cervical region with contraction and hypertrophy of contralateral sternocleidomastoid muscle.

Front 46

What are some etiologies of dystonia?

Back 46

Genetic, perinatal/cerebral palsy, Wilson's disease, drug induced (antipsychotics), focal intracranial disease)

Front 47

What are the treatment options of dystonia?

Back 47

Baclofen, Benzodiazepines, Botulinum toxin injections and L-dopa.

Front 48

What is the treatment of tic disorders or Tourette's during severe periods?

Back 48

Dopamine antagonists like Haldol

Front 49

What is the triad of Huntington's disease?

Back 49

chorea, cognitive decline and positive family history

Front 50

What is Syndenham's chorea?

Back 50

Autoimmune chorea preceded by a streptococcal infection.

Front 51

What are causes of myclonus?

Back 51

anoxic brain injury, encephalitis, toxic metabolic encephalopathies. Can also be a result of an epileptic d/o, paraneoplastic d/o, or neurodegenerative d/o.

Front 52

What are the treatment options for myoclonus?

Back 52

Valproic acid, Klonopin (clonazepam), and Keppra (levitiracetam).

Front 53

What is hemiballism?

Back 53

Flailing proximal limb movement.

Front 54

What causes hemiballism?

Back 54

It is most commonly secondary to ischemia, hemorrhage, or trauma of subthalamic nucleus.

Front 55

What is tardive dyskinesia?

Back 55

Hyperkinetic movment disorder that may be an early or tardive (delayed) side effect of dopamine receptor blocking drugs.