Neuroanatomy Lecture #43: Intro To Movement D/os

Front 1

Five common features of movement disorders

Back 1

• Impaired postural reflexes during movement or while stationary that would normally contribute to balance

• Hypokinesia or Hyperkinesia
• Bradykinesia
• Hyperkinesia
• Ataxia

Front 2

Three types of tremors

Back 2

• Physiological
• Resting
• Intention.kinetic

Front 3

Def of Physiological tremor

Back 3

A nonpathological tremor barely visible to the naked eye; it reflects low-amp cycle of flexion and extension of a region of the body

Front 4

Resting Tremor
• is common in this disease
• its appearance during voluntary movement
• a secondary dysfxn of this tremor

Back 4

• common in Parkinson's disease
• the tremor wanes/gradually decreases in the body part of intended movement
• Basal gangliar dysfxn is often 2ndary to it

Front 5

Intention/Kinetic tremor
• The period in a voluntary movement where the tremor normally appears
• Often causes by lesions in this area

Back 5

• appear when the affected body part approaches a target
• Cerebellar lesions

Front 6

Chorea
• Often originates from this disease
• Def

Back 6

• Often originates from basal gangliar disease
• brief, purposeless, irregular jerky movements of body parts

Front 7

Athletosis
• Often originates from this disease
• Def

Back 7

• Often originates from basal gangliar disease
• Continuous slow writhing of body parts

Front 8

Ballismus
• Type of movements involved
• Often involves lesions to this area

Back 8

• involuntary flinging movements of the arm and/or rotational movments of the leg
• Lesions to the subthalamic nucleus, a contributor to basal ganglia fxn

Front 9

Possible lesion sites for Hypokinetic d/os (3)

Back 9

LMNs, the NMJ, Basal ganglia (or any dysfxn involving modulatory/regulatory circuits)

Front 10

General differences between decorticate and decerebrate postures:
• red nucleus input
• upper/lower limb positioning

Back 10

• Decorticate posturing has red nucleus input while decerebrate posturing has none
• Limb positioning
- Decorticate: flexing of the upper limb, extension of lower limb
- Decerebrate: extension of both upper & lower limbs

Front 11

Assessing Station

Back 11

Ask patient to stand steadily w/ feet together and eyes closed. The visual system will be unable to compensate for other nervous deficits

Front 12

Assessing Gait

Back 12

Patient is asked to walk in a straight path w/ following visual cues and their ability to turn smoothly while reversing direction should also be observed.

Front 13

List and Describe Six features of Parkinson's Disease

Back 13

1) Facial masking - diminished facial expression

2) Muscle rigidity - expressed in various forms during a passive assessment passive movement
- Cogwheel rigidity
- Lead-pipe rigidity

3) Loss of Postural reflexes
- failure to make adjustments in restoring equilibrium

4) Parkinsonian Gait
- small shuffling steps with festination and difficulty turning

5) Loss of habituation to Glabellar Stimulations
- tapping btwn the eyes to elicit lateral blinking

6) Speech
- Quiet, hoarse and monotanous with festination

Front 14

Five stages of Parkinson's Disease

Back 14

1. Unilateral
2. Bilateral but w/ preserved postural reflexes
3. Loss of postural reflexes
4. Severe disability but some movement
5. Akinesia

Front 15

Differential Diagnosis of Parkinson's Disease
• Which three tremors need to be discriminated?

Back 15

• Resting: + sign for Parkinson's
• Essential/Postural: only expressed when a particular posture is maintained
• Intention: + for cerebellar disease

Front 16

Two diseases that feature choreoform movements and their etiology

Back 16

Huntington's Disease: Autsomal dominant mutation

Sydenham disease: linked to rheumatic fever, has autoimmune characteristics

Front 17

Athetosis
• Def and disease it which it is linked
• difficult to differentiate from these type of movements
• often accompanies this condition

Back 17

• slow, continuous writhing movements linked to basal ganglia disease
• difficult to differentiate from choreoform movements
• often accompanies hemiplagia with a hemiplegic gate

Front 18

Ballismus
• How hemiballismus is expressed in relation to the lesion

Back 18

Is expressed cotralaterally to the lesion

Front 19

Dystonia
• Def
• a specific type involving the neck

Back 19

• Involves muscle spasms or sustained abnormal postures involving the trunk and limbs

• Spasmodic torticollis

Front 20

Tourette's Syndrome
• Specific type of this d/o
• The key to the diagnosis

Back 20

• a specific type of tic d/o
• The key dx is the vocal component which can involve barking or grunting

Front 21

Three types of drug-induced movement d/o

Back 21

Tardive dyskiesia
Dopa-induced dyskinesis
Drug-induced parkinsonism

Front 22

Tardive Dyskinesia
• may manifest with these type of drugs
• common feature
• affect upon drug withdrawal

Back 22

• antipsychotic/dopamine receptor antagonists
• oral movements
• d/o does not necessarily abate

Front 23

Dopa-induced dyskinesia
• often arises during tx for this disease and w/ this drug
• two manifestations

Back 23

• Often arises during tx w/ Parkinson's, L-dopa
• Choreoform movements, facial dystonia

Front 24

Drug-induced Parkinsonism
• can arise with agents/drugs performing these actions
• Effect on agent/drug withdrawal

Back 24

• Block dopamine receptors or deplete stores of dopamine

• Sx dissipate within weeks