Neurology - Movement Disorders

Front 1

what are the 5 componenents of the basal ganglia?

Back 1

1. Putamen
2. Globus Pallidus
3. Caudate Nucleus
4. Subthalamic Nuclei
5. Substantia Nigra

Front 2

What 2 components of the basal ganglia compose the lentiform nucleus?

Back 2

1. Putamen
2. Globus Pallidus

Front 3

What are the two parts of the the corpus striatum?

Back 3

1. Lentiform nucleus (Putamen, Globus Pallidus)
2. Caudate nucleus

Front 4

What are the 6 types of abnormal movement?

Back 4

1. tremor
2. chorea
3. athetosis or dystonia
4. ballismus
5. myoclonus
6. tics

Front 5

The type of tremor seen with Parkinson disease is called?

Back 5

Resting tremor (present at rest, disappears or is reduced with movement.)

Front 6

Benign essential tremor is what type of tremor?

Back 6

Postural - strong familial link

Front 7

What drugs are associated with worsening physiologic tremor?

Back 7

1. Valproic acid
2. Lithium
3. Bronchodilators
4. TCA's

Front 8

what type of movement abnormality is asterixes classified as?

Back 8

myoclonus - intermittent cessation of extensor action reveals underlying flexor myoclonus resulting in flapping up and down o hand at wrist.

Front 9

Damage to what brain structure results in intention tremor?

Back 9

superior cerebellar peduncle

Front 10

what is the typical frequency of a resting tremor such as that seen with Parkinson disease

Back 10

4-6 Hz

Front 11

Which disease can cause, resting, postural, and intention tremors?

Back 11

Wilsons disease (diffuse brain damage leads damage to multiple areas of the movement circuitry

Front 12

What is rapid, irregular, muscle jerks that occur involuntarily and unpredictably in different parts of the body?

Back 12

Chorea

Front 13

Sudden dipping or lurching to one side during gate is characteristic of which movement abnormality?

Back 13

Chorea

Front 14

Damage to what two brain structures can cause chorea?

Back 14

Caudate nucleus and putamen

Front 15

What are two potentially curable causes of chorea?

Back 15

Thyrotoxicosis and polycythemia vera

Front 16

What are the two important hereditary causes of chorea?

Back 16

Wilsons and Huntington's Disease

Front 17

What is sydenham chorea?

Back 17

Chorea caused by acute Rhematic fever. Usually clears within several months of antibiotic treatment, but can sometimes appear later in life.

Front 18

What are common iatrogenic causes of chorea?

Back 18

Antipsychotic meds and Parkinson treatment (levodopa or other dopaminergic drugs

Front 19

What is unilateral chorea that is especially violent because the proximal muscles of the limbs
are involved?

Back 19

Hemibalismus

Front 20

What causes hemibalismus?

Back 20

vascular damage to the contralateral subthalamic nucleus - usually clears within several weeks

Front 21

Abnormal movements that are slow, sinuous, and writhing are called?

Back 21

Athetosis - if these movements are sustained the may be regarded as a postural dystonia

Front 22

Which diseases can be associated with athetosis/dystonias?

Back 22

Parkinsons, Huntingtons, and Wilsons

Front 23

What are the common iatrogenic causes of athetosis/dystonias?

Back 23

Dopaminergic drugs and antipsychotics

Front 24

Sudden, rapid, twitch-like movements are known as?

Back 24

Myoclonus

Front 25

What is an important infectious cause of myoclonus?

Back 25

Creutzfeldt-jakobs disease

Front 26

Segmental myoclonus can be caused by damage to what brain structures?

Back 26

Actually damage caused to any of the central nervous system structures can cause this (cortex, brainstem, spinal cord)

Front 27

what is epilepsia partialis continua and what causes this disorder?

Back 27

repetitive focal epileptic discharge occuring from the contralateral sensorimotor cortex leading to segmental myoclonus. Caused by hyperosmolar nonketotic hyperglycemia

Front 28

Treatment of myoclonus?

Back 28

Depakote 250-500mg TID, clonazepam .5mg up to 12mg daily. For myoclonus associated with anoxic brain injury, 5-HT precursor to serotonin is very effective (combine with carbodopa to avoid peripheral metabolism).

Front 29

Familial essential tremor has what sort of inheritance pattern?

Back 29

AD

Front 30

what is treatment of familial essential tremor?

Back 30

Propranolol 40-120 mg daily. Also high frequency thalamic stimulation can be helpful in severe cases which do not respond to other approaches.

Front 31

"lower body Parkinsons" or primary disturbances of gait with only other minor parkinsonian symptoms may be caused by?

Back 31

Vascular disease of white matter

Front 32

what is Myerson sign?

Back 32

sustained blink relfex after tapping bridge of nose on someone with Parkinsons disease

Front 33

Common cause of falls in persons with parkinsons disease related to therapy with dopaminergic agents?

Back 33

Orthostatic hypotension - always get orthostatic BP's in office

Front 34

neuronal degeneration with the
The presence of neurofibrillary tangles in the midbrain, pons, basal ganglia, and dentate nuclei of the
cerebellum is hallmark for what movement disorder?

Back 34

PROGRESSIVE SUPRANUCLEAR PALSY

Front 35

What movement disorder does this discribe? Gait disturbance with early falls, supranuclear ophthalmoplegia, pseudobulbar palsy, axial dystonia with
or without extrapyramidal rigidity of the limbs, and dementia.

Back 35

progressive supranuclear palsy

Front 36

This is characterized by prominent failure of voluntary vertical gaze, with later paralysis of horizontal gaze?

Back 36

Supranuclear ophthalmoplegia

Front 37

What movement disorder presents this way? Neck often assumes an extended posture (axial
dystonia in extension), with resistance to passive flexion.

Back 37

progressive supranuclear palsy

Front 38

midbrain atrophy
(hummingbird sign)?

Back 38

progressive supranuclear palsy

Front 39

Apraxia and clumsiness are more common in this movement disorder rather than extrapyramidal deficits (tremors, dyskinesia, rigidity) often seen with Parkinsons

Back 39

Corticobasal degeneration

Front 40

Alien limb syndrome (involuntary, semi-purposeful, movement of limb without owners recognition)

Back 40

Corticobasal degeneration

Front 41

this disease is characterized by a mutation involving a gene located on chromosome 4p16.3

Back 41

Huntings disease and huntingtin

Front 42

how is huntingtons inherited?

Back 42

AD with complete penetrance

Front 43

what is the characteristic mutation which causes huntingtons?

Back 43

expansion of a CAG trinucleotide repeat that codes for
a polyglutamine tract

Front 44

Biochemical studies have shown that the concentrations of the inhibitory neurotransmitter GABA, its biosynthetic enzyme glutamic acid decarboxylase (GAD), and acetylcholine and its biosynthetic enzyme choline acetyltransferase are all reduced in the basal ganglia of patients with this disease?

Back 44

Huntingtons

Front 45

what is action of drugs such as reserpine and tetrabenazine?

Back 45

reduce dopaminergic inhibition of striatal output neurons by depleting dopamine at a nerve terminals

Front 46

mutations in the gene localized in the region of chromosome 13q14–21 causes what disease?

Back 46

Wilsons

Front 47

"face of the giant panda" sign in
the midbrain and sometimes a "face of the miniature panda" in the pontine tegmentum?

Back 47

Wilsons disease

Front 48

what is treatment for Wilsons disease?

Back 48

Chelating agent penicillamine to remove copper from serum