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Movments D/O
Clinical Medicine II-Spring 2012
Question | Answer |
---|---|
How do we diagnose movement disorders | after r/o other causes such as drugs, lesions, systemic illnesses |
Overall tx of a movement d/o | symptomatic |
Three classifications of abnl movement | Impaired voluntary: paralysis, ataxia, impaired motor planning, abnl muscle tone: spasticity, rigidity, involuntary movements: tremor, chorea/athetosis/dystonia, tics/myoclonus |
Dance like movement uncontrolled | chorea |
Twisting, rotational involuntary movement | athetosis |
Myoclonic movement | falling asleep in class and jolting awake: nl, not nl is involuntary happening frequently |
Where is the parkinson’s belt | upper Midwest, most per capita is in ND |
Pathology of Parkinson’s | sustantia nigra: dopamine producing cells→by product is melonin linked to parkinson’s movements? |
With someone is having parkinson’s movements, what should we look for | skin cancer: melanoma |
Cause of parkinson’s | both environmental and possibly genetic, not set and stone pathology |
At dx, how much damage is happening | ~70 at start of of sxs, slow onset, hard to dx sometimes |
Core motor features of Parkinson’s | resting tremor, bradykinesia, rigidity, posture/balance changes |
Pt’s with simultaneous PD, dementia, and hallucinations | lewy body dz |
Sxs with rididity of trunk, falling, unable to look up/down | supranuclear palsy-no tremor |
How do we test for PD | can’t actually test for it, just r/o other causes, r/I by clinical sxs: give them a PD drug see if +result |
What is the tx for PD | no tx just treat the symptoms, MC levodopa (dopamine), or dopamine agonists, |
SE’s of levodopa | nausea, postural hypotension, dyskinesia, motor fluctuations |
As dz progresses, what happens to sxs | need more meds, cells die, need more dopamine, sxs: tremors/can’t move, take pills, control, dyskinesia,then can’t move again |
When do the motor complications of PD start | 3-10yrs post start of levodopa: dyskinesias |
What does deep brain stimulation do | high frequency pulsatile, to “ablate” the overactive nerves, targets the nucleus (subthalamic) |
When do we do the DBS to the brain | middle dz when drugs aren’t nearly as effective, but before in nursing home |
What are some sxs that will precede the motor sxs of parkinsons | REM, constipation, loss of smell |
Cause of death in pt’s w/ PD | pulmonary infx/aspiration, UTI, PE, complications w/ falls and fxs |
Classification of Essential tremor | Action or postural tremor or kinetic with tasks, can move to rest post action |
Two most common places to see E.T. | Hands and voice, usually bilaterally |
Secondary criteria for identifying E.T | long duration to dx, Fhx, beneficial response to EtOH |
What can a “neck tremor” be | contraction of sternocleidomastoid muscle: torticollis |
Cause of E.T and Dx | Genetic, Fhx, Dx: clinical hx, movement tremor, |
Tx for E.T. | none, life modifications, wrist weights, biofeedback, BB’s primidone, benzodiazepines, thalamic DBS |
Desire to move in association w/ paresthesias/dysethesias of the limbs | Restless legs syndrome |
Is jerking while sleeping at night RLS? | no it is most likely nocturnal myoclonus |
Two types of RLS | idiopathic, or secondary RLS d/t renal failure, DB neuropathy, RA, radiculopathy, preggo, iron def, |
Pathophysiology of RLS | CNS abnormality, dopamine dysfx, endogenous opiate system |
Why does iron deficiency cause RLS | iron a cofactor for dopamine production |
Tx RLS | tx underlying dz, remove potential aggravators, ↑sleep hygiene, relaxation techniques, Dopamine agonists 1st line drug |
Problem with shorter length drugs | Levodopa: sxs will start occurring more and more throughout the day |
When would we use opioids for RLS tx | usually only when there are other sxs with pain |
Neurologic movement d/o w/ sustained muscle contractions that cause twisting or repetitive movements w/abnl sometimes painful, postures or positions | Dystonia |
What is primary dystonia | only sign, no specific pathology, DYT1 mutation inheritation |
What is secondary dystonia | from drugs, w/ parkinsonism, psychogenic causes |
5 types of dystonia | focal, segmental, multifocal, generalized, hemidystonia |
MC types of focal dystonia | laryngeal dystonia |
Tx of dystonia | botox, inject while in a flexed position, just enough to relax/paralysis the muscle good for focal |
How do we dx dystonia | r/o other causes |
Dry eye syndrome or tics | blepharospasm |
Subtypes of dystonia | Blepharospasm, cervical dystonia, writer’s cramp |
What is a sign associated with problems in Upper motor neurons | Babinski sign + for spasticity |
What signs are associated w/ spasticity | muscle shortening, motor weakness, + Babinski, muscle overactivity |
Tx of spasticity | oral meds, muscle relaxants: careful d/t weakness in muscles can turn into jelly, PT, Denervation, intrathecal drug delivery, botox, |
What is poor coordination, examples? | ataxia, dysmetria of eye movements, nystagmus, dysarthria, limb dysmetria, gait ataxia |
Trouble forming words | dysarthria |
When does ataxia occur | anytime from many causes |
Workup of ataxia | look for underlying causes and treatable conditions, Brain MRI: detect cerebellar atropy and lesions |
DDx of Ataxia | toxins, paraneoplastic cerebellar syndrome, sporadic cerebellar degeneration or hereditary |
Tx of ataxia | supportive, assistive devices |
What diz has chorea or involuntary movements, later dystonia, and voluntary motor dyscontrol, cognitive, and emotional d/o | Huntinton’s disease |
Dx and patho of HD | gene test, autosomal dominant, attacks the caudate nucleus and putamen, and secondary atrophy in the brain |
When does HD set in | age 30-40, survival about 15-20yo |
Tx HD | none, tx sxs: antipsycotic or dopamine antagonists, therapy: PT, OT, speech, nutrition, social services |
What is the genetic testing for HD | repeated CAG (poly Q) in the HD gene, blood test |