Term
| What system in the brain is responsible for most movement d/o? |
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Definition
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Term
| Dopamine depletion results in ____ and dopamine excess results in _____. |
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Definition
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Term
| Rhythmic oscillatory movement. |
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Definition
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Term
| Do tremors occur during sleep? |
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Definition
| No, disappear during sleep. |
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Term
| A visible tremor exhibited by alcoholics. |
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Definition
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Term
| A visible tremor exhibited by alcoholics. |
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Definition
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Term
| An action tremor associated with catecholamine excess. |
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Definition
| Enhanced Physiologic Tremor |
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Term
| Other than drugs, name 4 factors associated with enhanced physiologic tremors. |
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Definition
| 1)Anxiety/fear 2)Thyrotoxicosis 3)Hypoglycemia 4)Etoh withdrawal |
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Term
| Name 8 meds that have enhanced physiologic tremors as a SE. |
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Definition
| 1)Epinephrine 2)Caffeine 3)Theophylline 4)Amphetamines 5)Levodopa 6)Tricyclic AD 7)Lithium 8)Corticosteroids |
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Term
| A tremor occuring in normal individuals that may be transient and occur w/ excessive physical exertion, fatigue, excitement, and hunger. |
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Definition
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Term
| A coarse tremor of a muscle group. |
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Definition
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Term
| What conditions result in flapping tremors? |
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Definition
| Hepatic encephalopathy/coma |
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Term
| A tremor that occurs when voluntary motion is attempted. |
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Definition
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Term
| A tremor present when the involved part is at rest but absent or diminished when active movements are attempted. |
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Definition
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Term
| A rest tremor that is suppresed briefly during voluntary activity. |
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Definition
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Term
| Name 3 causes of intention tremors. |
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Definition
| 1)Brainstem/cerebellar dz 2)Drug toxicity (etoh, sedatives, anticonvulsants) 3)Wilson dz |
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Term
| Name 3 causes of rest tremors. |
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Definition
| 1)Parkinsonism 2)Wilson dz 3)Heavy metal poisoning |
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Term
| What is the MC movement d/o? |
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Definition
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Term
| What body parts does essential tremor usually affect? |
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Definition
| Head, chin, outstretched hands, and occasionally the voice |
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Term
| Is essential tremor considered a pathology? |
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Definition
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Term
| Essential tremors are characterized by a slowly progressive ____ and/or kinetic tremor. |
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Definition
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Term
| Prevalence of essential tremors increases with what? |
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Definition
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Term
| Are parkinsonism or essential tremors worsened by anxiety or action? |
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Definition
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Term
| Is there usually a family hx of tremor in essential or parkinsonism tremor? |
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Definition
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Term
| Meds are effective at tx essential or parkinsonism tremors? |
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Definition
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Term
| Are Parkinson tremors rest or action tremors? Essential? |
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Definition
| Parkinson - rest. Essential - active. |
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Term
| What other sx occur w/ essential tremor? |
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Definition
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Term
| What does a postural characteristic of a tremor mean? |
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Definition
| Occurs w/ voluntary maintenance of a position a/g gravity |
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Term
| What does a kinetic characteristic of a tremor mean? |
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Definition
| Occurs during voluntary movement |
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Term
| Do pts w/ essential tremors typically have abn in gait and balance? Abn in tone and reflexes? |
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Definition
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Term
| Name 4 causes of metabolic tremors. |
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Definition
| 1)Hyperthyroidism 2)B12 def. 3)Kidney dz 4)Liver dz |
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Term
| What meds are used for maintenance tx in essential tremors and have been shown to reduce tremors in 75% of pts? |
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Definition
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Term
| What is the surgical tx of choice for essential tremor? |
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Definition
| Deep brain stimulation (permanent electrode placement in thalamus) |
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Term
| What is the surgical tx of choice for severe tremor and when deep brain stimulation is not appropriate? |
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Definition
| Thalamotomy (elec. current destroys part of thalamus) |
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Term
| What is the most common neurologic d/o? |
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Definition
|
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Term
| Name 3 cardinal s/sx of Parkinson's dz. |
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Definition
| 1)Rigidity 2)Bradykinesia 3)Resting tremor |
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Term
| What are 4 environmental RF for Parkinson's dz? |
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Definition
| 1)Pesticides/herbicides 2)Rural 3)Well water 4)Industrial plants/quarries |
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Term
| Pathiphysiology of Parkinson's dz includes loss of dopaminergic neurons in the _____ and the presence of ____. |
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Definition
| Substantia nigra. Lewy bodies. |
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Term
| A common onset of PD is a resting tremor that starts asymmetrically or symetrically in UE? |
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Definition
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Term
| What is the 4th cardinal sign of PD that emerges later in the dz, usu. /p 8yrs? |
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Definition
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Term
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Definition
|
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Term
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Definition
| Rigidity - resistance to passive movement, a cardinal sx of PD |
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Term
| Describe the resting tremor seen in PD. |
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Definition
| "pill-rolling" motion of hand, 3-5 cycles/sec. |
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Term
| Describe the posture and turning of a pt w/ PD. |
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Definition
| Posture is stooped forward and turning is en bloc like a statue |
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Term
| Describe the facial expression of a pt w/ PD. |
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Definition
| Decreased facial expression - "masklike" |
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Term
| What is the symptomatic med. for PD? How long do meds help? |
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Definition
| Levodopa + peripheral decarboxylase inhibitor (carbidopa). 4-6yrs. |
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Term
| What meds are used to tx the resting tremor of PD? |
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Definition
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Term
| An incurable, adult-onset, autosomal dominant d/o assoc. w/ cell loss w/i the basal ganglia and cortex. |
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Definition
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Term
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Definition
| Huntington or hereditary chorea |
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Term
| What is the mean age of onset of HD? How long do pts typ. survive /p dx? |
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Definition
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Term
| The pathophysiology of HD is a gross atrophy of the what accompanied by neuronal loss? |
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Definition
| Caudate nucleus and putamen |
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Term
| What is the genetic basis for HD? |
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Definition
| CAG repeat encoding of huntingtin by chromosome 4 |
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Term
| Describe the movement d/o experienced by pts w/ HD. |
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Definition
| Chorea - intial fidgeting later replaced by Parkinsonism features |
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Term
| Describe the early cognitive dysfunction experienced by pts w/ HD. |
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Definition
| Dementia w/ behavioral changes (irritability, loss of interest, untidy), and short term memory loss |
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Term
| Describe the later cognitive dysfunction experienced by pts w/ HD. |
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Definition
| Diminished speech, attention deficit, loss of executive fxn, visuospatial processing, and abstract reasoning. |
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Term
| Describe the behavioral dysfunction experienced by pts w/ HD. (6) |
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Definition
| Depression, bipolar, suicide, psychosis, OCD, and sexual/sleep problems. |
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Term
| Measurement of the _________ by CT or MRI is a reliable marker of HD progression. |
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Definition
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Term
| What meds are used to tx HD pts w/ chorea that is interfering w/ function? |
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Definition
| Benzos (clonazepam or diazepam) or valproic acid (depakote) |
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Term
| What is the first line med to tx depression in HD? |
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Definition
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Term
| What meds are used to tx bradykinesia or rigidity from HD? |
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Definition
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Term
| What meds are used to tx HD pts w/ schizophrenia-like sx such as hallucinations or delusions? |
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Definition
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Term
| A neurodegenerative dz of copper metabolism in which the body is unable to export copper from the liver into bile and incorporate it into hepatic cerulopasm? |
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Definition
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Term
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Definition
|
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Term
| Describe the etiology of Wilson's dz. |
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Definition
| Autosomal recessive - mutation/deletion of ATP7B protein encoded by chromosome 13 |
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Term
| What is the most common initial manifestation of Wilson's dz in children? Older pts? |
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Definition
| Liver dz. Neuropsychiatric sx. |
|
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Term
| What is the ophthalmic finding of Wilson's dz? |
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Definition
| Kayser-Fleisher rings (green-yellow rings at limbus of cornea) |
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Term
| What are the neurologic sx of Wilson's dz? |
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Definition
|
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Term
| What are the psychiatric signs of Wilson's dz? (4) |
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Definition
| Personality change, irritability, schizo-like, and depression |
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Term
| What are 3 skeletal abnormalities of Wilson's dz? |
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Definition
| Osteoporosis, OA, and joint hypermobility |
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Term
| Name 2 lab values used for dx of Wilson dz. |
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Definition
| Low ceruloplasm and high urinary copper |
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Term
| Name 4 imaging studies to help dx Wilson's dz? |
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Definition
| 1)X-ray or DEXA 2)CT of head 3)MRI of head 4)Liver bx |
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Term
| What is the drug therapy for Wilson's dz? What is used for children and pregnant women? |
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Definition
| Chelating agent. Zn acetate. |
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|
Term
| What is the dietary rec. for a pt w/ Wilson's dz? |
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Definition
| Low copper (high copper foods: shellfish, liver, mushrooms, broccoli, chocolate, nuts) |
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Term
| What is the tx for a pt w/ fulminant liver dz from Wilson's dz? |
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Definition
| Plasma exchange and/or dialysis w/ alb + penicillamine |
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Term
| When is a liver transplant indicated for a pt w/ Wilson's dz? |
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Definition
| Acute hepatic insufficiency or no response to med. tx |
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|
Term
| A common term for various conditions of head and neck dystonia. |
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Definition
|
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Term
| What are other names for torticollis? |
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Definition
| Cervical dystonia or wry neck |
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Term
| What is the most common etiology of torticollis comprising ~80-90% of cases? |
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Definition
| Idiopathic/environmental toxins |
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Term
| What is the 2nd most common etiology of torticollis, comprising ~10-20% of cases? |
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Definition
|
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Term
| Which gender is torticollis more common? Typical age of onset? |
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Definition
|
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Term
| Describe the onset of sx of idiopathic torticollis. |
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Definition
| Slowly progressive flexion w/ inc. tone of cervical muscle |
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|
Term
| What makes sx better/worse in idiopathic torticollis? |
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Definition
| Worse w/ activity. Better in morning. |
|
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Term
| What additional sx may be present in a pt w/ idiopathic torticollis? |
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Definition
|
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Term
| Describe the onset of sx in traumatic torticollis. |
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Definition
| Local pain immediately /p trauma followed w/i days by marked limitation of ROM in neck, abn head posture, and eventually hypertrophy of trapezius. |
|
|
Term
| What is the med. for torticollis? |
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Definition
|
|
Term
| An autosomal dominant d/o that causes involuntary motor and vocal "tics". |
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Definition
|
|
Term
| What age does Tourettes become most severe? |
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Definition
|
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Term
| Name 4 factors that may influence the dev. of Tourettes. |
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Definition
| 1) Strep infection 2)Mg deficiency 3)LBW 4)Maternal life stress during pregnancy |
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|
Term
| What are the 2 types of tics? |
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Definition
|
|
Term
| One of the diagnostic criteria for Tourettes is that the onset is before what age? |
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Definition
|
|
Term
| An abnormal tremor consisting of involuntary jerking movements. |
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Definition
|
|
Term
| A defective muscular coordination especially manifested when voluntary muscular movements are attempted. |
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Definition
|
|
Term
|
Definition
| Motor, sensory, and alcoholism ataxia |
|
|
Term
| A condition in which slow, irregular, twisting, snakelike movements occur in the UE, esp. hands and fingers. |
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Definition
|
|
Term
| A neurologic condition marked by involuntary muscle twisting of the limbs or facial muscle. |
|
Definition
|
|
Term
| Usually occurs during pregnancy or childhood, char. by involuntary contraction of muscles of the trunk and extremeties, impairment of memory/speech. |
|
Definition
| Sydenham's or acute chorea |
|
|
Term
| Chronic progressive chorea, inherited dz of the CNS w/ onset b/t 30-50yo. |
|
Definition
| Hereditary of Huntington's chorea |
|
|
Term
| An impaired ir disordered tonicity, esp. of muscle tone. |
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Definition
|
|
Term
| A defect in voluntary movement. |
|
Definition
|
|
Term
| A condition of slow, rhythmical, automatic, sterotyped movements, either generalized or in single muscle groups. |
|
Definition
|
|
Term
| Spasmodic muscle contraction most commonly affecting the face, head, neck, or shoulder muscles. |
|
Definition
|
|
Term
| Spasmodic torticolis in which the head and neck is forcibly rotated or turned from one side to another. |
|
Definition
|
|
Term
| A degenerative d/o or pressure on the trigeminal nerve, resulting in neuralgia. |
|
Definition
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