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Clerkship - Neuro - Movement Disorders (blueprints)


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4 Cardinal Features of Idiopathic Parkinsons
tremor, rigidity, bradykinesia, postural instability
5 Parkinsonian Syndromes
Progressive Supranuclear Palsy

Corticobasal Ganglionic Degeneration

Diffuse Lewy Body Disease

Vascular Parkinsonism

Multiple Systems Atrophy
Supranuclear opthalmoplegia, with limitation of vertical more than horizontal gaze; axial rigidity and neck extension early falls as a consequence of imparied postural reflexes, neck extension, and inability to look down
Progessive Supranuclear Palsy
Apraxia, cortical sensory impairment and alien-limb phenomenon; severe unilateral rigidity; stimulus-sensative myoclonus
Corticobasal Ganglionic Degeneration
Early dementia
Prominant visual hallucinations
Extreme sensativity to extrapyramidal side-effects of antidopaminergic neuroleptic drugs
Diffuse Lewy Body Disease
"Lower-half" parkinsonism with rigidity in legs and marked gait impairment; other evidence of diffuse vascular disease (corticospinal tract dysfunction, pseudobulbar palsy)
Vascular Parkinsonism
Early and prominent features of autonomic dysfunction
Evidence of corticospinal tract dysfunction
Cerebellar signs
Stimulus-sensative myoclonus
Vocal cord paresis
Multiple systems atrophy
The tremor in Idiopathic Parkinsons is fast/slow?
and more prominant when limb is at rest/in motion?

worst when limb is at rest
Dementia or delerium is seen in Parkinsons?
Dementia in 1/3 of pts
What is the name of L-Dopa + Carbidopa?
Sinemet. Carbidopa inhibits peripheral decarboxylase (preventing dopamine formation outside the CNS)
What is selegeline?
monoamine oxidase B inhibitor
Muscular rigidity, fever, autonomic lability, altered level of consciousness, elevated creatine kinase level, leukocytosis
Neuroleptic Malignant Syndrome (NMS) <-- drugs with dopamine receptor-blocking activity
Neuroleptic Malignant Syndrome (NMS)
Muscular rigidity, fever, autonomic lability, altered level of consciousness, elevated creatine kinase level, leukocytosis <-- drugs with dopamine receptor-blocking activity (neuroleptics)
What is Akathisia?
an dysphoric state characterized by the subjective desire to be in constant motion <-- drugs with dopamine receptor-blocking activity

Anticholinergics and Beta blockers can be used to treat this
symptoms of Tardive Dyskinesia
Orolinguomasticatory dyskenisia <-- drugs with dopamine receptor-blocking activity (neuroleptics)

Sx: chewing movements, lip smacking, rolling of the tongue inside the cheek.

Tx: discontinue affecting agent. Dopamine depleting agents (reserpine, tetrabenzine) may help
Name 2 anticholinergics for Parkinsons Tx

Benztropin (Michael J Fox driving a Benz)

Side Effects: Dry mouth, constipation, urinary retention, confusion, hallucination, narrow-angle glaucoma
Name an NMDA antagonist for Parkinsons Tx
Name 4 Dopamine agonists for Parkinsons Tx




Side effects: Nausea, orthostatic hypotension, psychosis, hallucinations, dyskinesia (Same as Levodopa/Carbidopa)
Name 2 COMT inhibitors for Parkinsons Tx


similar side effects to levodopa/carbidopa and dopamine agonists.
Nausea, orthostatic hypotension, confusion, dyskinesia
Mechanism of levodopa/carbidopa
Dopamine precursor/dopa decarboxylase inhibitor

Side effects: anorexia, nausea, psychosis, hallucinations, orthostatic hypotension, dyskinesia
chonic axial muscle rigidity and stiffness and painful muscle spasms
Stiff-person syndrome
What antibody is associated with Stiff-person syndrome?
Anti-GAD antibodies

"chonic axial muscle rigidity and stiffness and painful muscle spasms"
Causes of resting tremor
Parkinson's Disease

Parkinsonian Syndromes
Causes of postural tremor
(emerges during sustained maintenance of posture)

Essential Tremor
Physiologic tremor
Drugs (eg. theophylline, beta-agonists)
Causes of action tremor
Cerebellum and cerebellar outflow tract dysfunction (e.g. infarction, multiple sclerosis, tumor, Wilson's disease, drugs)
what is intention tremor?
a tremor that increases as the target is approached

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