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16 out of 18

In Parkinson's disease the deposit seen in the brain are? (LQ)

A Tau
B Alpha-synuclein

C Prion
D Beta amyloid

Ans. B


D. Hyperkinetic disorders (Ref. Hari-18th ed., pg- 3327)

Abnormal movement

Site of lesion

1). Chorea

2. Athetosis

3). Hemiballismus

4). Parkinsonism

Caudate nucleus and putamen (striatum)

Lentiform nucleus (Globus pallidus)

Subthalamic nucleus

Substantia nigra

1). Tremor

a. Resting tremor = Parkinson,

b. Intention tremor = cerebellar disease,

c. Positional tremor = hyperthyroidism,

d. Flapping tremors = Renal failure, Hepatic failure, Respiratory failure, Phenytoin toxicity, acute parietal lobe or thalamic lesion.

e. Benign essential tremor is characterized by a posture-related 5-9- Hz oscillation of the hands and forearms that impairs performance of fine motor tasks.

This type of tremor is often familial and may be accompanied by titubation ( Ref. Hariead tremor).

Consumption of alcohol may temporarily suppress the tremor; stress, caffeine, or sleep deprivation may exacerbate the condition.

β-Adrenergic blocking agents and primidone are effective treatments.

2). Chorea describes rapid, "dance-like" distal limb and facial movements.

Causes (Ref. Hari-18th ed., pg- 3330)

a. Hyperthyroidism,

b. Sydenham's chorea,

c. SLE,

d. Stroke,

e. Lyme disease,

f. Drugs (e.g., birth control pills and levodopa),

g. Pregnancy,

h. Antiphospholipid syndrome,

i. Porphyria,

j. Huntington's disease,

k. Neuroacanthocytosis.

3). Athetosis - Involuntary, slow, writhing, "snake-like" limb movements.


a. Wilson's disease,

b. Anoxic encephalopathy,

c. Huntington's disease,

d. Trauma,

e. Birth control pills

f. Several rare hereditary disorders.

4). Dystonia

a. Slow, writhing, sustained and involuntary contractions of the proximal limb, trunk, and neck musculature.

b. Dystonia is associated

i. Wilson's disease,

ii. trauma,

iii. drugs (e.g., neuroleptics, levodopa),

iv. Parkinson's disease,

v. neuronal storage disorders,

vi. Huntington's disease,

vii. encephalitis,

viii. other rare hereditary conditions.

Focal dystonias such as writer's cramp, blepharospasm, spastic dysphonia, and torticollis can occur. Treatment with local botulinum toxin infiltration can be beneficial.

Extra Edge: Movement disorders in Wilson disease.

1). Dystonia

2). Incoordination

3). Tremors.

5). Hemiballismus describes wild, flinging, principally proximal movements of the arms or legs. It is often caused by an infarct in the subthalamic nucleus. Haloperidol can decrease the involuntary movements.

6). Blepharospasm can occur in isolation or as part of a more widespread disorder such as Parkinson's disease, stroke, or Meige's syndrome (orofacial dystonia). Blepharospasm can be of such severity as to cause functional blindness.

7). Neuroleptic malignant syndrome (NMS) (Ref. Hari-18th ed., pg- 3333) is an idiosyncratic reaction to on starting neuroleptic agents. It can also occur in Parkinson's disease patients after the abrupt discontinuation of anti parkinsonian medications. Dopamine receptor blockade is thought to be the cause of NMS.

a. Clinical signs include altered mentation, high fever, rigidity, autonomic instability, high creatine kinase (CK) levels, and myoglobinuria.

b. Therapy for this potentially lethal condition includes hydration, cooling blankets, antipyretics, dantrolene, and levodopa/carbidopa preparations or bromocriptine, although the use of antiparkinsonian drugs is controversial.

8). Tardive dyskinesia is an almost constant writhing movement of the tongue and oromandibular area, which may be accompanied by blepharospasm, respiratory grunts, choreoathetosis, and truncal hyperactivity.

a. Tardive dyskinesia is usually an adverse side effect of long- term use of neuroleptic agents; occasionally other drugs such as amphetamines, antihistamines, and carbamazepine are .' causally implicated.

b. Clonazepam, reserpine, tetrabenazine, and other drugs have been used to treat tardive dyskinesia with variable success.

9). Spasmodic torticollis

Dystonia of neck movements. Head turns to one side for prolonged periods

10). Tics

a. Simple: Repeated stereotyped brief face and limb co-ordinate movements

b. Complex: Multiple often obscene (coprolalia) an rude gestures (Giles de la Tourette syndrome)

Neurology Flashcard List

18 flashcards