Neuro shelf - movement disorders

progressive death of selevted neuronal populations, mostly ventral tier of neuromelatonin-containing dopaminergic neurons of the substantia nigra. Hallmark is Lewy body

supranuclear ophthalmoplegia, with limitation of vertical more than horizontal gaze, axial rigidity and neck extension, early falls due to impaired postural reflexes, neck extension, and inability to look down

apraxia, cortical sensory impairment and alien-limb phenomenon, severe unilateral rigidity, stimulus sensitive myoclonus

early dementia, prominent visual hallucinations, extreme sensitivity to extrapyramidal side effects of antidopaminergic neuroleptic drugs

"lower-half" parkinsonism with rigidity in the legs and marked gait impairment, other evidence of diffuse vascular disease (corticospinal tract dysfunction, pseudobulbar palsy)

early and prominent features of autonomic dysfunction, evidence of corticospinal tract dysfunction, cerebellar signs, stimulus-sensitive myoclonus, vocal cord paresis

beta blockers

• fluctuating and progressive muscle rigidity with spasms, may occur as an autoimmune of paraneoplastic process. begins with stiffness of the axial and trunk muscles with spread to proximal limb muscles over time.
• pts develop lumber hyperlordosis with restricted movements of the hip and spine that leads to the description of the gait as like that of tin man. paroxysmal painful painful muscles spasms proveoked by sudden movement or startle

May be antibodies against glutamic acid decarboxylase (GAD) Tx with benzos and baclofen

primidone and propanolol. maybe topiramate and gabapentin

haloperidol

• huntingtons
• neuro-acanthocytosis
• wilson disease
• neuroleptics
• antiparkinsonian medications
• alcohol
• anoxia
• carbon monoxide
• hyperthyroidism
• hyperglycemia and hypoglycemia
• hepatocerebral degeneration
• pregnancy
• SLE
• poststreptococcal (sydenham chorea)
• caudate infarction or hemorrhage

contralateral lesion in the caudate, putamen, or subthalamic nucleaus. possibly hyperglycemia

botulinum toxin

sudden lightning-like movement produced by abrupt and brief muscle contraction or inhibition

tx with clonazepam and valproate

copper chelation with D-penicillamine. remeber to screen family members

recurrent attacks of hyperkinesis with preserved consciousness

tx: carbamazepine