Updated: 2/20/2018

Movement Abnormalities

Topic
Review Topic
0
0
Questions
1
0
0
Snapshot
  • A 65-year-old man is brought to his primary care physician by his wife due to "abnormal movement." She states that her husband appears depressed and has a tremor that occurs at rest. She also reports that he "moves very slowly." The patient says that he has no current concerns. Past medical history includes hypertension, which is treated with hydrochlorothiazide. On physical exam, there is a right-sided 3-5 Hz resting "pill-rolling" tremor and cogwheel rigidity of the right upper extremity. On gait testing, the patient takes short steps and has a stooped posture. (Parkinson disease)
Introduction
  • Abnormal movements can result from impairment of the
    • upper and lower motor neurons
    • motor cortex
    • motor association cortex
    • cerebellum
    • basal ganglia
      • e.g., Wilson's disease

Movement Disorders
Type
Comments
Tremor
  • Essential tremor 
    • presentation
      • most commonly affects the hands or arms
        • typically bilateral
        • can cause functional impairment
      • the tremor worsens with stress and improves with
        • alcohol
        • β-blockers
      • often familial with an
        • autosomal dominant inheritance pattern
    • treatment
      • β-blockers (e.g., propranolol)
      • primidone
  • Physiologic tremor
    • presentation
      • affects all people but may become visible with
        • caffeine
        • beta-agonists
        • hypoglycemia
        • anxiety
        • excitement
        • alcohol and opioid withdrawal
        • thyrotoxicosis
    • treatment
      • dependent on etiology
        • e.g., decrease caffeine intake
  • Intention tremor
    • presentation
      • appendicular ataxia
        • when using their extremity towards a target there is
          • irregular and oscillating moevment
        • associated with cerebellar disorders
  • Resting tremor
    • presentation
      • tremor that occurs when the limbs are relaxed
        • can be best observed when distracting the patient
        • tremor improves when the patient moves their limbs
        • can be described as "pill rolling"
      • this is an important of Parkinson's disease
Dystonia
  • Presentation
    • sustained or slowed abnormal positions of the limb, trunk, or face
      • examples of dystonia include
        • torticollis
        • blepharospasm
        • spasmodic dysphonia
        • writer's cramp
  • Believed to be due to dysfunction of the
    • basal ganglia
  • Treatment
    • many cases have a good response to
      • botulinum toxin injection
Myoclonus
  • Presentation
    • rapid muscular jerk that can be due to multiple causes
      • seizure
        • e.g., juvenile myoclonic epilepsy
      • anoxi brain injury
      • encephalitis
      • toxic or metabolic encephalopathy
      • paraneoplastic syndromes
      • Creutzfeldt-Jakob disease
Chorea 
  • Presentation
    • dance-like involuntary movement
  • An important cause of chorea is
    • Huntingon's disease
Athetosis
  • Presentation
    • writhing and twisting movement
      • of the limbs, face, and trunk
      • that can merge with chorea to form
        • choreoathetosis
Ballismus 
  • Presentation
    • rotatory or flinging movement of the proximal limb muscles
  • The most common type of ballismus is
    • hemiballismus
      • contralateral extremity flinging movement secondary to
        • a lesion (e.g., lacunar stroke) to the subthalamic nucleus
Tics
  • Presentation
    • a sudden and brief movement that is preceded by
      • an urge that is then relieved after
        • the movement is performed
  • The types of tics include
    • motor tics
    • vocal tics
      • e.g., barking-like noises and coprolalia
  • An important syndrome to know is
    • Tourette's syndrome
 
 

Please rate topic.

Average 4.0 of 3 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Topic COMMENTS (2)
Private Note