PRESENTATION: Restlessness and intense urge to move
NOTES: Can be seen with neuroleptic use or in Parkinson disease. ------------------------------------------------------------------------- DISORDER: Asterixis PRESENTATION: Extension of wrists causes “flapping” motion NOTES: Associated with hepatic encephalopathy, Wilson disease, and other metabolic derangements. --------------------------------------------------------------------------------- DISORDER: Athetosis PRESENTATION: Slow, snake-like, writhing movements; especially seen in the fingers CHARACTERISTIC LESION: Basal ganglia ----------------------------------------------------------------------------------- DISORDER: Chorea PRESENTATION: Sudden, jerky, purposeless movements CHARACTERISTIC LESION: Basal ganglia NOTES: Chorea = dancing. Sydenham chorea seen in acute rheumatic fever. -------------------------------------------------------------------------------- DISORDER: Dystonia PRESENTATION: Sustained, involuntary muscle contractions NOTES: Writer’s cramp, blepharospasm, torticollis. ------------------------------------------------------------------------------ DISORDER: Essential tremor PRESENTATION: High-frequency tremor with sustained posture (eg, outstretched arms), worsened with movement or when anxious. NOTES: Often familial. Patients often self- medicate with alcohol, which decreases tremor amplitude. Treatment: nonselective β-blockers (eg, propranolol), primidone. DISORDER: Hemiballismus PRESENTATION: Sudden, wild flailing of 1 arm +/− ipsilateral leg CHARACTERISTIC LESION: Contralateral Subthalamic nucleus (eg, lacunar stroke). NOTES: Pronounce “Half-of-body ballistic.” Contralateral lesion. --------------------------------------------------------------------------------- DISORDER: Intention tremor PRESENTATION: Slow, zigzag motion when pointing/extending toward a target. CHARACTERISTIC LESION: Cerebellar dysfunction _________________________________________________________ DISORDER: Myoclonus PRESENTATION: Sudden, brief, uncontrolled muscle contraction NOTES: Jerks; hiccups; common in metabolic abnormalities such as renal and liver failure. ------------------------------------------------------------------------------------------------ DISORDER: Resting tremor PRESENTATION: Uncontrolled movement of distal appendages (most noticeable in hands); tremor alleviated by intentional movement CHARACTERISTIC LESION: Substantia nigra (Parkinson disease). NOTES: Occurs at rest; “pill-rolling tremor” of Parkinson disease. When you park your car, it is at rest.