MOVEMENT DISORDERS & STROKE

Introduction to Movement Disorders

Movement disorders are neurological conditions characterized by either excessive movements (hyperkinetic) or reduced movements (hypokinetic). They arise primarily due to dysfunction of the basal ganglia and its connections.

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Classification of Movement Disorders

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Hypokinetic

• Parkinson disease

• Parkinson-plus syndromes

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Hyperkinetic

• Tremor

• Chorea

• Dystonia

• Myoclonus

• Tics

Tremor

Tremor is a rhythmic, oscillatory movement of a body part.

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Types of Tremor

Resting Tremor

• Occurs at rest

• Decreases with action

• Seen in Parkinson disease

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Action Tremor

Occurs during voluntary movement and includes:

• Postural tremor

• Intention tremor

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Essential Tremor

• Most common movement disorder

• Action tremor

• Improves with alcohol

• Family history common

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Intention Tremor

• Worsens as target is approached

• Seen in cerebellar disease

Chorea and Athetosis

Chorea

• Irregular, purposeless movements

• Flows from one muscle to another

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Causes:

• Huntington disease

• Sydenham chorea

• Drug-induced

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Athetosis

• Slow, writhing movements

• Often associated with chorea

Dystonia

Dystonia is characterized by sustained muscle contractions causing abnormal postures.

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Types

• Focal (writer’s cramp)

• Segmental

• Generalized

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Clinical Features

• Twisting movements

• Painful postures

• Task-specific dystonia common

Myoclonus

Myoclonus consists of sudden, brief, shock-like movements.

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Causes

• Metabolic encephalopathy

• Epilepsy

• Post-hypoxic states

Parkinson Disease

Parkinson disease is a progressive neurodegenerative disorder characterized by degeneration of dopaminergic neurons in the substantia nigra.

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Cardinal Features

1. Bradykinesia

2. Rigidity

3. Resting tremor

4. Postural instability

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Clinical Features

• Mask-like face

• Shuffling gait

• Festination

• Reduced arm swing

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Non-Motor Symptoms

• Autonomic dysfunction

• Depression

• Sleep disorders

• Cognitive impairment

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Hoehn and Yahr Staging

• Stage I: unilateral

• Stage V: wheelchair-bound

Parkinson-Plus Syndromes

These conditions mimic Parkinson disease but have poor response to levodopa.

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Multiple System Atrophy (MSA)

• Parkinsonism + autonomic failure

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Progressive Supranuclear Palsy (PSP)

• Early falls

• Vertical gaze palsy

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Corticobasal Degeneration (CBD)

• Asymmetric rigidity

• Apraxia

• Alien limb phenomenon

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Dementia with Lewy Bodies (DLB)

• Parkinsonism

• Early dementia

• Visual hallucinations

Introduction to Stroke

Stroke is defined as a sudden onset neurological deficit of vascular origin.

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Types of Stroke

• Ischemic (≈80%)

• Hemorrhagic (≈20%)

Transient Ischemic Attack (TIA)

TIA is a transient neurological deficit without permanent infarction.

• Duration: <24 hours (modern definition: no infarct)

• High risk of future stroke

Risk Factors for Stroke

Modifiable

• Hypertension

• Diabetes

• Smoking

• Dyslipidemia

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Non-modifiable

• Age

• Sex

• Genetics

Clinical Features of Stroke

Cortical Stroke

• Aphasia

• Neglect

• Visual field defects

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Subcortical Stroke

• Pure motor stroke

• Pure sensory stroke

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Brainstem Stroke

• Cranial nerve involvement

• Crossed findings

Vascular Territories

Anterior Cerebral Artery (ACA)

• Contralateral leg weakness

• Behavioral changes

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Middle Cerebral Artery (MCA)

• Face and arm weakness

• Aphasia (dominant side)

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Posterior Cerebral Artery (PCA)

• Visual field defects

• Memory impairment

Brainstem Stroke Syndromes

• Weber syndrome

• Claude syndrome

• Wallenberg syndrome

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Characterized by crossed motor and sensory deficits.

Approach to a Patient with Stroke

• Identify stroke type

• Localize vascular territory

• Assess severity

• Initiate urgent management