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Athetosis

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101. Multiple Sclerosis (Treatment)

(medial rectus); upper eyelid elevation; and pupillary constriction. [ ] In rare cases, these lesions may be highly selective and may cause weakness of a single muscle, which can lead to diagnostic confusion. The oculomotor nerve runs in close proximity to numerous midbrain structures; therefore, features of a third nerve palsy can be associated with other neurological deficits, including contralateral hemiparesis (Weber syndrome), contralateral tremors (or chorea, athetosis) (Benedict syndrome

2014 eMedicine.com

102. Neurological History and Physical Examination (Follow-up)

with gravity eliminated 3 Movement against gravity 4 Movement against partial resistance 5 Full strength Involuntary movements Involuntary movements include fibrillations, fasciculations, asterixis, tics, myoclonus, dystonias, chorea, athetosis, hemiballismus, and seizures. Fibrillations are not visible to the naked eye except possibly those in the tongue. Fasciculations may be seen under the skin as quivering of the muscle. Although fasciculations are typically benign (particularly when they occur (...) dysphonia, and writer's cramp. In athetosis, the spasms have a slow writhing character and occur along the long axis of the limbs or the body itself; the patient may assume different and often peculiar postures. The term chorea means dance. Quasi-purposeful movements affect multiple joints with a distal preponderance. Hemiballismus is a violent flinging movement of half of the body. It is associated with lesions of the subthalamic nucleus (ie, body of Louis). Seizures may result in orofacial

2014 eMedicine.com

103. Multiple Sclerosis (Follow-up)

(medial rectus); upper eyelid elevation; and pupillary constriction. [ ] In rare cases, these lesions may be highly selective and may cause weakness of a single muscle, which can lead to diagnostic confusion. The oculomotor nerve runs in close proximity to numerous midbrain structures; therefore, features of a third nerve palsy can be associated with other neurological deficits, including contralateral hemiparesis (Weber syndrome), contralateral tremors (or chorea, athetosis) (Benedict syndrome

2014 eMedicine.com

104. Surgical Treatment of Parkinson Disease (Follow-up)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

105. Surgical Treatment of Tremor (Follow-up)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

106. Tardive Dyskinesia (Follow-up)

movements Voluntary Involuntary Pathologic movements Paralysis, paresis, hyperreflexia, and spasticity Akathisia, athetosis, ballismus, chorea, dystonia, myoclonus, stereotypy, tic, and tremor Classic disorders of the extrapyramidal system include a variety of involuntary movement disorders. Some of these movement disorders include dyskinesias such as akathisia, chorea, dystonia, myoclonus, stereotypy, tic, and tremor. The pathophysiology of extrapyramidal disorders has been disputed on the grounds

2014 eMedicine.com

107. Chorea in Adults (Follow-up)

, recessively inherited choreo-athetosis of early onset. J Med Genet . 1969 Dec. 6(4):408-10. . Fisher M, Sargent J, Drachman D. Familial inverted choreoathetosis. Neurology . 1979 Dec. 29(12):1627-31. . Wheeler PG, Dobyns WB, Plager DA, Ellis FD. Familial remitting chorea, nystagmus, and cataracts. Am J Med Genet . 1993 Dec 1. 47(8):1215-7. . Evans BK, Jankovic J. Tuberous sclerosis and chorea. Ann Neurol . 1983 Jan. 13(1):106-7. . Ross CA, Margolis RL, Rosenblatt A, et al. Huntington disease

2014 eMedicine.com

108. Chorea in Children (Follow-up)

" Neoplastic See the list below: Primary and metastatic brain tumors Primary CNS lymphoma Nutritional See the list below: Vitamin B-12 deficiency in infants Toxins See the list below: Carbon monoxide Manganese Organophosphate poisoning Previous Next: Pathophysiology and General Principles in Treatment of Chorea Movement disorders (particularly chorea, athetosis, and dystonia) are thought to result from basal ganglia pathology. Connections of the basal ganglia can be categorized as follows: Input from (...) motor development, dysarthria, intention tremor, athetosis, and hypotonia. Severity is highly variable but choreic movements are typically continuous and not episodic. Intellectual function is typically normal. Intellectual impairment has been reported in one family in which affected individuals had intelligence quotient scores averaging 10 points lower than unaffected relatives. Functional neuroimaging showed decreased striatal FDG metabolism in one study. Routine imaging and EEG results are normal

2014 eMedicine.com

109. Cerebral Palsy (Follow-up)

(AFO) in foot drop to prevent tripping over the toes in a patient with inadequate dorsiflexion. [ , ] If a patient has impaired mobility, a wheelchair and/or mobility aids such as a cane or walker may help. Seating adaptations should be included with a manual wheelchair to keep the back straight and protect the hips from excessive adduction or abduction. A power wheelchair may be needed for children with severe spasticity or athetosis; this device can be introduced to children who have the ability (...) augmentative communication devices if they have some motor control and adequate cognitive skills. Patients with athetoid cerebral palsy may benefit the most from speech therapy, because most of these individuals have normal intelligence, and communication is an obstacle that is secondary to the effect of athetosis on speech. Adequate communication is probably the most important goal for enhancing function in a patient with athetoid cerebral palsy. Many children with cerebral palsy have feeding difficulties

2014 eMedicine.com

110. Cerebral Palsy (Follow-up)

: Management of Abnormal Movements Numerous medications, although often used off label for age and indication, may relieve the movement difficulties associated with cerebral palsy. These drugs target spasticity, dystonia, myoclonus, chorea, and athetosis. For example, baclofen, administered either orally or intrathecally, is often used for treating spasticity in these patients. Botulinum toxin with or without casting AbobotulinumtoxinA (Dysport) is the first botulinum toxin to gain FDA approval (...) , and barbiturates) have been useful in the management of myoclonus. Chorea and athetosis are often difficult to manage, although benzodiazepines, neuroleptics, and antiparkinsonian drugs (eg, levodopa) have been tried. Benzodiazepines and baclofen are commonly used to manage spasticity. Management by spasticity type A multidisciplinary panel conducted a systematic evaluation of published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. [ ] The panel

2014 eMedicine.com

111. Childhood Habit Behaviors and Stereotypic Movement Disorder (Overview)

deprivation Factitious disorder with predominately physical signs and symptoms Mannerisms Myoclonus Neglect Neurologically based movement disorder (eg, chorea, dystonic movements, athetosis, myoclonus, hemiballismus, or spasms) Pain Poisoning (eg, with amphetamine or cocaine) Seizure disorder Self-mutilation associated with certain psychotic disorders and personality disorders Self-stimulatory behaviors in individuals with hearing impairment or other sensory deficits Consultation with a developmental

2014 eMedicine Pediatrics

112. Methemoglobinemia (Diagnosis)

, microcephaly, hypertonia, athetosis, opisthotonos, strabismus, mental retardation, and growth retardation; cyanosis is evident at an early age. Type III – Although the entire hematopoietic system (platelets, RBCs, and white blood cells [WBCs]) is involved, the only clinical consequence is cyanosis. Type IV – As in type I, involvement is limited to the erythrocytes. This type results in chronic cyanosis Deficiency of NADPH-flavin reductase can also cause methemoglobinemia. Acquired methemoglobinemia

2014 eMedicine Pediatrics

113. Hemolytic Disease of Newborn (Treatment)

progresses to opisthotonus. Phase 3 is characterized by high-pitched cry, hearing and visual abnormalities, poor feeding, and athetosis. Long-term sequelae include choreoathetoid CP, upward gaze palsy, sensorineural hearing loss, dental enamel hypoplasia of the deciduous teeth, and, less often, mental retardation. The abnormal or reduced auditory brainstem response of wave I (auditory nerve) and wave II and V (auditory brainstem nuclei), depicted as decreased amplitudes, and increased interval I-III

2014 eMedicine Pediatrics

114. Methemoglobinemia (Overview)

, microcephaly, hypertonia, athetosis, opisthotonos, strabismus, mental retardation, and growth retardation; cyanosis is evident at an early age. Type III – Although the entire hematopoietic system (platelets, RBCs, and white blood cells [WBCs]) is involved, the only clinical consequence is cyanosis. Type IV – As in type I, involvement is limited to the erythrocytes. This type results in chronic cyanosis Deficiency of NADPH-flavin reductase can also cause methemoglobinemia. Acquired methemoglobinemia

2014 eMedicine Pediatrics

115. Methemoglobinemia (Overview)

, microcephaly, hypertonia, athetosis, opisthotonos, strabismus, mental retardation, and growth retardation; cyanosis is evident at an early age. Type III – Although the entire hematopoietic system (platelets, RBCs, and white blood cells [WBCs]) is involved, the only clinical consequence is cyanosis. Type IV – As in type I, involvement is limited to the erythrocytes. This type results in chronic cyanosis Deficiency of NADPH-flavin reductase can also cause methemoglobinemia. Acquired methemoglobinemia

2014 eMedicine Emergency Medicine

116. Neurological History and Physical Examination (Diagnosis)

with gravity eliminated 3 Movement against gravity 4 Movement against partial resistance 5 Full strength Involuntary movements Involuntary movements include fibrillations, fasciculations, asterixis, tics, myoclonus, dystonias, chorea, athetosis, hemiballismus, and seizures. Fibrillations are not visible to the naked eye except possibly those in the tongue. Fasciculations may be seen under the skin as quivering of the muscle. Although fasciculations are typically benign (particularly when they occur (...) dysphonia, and writer's cramp. In athetosis, the spasms have a slow writhing character and occur along the long axis of the limbs or the body itself; the patient may assume different and often peculiar postures. The term chorea means dance. Quasi-purposeful movements affect multiple joints with a distal preponderance. Hemiballismus is a violent flinging movement of half of the body. It is associated with lesions of the subthalamic nucleus (ie, body of Louis). Seizures may result in orofacial

2014 eMedicine.com

117. Tardive Dyskinesia (Diagnosis)

movements Voluntary Involuntary Pathologic movements Paralysis, paresis, hyperreflexia, and spasticity Akathisia, athetosis, ballismus, chorea, dystonia, myoclonus, stereotypy, tic, and tremor Classic disorders of the extrapyramidal system include a variety of involuntary movement disorders. Some of these movement disorders include dyskinesias such as akathisia, chorea, dystonia, myoclonus, stereotypy, tic, and tremor. The pathophysiology of extrapyramidal disorders has been disputed on the grounds

2014 eMedicine.com

118. Hemolytic Disease of Newborn (Follow-up)

progresses to opisthotonus. Phase 3 is characterized by high-pitched cry, hearing and visual abnormalities, poor feeding, and athetosis. Long-term sequelae include choreoathetoid CP, upward gaze palsy, sensorineural hearing loss, dental enamel hypoplasia of the deciduous teeth, and, less often, mental retardation. The abnormal or reduced auditory brainstem response of wave I (auditory nerve) and wave II and V (auditory brainstem nuclei), depicted as decreased amplitudes, and increased interval I-III

2014 eMedicine Pediatrics

119. Methemoglobinemia (Diagnosis)

, microcephaly, hypertonia, athetosis, opisthotonos, strabismus, mental retardation, and growth retardation; cyanosis is evident at an early age. Type III – Although the entire hematopoietic system (platelets, RBCs, and white blood cells [WBCs]) is involved, the only clinical consequence is cyanosis. Type IV – As in type I, involvement is limited to the erythrocytes. This type results in chronic cyanosis Deficiency of NADPH-flavin reductase can also cause methemoglobinemia. Acquired methemoglobinemia

2014 eMedicine Emergency Medicine

120. Effectiveness of adaptive seating on sitting posture and postural control in children with cerebral palsy

co-interventions were excluded. Adaptive seating included saddle position, positional angle changes of the seat and/or backrest inclinations, seat inserts, external supports and modular seating systems. Participant ages ranged from 12 months to 20.8 years. Distribution of motor impairments included diplegia, triplegia and tetraplegia/quadriplegia. Most studies included participants with spasticity; other participants had dystonia or athetosis. Severity of motor impairment ranged from mild

2008 DARE.

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