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Movement Disorders Associated with General Medical Diseases
CHAPTER
Movement Disorders Associated With General Medical Diseases
59
CHADWICK W. CHRISTINE ■ MICHAEL J. AMINOFF
TREMOR Stroke Medications Toxins and Recreational Agents Metabolic Disorders Infections Immune Disorders Other Causes of Tremor Approach to Diagnosis Treatment
CHOREA AND DYSTONIA Hypoxic-Ischemic Disorders Toxins Drug-Induced Dystonia and Chorea Infectious Disorders Bacterial Infections Viral Infections Fungal and Parasitic Infections Autoimmune, Inflammatory, and Paraneoplastic Disorders Metabolic Disorders Approach to Diagnosis Treatment MYOCLONUS Hypoxia-Ischemia Metabolic Disorders Autoimmune and Inflammatory Disorders Drug- and Toxin-Induced Myoclonus Paraneoplastic Disorders Infections Injury by Physical Agents Approach to Diagnosis Treatment
PARKINSONISM Vascular Causes Medications and Bone Marrow Transplantation Toxins Metabolic Disorders Infections Autoimmune and Paraneoplastic Disorders Trauma Other Causes of Parkinsonism Approach to Diagnosis Treatment
CHOREA AND DYSTONIA Dystonia or chorea occurs in a wide variety of medical disorders. Although chorea is typically a more fluid, “dance-like” undulation of a limb, and dystonia is a slower movement or a sustained abnormal posture of a limb or the trunk, it is sometimes difficult to distinguish between them. Approximately 25 percent of dystonias and most choreas are symptomatic or secondary to a neurodegenerative disorder, hereditary metabolic defect, or systemic medical disorder. Responsible neurodegenerative or inherited metabolic disorders are reviewed elsewhere.1,2 In a series of 51 cases of chorea from Italy, vascular causes were identified in 40 percent, drug-induced causes in 14 percent, acquired immunodeficiency syndrome (AIDS)–related causes in 10 percent, Huntington’s disease in 10 percent, hyperglycemia in 4 per-
cent, and hyponatremia in 4 percent; single cas (2 percent each) of borreliosis (Lyme disease), Syde ham’s chorea, and acanthocytosis were also identified The epidemiology will differ in regions where AIDS other infectious conditions are more prevalent. Chor is usually associated with dysfunction of the thalamus basal ganglia. In most cases, the physiological effect the disorder reduces inhibitory input from the glob pallidus interna to the motor thalamus, resulting excessive thalamocortical motor facilitation.2 Dystonia is characterized by impaired inhibition multiple levels of the central nervous system, and alter levels of several neurotransmitters have been report in various diencephalic nuclei, as well as the putame globus pallidus, red nucleus, and subthalamic nucleu Nonetheless, the generation of dystonia remains poo understood.4
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Movement Disorders Associated With General Medical Diseases
59
CHADWICK W. CHRISTINE ■ MICHAEL J. AMINOFF
TREMOR Stroke Medications Toxins and Recreational Agents Metabolic Disorders Infections Immune Disorders Other Causes of Tremor Approach to Diagnosis Treatment
CHOREA AND DYSTONIA Hypoxic-Ischemic Disorders Toxins Drug-Induced Dystonia and Chorea Infectious Disorders Bacterial Infections Viral Infections Fungal and Parasitic Infections Autoimmune, Inflammatory, and Paraneoplastic Disorders Metabolic Disorders Approach to Diagnosis Treatment MYOCLONUS Hypoxia-Ischemia Metabolic Disorders Autoimmune and Inflammatory Disorders Drug- and Toxin-Induced Myoclonus Paraneoplastic Disorders Infections Injury by Physical Agents Approach to Diagnosis Treatment
PARKINSONISM Vascular Causes Medications and Bone Marrow Transplantation Toxins Metabolic Disorders Infections Autoimmune and Paraneoplastic Disorders Trauma Other Causes of Parkinsonism Approach to Diagnosis Treatment
CHOREA AND DYSTONIA Dystonia or chorea occurs in a wide variety of medical disorders. Although chorea is typically a more fluid, “dance-like” undulation of a limb, and dystonia is a slower movement or a sustained abnormal posture of a limb or the trunk, it is sometimes difficult to distinguish between them. Approximately 25 percent of dystonias and most choreas are symptomatic or secondary to a neurodegenerative disorder, hereditary metabolic defect, or systemic medical disorder. Responsible neurodegenerative or inherited metabolic disorders are reviewed elsewhere.1,2 In a series of 51 cases of chorea from Italy, vascular causes were identified in 40 percent, drug-induced causes in 14 percent, acquired immunodeficiency syndrome (AIDS)–related causes in 10 percent, Huntington’s disease in 10 percent, hyperglycemia in 4 per-
cent, and hyponatremia in 4 percent; single cas (2 percent each) of borreliosis (Lyme disease), Syde ham’s chorea, and acanthocytosis were also identified The epidemiology will differ in regions where AIDS other infectious conditions are more prevalent. Chor is usually associated with dysfunction of the thalamus basal ganglia. In most cases, the physiological effect the disorder reduces inhibitory input from the glob pallidus interna to the motor thalamus, resulting excessive thalamocortical motor facilitation.2 Dystonia is characterized by impaired inhibition multiple levels of the central nervous system, and alter levels of several neurotransmitters have been report in various diencephalic nuclei, as well as the putame globus pallidus, red nucleus, and subthalamic nucleu Nonetheless, the generation of dystonia remains poo understood.4
10
Ch059_F06707.indd 1095
9/