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Tremor by Mind Map: Tremor

1. 6. Management

1.1. include

1.1.1. Levodopa able to cross BBB (unlike dopamine) contraindicated with Vitamin B6 MAO inhibitors given with DOPA decarboxylase inhibitors

1.1.2. MAO-B inhibitor like Selegiline Rasagiline inhibits dopamine breakdown

1.1.3. COMT inhibitor like Entacapone Tolcapone inhibits L-DOPA/ Dopamine breakdown

1.1.4. Dopamine agonist like Bromocriptine Apomorphine Pramipexole Ropinirole

1.1.5. Dopamine reuptake inhibitor like Amantadine

1.1.6. Anticholinergics like Benztropine Trihexphenidyl corrects imbalance between ACh and Dopamine

2. 2. Physiology

2.1. Basal Nuclei

2.1.1. Modifies Motor Output

2.1.2. Input Cerebral Cortex Substansia Nigra Thalamus Raphe Nucleus

2.1.3. Output Thalamic Nuclei Reticular Formation Substansia Nigra

2.1.4. Pathways Direct Stimulates Motor Activity Indirect Inhibits Motor Activity

2.2. Cerebellum

2.2.1. Maintains Balance Muscle Tone Posture

2.2.2. Coordinates Muscle Movement

2.2.3. Input Dorsal Spinocerebellar Tract Information From Muscle Spindles Ventral Spinocerebellar Tract Information from Golgi Tendon Organs Cuneocerebellar Tract Information From Head, Neck & Upper Limb

2.2.4. Output Limb Movement Control Thalamic VL nuclei Trunk Movement Control Vestibular Nuclei Red Nuclei Reticular Formation

2.3. Ions and Contraction

2.3.1. Depends on Muscle Type

2.3.2. Main Ion Calcium

2.3.3. Mechanism Power Stroke & Cross-Bridge Cycling

3. Neurodegeneration of substantia nigra

3.1. ↑ Inhibitory signals to cortex

3.2. ↓ stimulatory signals to the cortex

4. 3. Movement Disorders

4.1. result from

4.1.1. damage to basal ganglia

4.2. Types

4.2.1. Parkinosn's Most common damage to substantia Nigra

4.2.2. Huntington's Inherited AD Degeneration in striatum Loss of GABA neurons

4.2.3. Hemiballism flinging movement of extremities damage to subthalamic nucleus

4.2.4. Wilson's Disease Disorder of copper metabolism damage to lentiform nucleus

5. 4. Types of tremors

5.1. Resting

5.1.1. seen in parkinson's

5.1.2. pill rolling tremor

5.2. Action

5.2.1. Postural Essential Most common inherited improves with alcohol Physiologic occurs at any age increases by sympathetic stimulation Orthostatic unknown cause trembling in feet

5.2.2. Intention causes cerebellar stroke Multiple sclerosis worst with goal directed movements

6. 1. Anatomy

6.1. Basal Nuclei

6.1.1. consists of a number of subcortical nuclei. the putamen globus pallidus externus, and internus the subthalamic nucleus (STN), a small collection of neurons situated ventral to the thalamus the substantia nigra (SN). region in the midbrain a dark appearance Caudate Nucleus lateral wall of the lateral ventricle

6.2. Cerebellum

6.2.1. embryonically derived from Metencephalon

6.2.2. Location inferior to the occipital and temporal lobes

6.2.3. lobes the anterior lobe the posterior lobe the flocculonodular lobe.

6.2.4. histology white matter coated by the outer grey cortex outer molecular layer, the middle layer of Purkinje cells the inner granular layer. medulla white matter does not contain any cell bodies

7. 5. Diagnosis

7.1. Physical examination

7.1.1. confirming diagnosis

7.1.2. follow ups

7.1.3. Consist of Inspection tests maneuvers

7.1.4. disease's characteristics Bradykinesia slowness of movement tested by Tests Rigidity resistance to passive movement not direction dependent not velocity dependent types test for Tremor involuntary trembling of a body part types Gait & Balance abnormalities caused by tests

7.2. Lab investigation

7.2.1. no test to confirm

7.2.2. to rule out imaging stroke brain tumor blood test thyroid causes liver causes

8. Financial burden of healthcare

8.1. Healthcare expenditure determinants

8.1.1. Population

8.1.2. size

8.1.3. structure

8.1.4. epidemiology

8.1.5. growth

8.2. Who pays for the healthcare?

8.2.1. a)Government programs (such as Medicare and Medicaid)

8.2.2. b)Private health insurance plans (some through employers)

8.2.3. c)The person's own funds (out-of-pocket).

8.2.4. Revenue collection

8.2.5. Pooling health risk pooling income pooling age pooling

8.2.6. Purchasing

9. Prognosis of PD

9.1. 1967 – life expectancy = 9.4 years

9.2. 1993 – life expectancy = 13.1 years

9.3. 2016 – life expectancy =14.6 (±7.7) years

10. PD and QoL

10.1. decreased significantly with increased disease severity

10.2. Greatest Impairment in Physical and social functioning

10.3. Decreased across all age groups with greater decrease in younger patients

10.4. Male = female

11. Otitis media complications

11.1. include

11.1.1. Cholesteatoma a small skin cyst 2 types Acquired Congenital treated by Mastoidectomy Tympanoplasty Ossiculoplasty

11.1.2. Aural polyp growths inside the ear canal may be mimicked by Squamous cell carcinoma of ear canal

11.1.3. Tympanosclerosis calcification and hardening of eardrum and middle manifest as bright white calcium deposits treated by removing sclerotic portions Stapesplasty hearing aid

12. generalized behavioral changes in a TBI patient

12.1. include

12.1.1. Emotional liability loss of control over their emotional responses include alternating between crying and laughing not reflect how the person really feels

12.1.2. Apathy reduced emotional expressiveness due to lack the ability to show emotions through facial expressions

12.1.3. Egocentricity reduced empathy due to lack the ability to interpret social cues damage to frontal lobe

12.1.4. PTSD long lasting effects of the trauma

12.1.5. Anxiety usually in noisy environment

12.1.6. Depression struggling with the new disability

12.1.7. Anger from the frustration