Adeel Memon MD
Neurologist in Birmingham, Alabama.
Enhanced physiological tremor is the most commonly observed postural tremor. Physiologic tremor is undetectable, low amplitude and high frequency (10-12 Hz) tremor in normal individuals. Sympathetic hyperactivity causes enhanced physiological tremor that can be detected on observation.
Restless legs syndrome (RLS) (also known as Willis-Ekbom disease) is characterized by an intense crawling sensation deep inside the lower legs. Most cases are familial but can be secondary to an underlying illness. Management includes treating underlying diseases, nonpharmacologic therapy, and pharmacological therapy. Severe RLS may spread to the arms and significantly reduce the quality of life. This chapter discusses etiology, pathophysiology, clinical features, diagnostic evaluation, and management of RLS.
It is an Autosomal Recessive trait, also known as Progressive Hepatolenticular Degeneration. Liver biopsy is the single most sensitive and accurate investigation for the disease. Males are more likely to develop neuropsychiatric disease, whereas females are more likely to develop acute liver failure due to Wilson's disease.
Acute Parkinsonism (AP) is a relatively uncommon phenomenon in which signs and symptoms evolve over a period of a few hours to weeks. Common causes include structural/vascular abnormalities, infections, psychiatric manifestations, intake of drugs, and autoimmune disorders. This chapter emphasizes the clinical manifestations, pathogenesis, diagnosis, treatment, and prognosis of each etiological factor involved in causing acute parkinsonism.
The most common cause of Parkinsonism is Parkinson's disease (PD), but this is a neurodegenerative process and presents in a chronic manner. In contrast, Secondary Parkinsonism (SP) may present in an acute, subacute, or chronic manner. Factors favoring a diagnosis of SP include sudden onset of symptoms at a young age, rapid progression with atypical findings on examinations as well as poor response to dopamine therapy. This chapter provides great insight into the causes of secondary parkinsonism along with a diagnostic approach and management.
Also known as Status Dystonicus is a rare life-threatening movement disorder emergency, characterized by marked exacerbations of dystonia that requires immediate intervention and ICU admission. It usually appears after weeks or months in the patients who have already been diagnosed with Dystonia and initial stabilization measures include intubation, mechanical ventilation, fluid resuscitation, antibiotics, nasogastric or parenteral nutrition, and antipyretics.
A rare hyperkinetic autoimmune movement disorder affecting children results in brief, involuntary, jerky, uncontrollable movements of the face, arms, legs, and trunk muscles. The patient is diagnosed clinically but high blood titers of streptococcal antibodies such as ASO are also helpful in making the diagnosis. The prognosis is good in most cases but the duration of symptoms usually varies between 3-6 weeks.
The most common cause of Hemiballismus is Stroke and Non-ketotic hyperglycemia being the second most common. Damage in the basal ganglia structures leads to decreased excitatory transmission of the globus pallidus internus (GPi) resulting in disinhibition of the thalamus. This creates an overactivation of the corticospinal and corticobulbar tracts with random firing. To provide a better understanding of hemiballismus, this chapter highlights the etiology, clinical features, diagnostic evaluation, management, and prognosis of this condition.