Adulthood (40) and mean duration is 20 years ends in complete motor disability adn dementia hd - dx imaging ------ mri - caudate atrophy  hd - tx  ------ none - no cure treating the depression adn psychosis may improve qol hd - genetic testing ------ unstable cag trinucleotide  motor tics ------ stereotypic repetitive, nonrhythmic, jerklike movements (same each time) rapid - clonic or sustained - dystonic usually preceded with a sensory urge to move that affected part can be suppressed initially but then crescendo simple motor tic  ------ nonpurposeful movement of related muscle groups eye blinks, eye rolling, shoulder shrugs, etc complex motor tics ------ appearing as semipurposeful ex: hitting the wall, bending to touch the floor vocal tics ------ repetitive stereotypic vocalization may interrupt the  normal flow of speech or emerge from silence simple vocal tic ------ sniff, grunt, squeak or shout complex vocal tic  ------ words or phrases out of contextrepeating the words of others = echolaliarepeating ones own words = palilalia using obscene words = coprolalia tic - diff dx ------  sporadic and genetic tic disorders infections (postviral encephalitis, hiv, lyme) drugs (amphetamines, cocaine, levodopa, anticonvulsants, opiate withdrawal) toxins (carbon monoxide) developmental problems (autism, mr) chromosomal disorders (down’s, fragile x) head trauma stroke schizophrenia benign essential tremor - imaging ------  mri/ct normal in etcheck mri if acute onset or stepwise progressionemg can be used to assess tremor frequency, rhythmicity, and amplitude; not routine  benign essential tremor - pe  ------  postural or kinetic tumor of ues, head and/or voice remainder of exam usually normal tends to be bilateral (worse on one side is possible) unlike parkinsons happens to occur on both sides and is more prominent with action than rest benign essential tremor cause  ------ genetic  benign essential tremor - diagnostic criteria (inclusion and exclusion)  ------  inclusion criteria for dx:  bilateral, largely symmetric postural or kinetic tremor of hands and forearms that is visible and persistent possible additional or isolated tremor in head, chin, head or voice tremor but absence of abnormal posturing parkinsons does not cause voice tremor ever – helps with diff exclusion criteria for dx other abnormal neurologic signs, especially dystonia presence of known causes of enhanced physiologic tremor historic or clinical evidence of psychogenic tremor convincing evidence of sudden onset or evidence of stepwise deterioration – be tremor does has more of a gradual onset primary orthostatic tremor  - tremor when standing and occurs in the legs isolated position- or task-specific tremors, including occupational tremors and primary writing tremor benign essential tumor - hx ------  tremor is usually the only symptom tremor resolves during sleep (action tremor) fh of et is common alcohol temporarily improves the tremor stress, lack o fsleep and stimul. generic viagra yahoo non prescription viagra safe viagra with no prescription cheap viagra viagra viagra viagra lequel choisir viagra for sale buy real viagra online 100 mg generic viagra Viagra time in body buy viagra online overnight shipping where can i buy viagra generic viagra yahoo reviews for viagra daily use generic viagra yahoo cheap viagra online how easy is it to get viagra on prescription Effects viagra has women viagra without a doctor prescription cheap generic viagra generic viagra online Brisbane, Qld, Australia


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