Movement disorders DDx

Overview

Movement disorders can be classified as hypokinesias and hyperkinesias.

• First, determine whether or not an involuntary movement disorder is actually present (typically worse with anxiety and diminished during sleep).
• Second, determine the nature of the involuntary movements (such as chorea, dystonia, myoclonus, and tremor) by assessing features such as rhythmicity, speed, duration, pattern, induction, complexity, and suppressibility.

Types of movement disorder

Hypokinesia

• Akinesia/bradykinesia (Parkinsonism)
• Catatonia
• Psychomotor depression
• Freezing phenomenon
• Hypothyroid slowness
• Stiff muscles
• Hyperkinesia

Hyperkinesia

• Essential tremor
• Tics, such as Tourette syndrome
• Dystonia
• Hemifacial spasm
• Ataxia
• Chorea
• Others including akathisia, dyskinesia, hyperekplexia, jumpy stumps, moving toes, myokymia, myorhythmia, restless legs, and stereotypy

Features distinguishing movement disorders

Rhythmic movements

• Tremor
• Myoclonus
• Dystonic tremor
• Tardive dyskinesia
• Moving toes and fingers

Sustained movements

• Dystonia
• Stiff-person syndrome

Intermittent movements

• Tics
• Paroxysmal dyskinesia

Speed of movements

• Myoclonus (faster) → chorea → athetosis (slower)

Suppressibility

• Tics (suppressible) → chorea → dystonia → tremor (hard to suppress)

Complex movements

• Tics (complex) → stereotypies → myoclonus → akathitic movements (simple)

CCC Differential Diagnosis Series
NEURO	Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision
RESP	Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement
CVS	Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction
GIT	Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage
GUT	Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency,
MSK	Arthritis, Shoulder pain, Wasting of the small muscles of the hand
DERM	Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans
ENDO	Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss
HAEM	Splenomegaly
PAEDS	Floppy infant
MISC	Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest
IMAGING	CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR, ABDO: Gas on abdominal X-ray, Kidney mass, BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly, OTHER: Pseudofracture on X-Ray,
LABS	LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia,  HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia,  ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis, Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

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