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46 Cards in this Set
- Front
- Back
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function of extrapyramidal system?
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MUSCLE TONE
POSTURE INVOL. MOVEMENT CO-ORDINATION OF VOLUNT. MOV'MNT |
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2 Classes of neurones in the basal ganglia?
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cholinergic -striatum
dopaminergic - nigrostriatal pway |
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what is basal ganglia made of
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striatum
sub nigra subthalamic ncl |
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striatum is made of
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caudate ncl
putamen |
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what is palladium made of
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globus pallidus
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what does the direct pathway do
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stimulate movement
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what does the indirect pathway do?
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inhibit movement
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loss of dopaminergic neurone leads to?
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inhibition of direct pathway and stimulation of indirect one
--> parkinsons disease |
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types of extrapyramidal syndromes
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HYPERTONIC-HYPOKINETIC- NEGATIVE SYMPTOMS
DYSKINESIAS- Positive symp -invol. movements -hyperkinesis |
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hypertonic-hypokinesis- define?
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Rigidity of muscles--> hypokinesis ( decreased amplitude of muscles)
Same muscle strength- contrast of corticospinal lesion RESTING TREMOR = parkinsonism |
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secondary parkinsonism is caused by?
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vascular, posttraumatic, drug induced or neurodegenerative disease
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what is diskinesias
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HYPERKINESIS- abnormal invol movements
DCAB dystonia chorea athetosis ballism |
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hypertonic hypokinesis symptoms
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hypomimetic
slow speech hypophonia small writing micrographia shuffling stooped gate rigidity - plastic stiffness resting tremor- disappears upon voluntary movement, counting money |
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causes of parkinsonism- most common
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loss of dopaminergic neurones
usually unilateral |
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treatment of early parkinsonism caused by loss of nigrostriatal pathway
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L-DOPA
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other causes of secondary parkinsonism?
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vascular
infectious posttraumatic drug toxicity |
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reason for drug induced parkinsons
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neuroleptic- block dopamine action- such as haloperidol, chlorpromazine
newer drugs less so cinnarizine and flunarizine- famous |
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reason vascular induced parkinsons
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lower body parkinsonism
gait disorder ischemic changes seen w/i basal ganglia, subcortical, periventricular white matter |
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which type of parkinsonism is associated with pseudo bulbar syndrome?
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vascular induced parkinsons
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explain toxic parkinsonism
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CO and manganese poisoning
--> AKINESIA --> rigidity |
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posttraumatic parkinsonism
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occur after sever or repeated blunt head injury
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chorea? what is it
and in which conditions does it occur? |
involuntary, frequent, irregular, rapid movements
flow from one limb to the next found in huntingdons, sydenhams- rheumatic fever (group A strep), neuroleptic surgery-> tardive dyskinesia |
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tardive dyskinesia
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long term treatment with neuroleptics
choreiform movements of lips and tongue |
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athetosis
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assoc frequently with chorea
characterised with slow, writhing, worm-like movements of distal extremities occurs as a result of injury to the neonatal basal ganglia |
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ballism
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violent, large amplitude flailing!
usually confined to one side of body- hemiballism- contralateral to a lesion in the sub thalamic nucleus |
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dystonia
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involunt. slow twisting contraction of agonist and antagonist muscles--> PAIN
can be primary or secondary, generalised- in childhood= primary torsion dystonia |
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secondary dystonia is caused by?
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insult to the basal ganglia- trauma or toxins
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types of dystonia
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CERVICAL
BLEPHAROSPASM TASK SPECIFIC ACUTE- DRUG INDUCED |
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Cervical dystonia
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spasmodic torticollis
affects the muscles of the neck--> head tilt or rotation |
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blepharospasm
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affects muscles around eyes--> involn closure of eye lids
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task specific dystonia
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appears after certain actions
--writers or musician cramp |
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dystonia that affects the cranium and neck is called
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meiges syndrome
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acute dystonia
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secondary dystonia that occurs as a result of drug damage- neuroleptics- w/i first 7 days of treatment
metoclopromide can also cause it (antiemetic) |
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myoclonus
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sudden brief rapid irregular rhythmic involuntary movements- caused by individual muscles or muscle groups
can be positive or negative discharges could be from cortex, brainstem, spinal cord, nerves or roots |
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diseases in which myoclonus is common?
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oxygen deprivation to the brain
epilepsy lennox gastaut syn parkinsons, alzheimers creutz jacob huntingdons encephalitis stroke paraneoplastic syn liver and kidney failure |
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treatment for myoclonus is
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anticonvulstants- clonazepam, Na valproate, gabapentin, topiramate
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asterixis
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rhythmic jerking- upper extremities, dorsiflexion in arms and wrists
------ its is a brief loss of muscle tonicity- drop of hand (negative myoclonus) it can be severe- flapping tremor found in hepatic or ureic encephalopathy and intoxifications |
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tics
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intermittent, repeated, stereotyped movement or sounds, that are infrequent or continuous
simple or complex- words or movements INVOLUNTARY can be transient or chronic severe type= tourettes |
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resting tremor
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present at rest when the limb is inactive, disappears upon voluntary movement
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postural tremor
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present when limbs and trunk are held in a certain position, against GRAVITY.
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kinetic tremor
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present during any active movement
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what is an action tremor
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postural and kinetic tremor together.
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intention tremor
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present during voluntary movement, increases when approaching target
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causes of enhanced physiological tremor
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hepatic and uremic encephalopathy
hypoglycemia hyperthyroidism hyperparathyroidism drug; lithium, tricyclics, valproate, bronchodilators, anti asthmatics, intoxication- Hg, Pb, Mn, As, CO, cyanide |
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essential tremor
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neurological disorder
present during voluntary movements such as eating and writing, and postural when arms are lifter forward. affects the head and limbs diminished with rest, or ethanol |
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cerebellar tremor
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typical intention tremor that maybe accompanied with ataxia and hypermetria
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