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the main cause behind the movement disorders is dysfunction of deep seated sub cortical gray matter called basal ganglia with subsequent affection of.

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Presentation on theme: "the main cause behind the movement disorders is dysfunction of deep seated sub cortical gray matter called basal ganglia with subsequent affection of."— Presentation transcript:

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2 the main cause behind the movement disorders is dysfunction of deep seated sub cortical gray matter called basal ganglia with subsequent affection of their NT (dopamine and Ach).,although there is no universally accepted definition of BG,BUT for clinical purposes it consisting of caudate,putamen, globus pallidus.subthalamus and substantial nigra. the main cause behind the movement disorders is dysfunction of deep seated sub cortical gray matter called basal ganglia with subsequent affection of their NT (dopamine and Ach).,although there is no universally accepted definition of BG,BUT for clinical purposes it consisting of caudate,putamen, globus pallidus.subthalamus and substantial nigra. Basic circuit loops in BG: Basic circuit loops in BG: CORTICO-STRIATO-CORTICAL CORTICO-STRIATO-CORTICAL NIGROSTRIATAL NIGROSTRIATAL STRIATOPALLIDAL STRIATOPALLIDAL

3 Tremor Tremor Involuntary rhythmic oscillation involving flexion and extension around a joint classified best in relation to motor activity in to: Involuntary rhythmic oscillation involving flexion and extension around a joint classified best in relation to motor activity in to: RESTING=static T. : in rest state typically seen Parkinson dis. =pen rolling T.. the rate of t is 4-6hz(slow),other causes of resting one is Wilsons disease, and heavy metal poisoning (mercury). RESTING=static T. : in rest state typically seen Parkinson dis. =pen rolling T.. the rate of t is 4-6hz(slow),other causes of resting one is Wilsons disease, and heavy metal poisoning (mercury). RESTING=static T. RESTING=static T. ACTION T. is of 2 types : postural and intention T. ACTION T. is of 2 types : postural and intention T. POSTURAL T. : POSTURAL T. : -PSL. Tremor: PSL. Tremor: Enhanced PSL tremor: Enhanced PSL tremor: cerebellar disease cerebellar disease Wilsons disease Wilsons disease Benign essential tremor: autosmal D., or idiopathic,50 % positive family history,it can affect head and neck -Benign essential tremor: autosmal D., or idiopathic,50 % positive family history,it can affect head and neck INTENTION TREMOR : seen in cerebellar disease,Wilsons disease, drug toxicity alcohol, anticonvulsants, sedatives). INTENTION TREMOR : seen in cerebellar disease,Wilsons disease, drug toxicity alcohol, anticonvulsants, sedatives). Asterixis ? episodic loss in postural tone and M. activity causes sudden flexion of the wrist followed return back to extension,more properly considered as type of myoclonus than tremor seen in patient with metabolic encephalopathy. it may associated with Post. tremor. How detect it? Asterixis ? episodic loss in postural tone and M. activity causes sudden flexion of the wrist followed return back to extension,more properly considered as type of myoclonus than tremor seen in patient with metabolic encephalopathy. it may associated with Post. tremor. How detect it?

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5 Chorea which is rapid irregular muscle jerk that is purposeless,and forceful occur involuntarily in different parts of the body. which is rapid irregular muscle jerk that is purposeless,and forceful occur involuntarily in different parts of the body. It may be mild in form of persistent restlessness and clumsiness to sever one interfering with daily activity in form of sever invol. and forceful movement with facial grimacing and tongue movement with gait affection. It may be mild in form of persistent restlessness and clumsiness to sever one interfering with daily activity in form of sever invol. and forceful movement with facial grimacing and tongue movement with gait affection. Pathology? Is unclear,in some it associated with atrophy (cell loss) of caudate and putamen. Pathology? Is unclear,in some it associated with atrophy (cell loss) of caudate and putamen. Causes: Causes: Hereditary: as in Huntingtons chorea, benign hereditary chorea, Wilsons disease, familial chorea with acanthocytosis. Hereditary: as in Huntingtons chorea, benign hereditary chorea, Wilsons disease, familial chorea with acanthocytosis. Static encephalopathy: cerebral palsy, Static encephalopathy: cerebral palsy, Sydenhams chorea Sydenhams chorea Chorea gravidarum Chorea gravidarum Drug toxicity as dopamine agonist as levodopa and antipsychotic, phenytoin,lithium, and oral contraceptives. Drug toxicity as dopamine agonist as levodopa and antipsychotic, phenytoin,lithium, and oral contraceptives. Medical disorders : thyrotoxicosis,hypoparathyroidism,or Addisons disease,Hypocalcemia, hypomagnesaemia, polycythemia,hypernatremia,SLE,hepatic cirrhosis,encephalitis Medical disorders : thyrotoxicosis,hypoparathyroidism,or Addisons disease,Hypocalcemia, hypomagnesaemia, polycythemia,hypernatremia,SLE,hepatic cirrhosis,encephalitis CVA: CVA: Str. pathology of Subthalamic n. Str. pathology of Subthalamic n.

6 Hemiballismus?Hemiballismus?Hemiballismus Unilateral chorea violent as proximal M. is involved. it is due to contralateral subthalamic nucleus mainly as vascular accident or following thalamotomy. Unilateral chorea violent as proximal M. is involved. it is due to contralateral subthalamic nucleus mainly as vascular accident or following thalamotomy. Dystonia and Athetosis? Dystonia and Athetosis? Athetosis? Is slow distal,irregular,sinusoidal in character (piano playing),when it sustained leading to abnormal posture we call it dystonia,which can be generalized or localized in one or 2 limbs segmental).if it affect group of muscle called focal dystonia as writers cram or torticollis. Athetosis? Is slow distal,irregular,sinusoidal in character (piano playing),when it sustained leading to abnormal posture we call it dystonia,which can be generalized or localized in one or 2 limbs segmental).if it affect group of muscle called focal dystonia as writers cram or torticollis. Nearly all EP involuntary movement are disappear in sleep. Nearly all EP involuntary movement are disappear in sleep. Etiology? Etiology? Cerebral palsy Cerebral palsy Wilsons disease Wilsons disease Huntingtons C Huntingtons C Drugs Drugs Encephalitis Encephalitis Ischemic anoxia Ischemic anoxia Idiopathic: hereditary or sporadic Idiopathic: hereditary or sporadic Idiopathic torsion dystonia. Idiopathic torsion dystonia. Progressive supranuclear palsy. Progressive supranuclear palsy.

7 Myoclonus? Sudden rapid twitching like M. contraction. it can be spontaneous or action (on initiation of movement), it can be essential myoclonus or epileptic myoclonus,it can be segmental or generalized,it can be PSL or symptomatic? Sudden rapid twitching like M. contraction. it can be spontaneous or action (on initiation of movement), it can be essential myoclonus or epileptic myoclonus,it can be segmental or generalized,it can be PSL or symptomatic? Generalized M. CAUSES? PSL :nocturnal and hiccup PSL :nocturnal and hiccup Essential DD M. Epilepsy Essential DD M. Epilepsy Epileptic Epileptic Symptomatic: degenerative?, infection?, metabolic? Symptomatic: degenerative?, infection?, metabolic? Differentiation between epileptic versus non E. myoclonus is impossible some times.it can be by EEG. Segmental M.: can arise from lesion affecting CC, brainstem,or spinal C can arise from lesion affecting CC, brainstem,or spinal C palatal m.(dentato -rubro-olivary pathways in stroke or MS )associated with audible click with synchronous movement of ocular,facial or bulbar muscle. palatal m.(dentato -rubro-olivary pathways in stroke or MS )associated with audible click with synchronous movement of ocular,facial or bulbar muscle. Epilepsia partialis continua Epilepsia partialis continua Same causes that produce symptomatic G. myoclonus. ex: non-k. Hyperosmlar hyperglycemia. Same causes that produce symptomatic G. myoclonus. ex: non-k. Hyperosmlar hyperglycemia.

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