Movement disorders
Movement disorders:impair regulation of voluntary motor activity without directly affected strength, sensation or cerebellar function.
It is result from dysfunction deep sub cortical gray matter termed basal gangalia.
Types:
Tremor:
it is a rhythmic oscillatory movement characterized by its relationship to voluntary motor activity.
A- postural tremor: it is present during sustained posture.
A-1- enhanced physiological tremor:
anxiety or fear.
excessive physical activity.
sleep deprivation.
sedative drug or alcohol withdrawal.
drug toxicity ( lithium, bronchodilators, sodium valproate )
co poisoning.
thyrotoxicosis.
A-2- cerebellar disorders.
A-3- essential tremor.
B- intention tremor:
It is occurs during activity , if the patient asked to touch the nose with a finger, the arm exhibit tremor during movement, often more marked as the target reached.
brainstem disorders.
cerebellar disorders.
drug toxicity ( alcohol, anticonvulsants, sedatives )
wilsons disease.
C- rest tremor:
usually has a frequency of 4-6 Hz and is characteristic of parkinsonism.
parkinsonism.
wilsons disease.
heavy metal poisoning ( mercury)
D- flapping tremor:
hold the arms outstretched with fingers and wrests extended, episodic cessation of muscular activity causes sudden flexion at wrests followed by return to extention.
hepatic failure.
renal failure.
respirotary failure.
hyponitremia.
Chorea:
it is rapid irregular jerks that occur involuntary and unpredictable in different parts of the body.
It is disappear during sleep.
It is affect limb, unilateral, whole of the body.
A- hereditary:
huntingtons chorea.
Benign heredirary chorea.
Wilsons disease.
Paroxysmal chorea-athetosis.
B- static encephalopathy:
anoxia
hemorrhage
trauma
kernicterus
C- sydenhams chorea.
D- chorea gravidarum.
E- drug toxicity:
Levodopa.
Antipsychotic drugs
Lithium
Oral contraceptive.
F- medical disorders:
Thyrotoxicosis
Hypoparathroidism.
Hypo Ca, Na, Mg.
SLE and antiphospholipid syndrume.
Hepatic cirrhosis.
G- cerebrovascular disorders:
Vasculitis
Ischemic or hemorrhagic.
Subdural hematoma.
H- structural lesions of the subthalamic nucleus.
Hemiballismus:
It is unilateral chorea that its violent because involved proximal muscles of the limbs, while chorea involved distal limbs.
It is due to contralateral subthalamic nucleus most commonly vascular in orogin.
dystonia and athetosis:
Dystonia: it is abnormal movement and postures.
Athetosis: it is abnormal movement that is slow, worm like and writhing in character.
Disappear during sleep.
Enhanced by emotional stress and voluntary activity.
cerebral palsy.
wilsons disease.
huntingtons disease.
parkinsons disease.
drugs. Levodopa and antipsychotic.
toxins. Mathanol and manganes.
ischemic.
anoxia.
Progressive supranuclear palsy.
dpoa-responsive dystonia.
psychogenic.
Myoclonus:
It is sudden rapid twitch like muscle contraction , which can be classified to their distribution, or etiology.-1- generalized M.: has a widespread distribution involved whole oh the body.
-2- segmental M.: it is restricted to a particular part of the body.
Causes:
physiological:
nocturnal.
hiccup.
essential M.
epileptic M.
symptomatic myoclonous:
focal brain damage:
head injury.
stroke.
tumors.
metabolic disorders:
drug intoxications ( penicillin, antidepressants and anticonvulsants ).
hyponatremia.
uremia.
hepatic encephalopathy.
hypoglycemia.
Hyperosmolar nonketotic hyperglycemia.
Hypoxia.
infectious disorders:
viral encephalitis.
AIDS dementia complex.
subacute sclerosing panencephalitis.
degenerative disorders:
Wilsons disease.
huntingtons disease.
alzheimers disease.
Neuropathy:
It is a general term indicating peripheral nerve disorders of any cause. It is classified to the following:
-1- mononeuropathy:
refers to focal involvement of a single nerve trunk and therefore implies a local cause.
direct trauma.
compression
entrapment.
ulnar neuropathy:
complete paralysis result in a characteristic claw-hand deformity, owing to wasting and weakness of many of the small muscles and hyperextension of the fingers at the metacarpophalangeal joints and flexion at the interphalangeal joints.
Site of the lesion at the elbow.
Origin at C8-T1.
carpal tunnel syndrome:
It is characterized by the following:
Entrapment is due to excessive use of the wrist most commonly.
Origin C6-T1.
Occasionally may be secondary to:
arthritis
acromegaly.
Hypothyroidism
Rheumatoid arthritis
D.M.
Amyloidosis
Nocturnal numbness of the thumb, index, and middle fingers.
Weakness and atrophy of the abductor pollicis brevis ( thener eminence).
cranial mononeuropathy:
- all C.N. could be affected in separate manner.
*Seventh C.N. palsy:
It is extranuclear lesion.
-it is LMNL, which characterized by involvement upper and lower muscle group of the face with inability to closed the eye.
Bells palsy is common cause.
Other causes.
Tumors that invade temporal bone.
Carotid body.
cholesteatoma.
dermoid.
*Ramsay hunt syndrome:
in addition to weakness, hearing loss and vesicular eruption in the pharynx and external auditory canal.
Acoustic neuroma
infaction.
Multiple sclerosis.
G.B.S.
sarciodosis.
-2-mononeuropathy multiplex:
simultateous or sequential involvement of individual noncontiguous nerve trunks.
CIDP.
leprosy.
sarcoidosis.
amyloodosis.
neuroAIDS.
Diabetic neuropathy.
-3- polyneuropathy:
The first symptoms tend to be sensory and consist of tingling, burning, or bandlike sensation in the balls of the feet, or tips of the toes.
Typical is distal symmetrical sensory or motor neuropathy in form of glove or stock.
Causes:
-1- G.B.S. -2- C.I.D.P. -3- D.M. -4- uremia. -5- hypoglysemia. -6- vit. B12, B6 deficiency. -7- hypothyroidism. -8- carcinoma. -9- HIV infection. -10- lymphoma. -11- chronic liver disease. -12- multiple myeloma. -13- celiac disease. -14- acromegaly. -15- chronic obstructive lung disease. -16- isoniazid. -17- cisplatin. -18- dapsone. -19- vincristine. -20- phenytion. -21- statins. -22- thallium. -23- inorganic lead. -24- organophosphates.
