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EXTRA PYRAMIDAL DISORDERS

EXTRA PYRAMIDAL DISORDERS. EXTRA PYRAMIDAL DISORDERS. increase tone decrease movement. decrease tone increase ab. movement. Parkinsonism Hypokinesia, rigidity, tremor, ab. Posture Causes -parkinson’s dis. -drugs: phenothiazines -postencephalitic -mptp toxicity -CVA. Pathophysiology

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EXTRA PYRAMIDAL DISORDERS

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  1. EXTRA PYRAMIDAL DISORDERS

  2. EXTRA PYRAMIDAL DISORDERS increase tone decrease movement decrease tone increase ab. movement Parkinsonism Hypokinesia, rigidity, tremor, ab. Posture Causes -parkinson’s dis. -drugs: phenothiazines -postencephalitic -mptp toxicity -CVA

  3. Pathophysiology -cell degeneration &depigmentaion of substantia nigra + Lewy bodies deposion - dopamine to caudate &putamen 2ry degeneration dopamine acetylcholine decarbxylase Tyrosin dopa dopamine

  4. Clinical features -progresive dis. , incidious onset , above 50 -Tremors: -70% of presentaion , usually unilateral -present at rest , by action , by emotion , disappear by sleep -arms affected 1st then spread to face , jaw &legs -frequency 4 – 6 Hz -Rigidity: -cogwheel or ledpipe -all muscles but mainly neck , trunk & proxymal muscles -Hypokinesia -delay of initiation of movements -slowness of movements -loss of automatic movements -Postural changes: -flexed posture &postural instability -freezing , festination

  5. Clinical staging Management -Medical -Physical -Surgical Medical: - L-dopa + dopadecarboxylase inhibitor - Amantadine - Anticholinergics Parkinsonian plus: -progressive supra nuclear palsy -multiple system atrophy

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