Basal Ganglia

What term is used to describe decreased numbers of spontaneous movements?

Akinesia

What are *nonmotor* symptoms of Parkinson's Disease?

Anosomia Low blood pressure GI dysfunction GU dysfunction Excess sweating Oily skin Difficulty swallowing Excessive daytime sleeping Dementia may or may not occur Mood change

__________ is a dystonic opening and closing of the eyes.

Blephospasm

What type of injections can be used to treat some localized dystonias?

Botox

What nuclei form the striatum?

Caudate nucleus, putamen, nucleus accumbens

Many parkinson's patients develop ___________ as a side effect of L-dope

Chorea

___________ frequent, quick, jerky movements usually in distal parts of the limbs and face. Movements are sudden and irregular.

Chorea

What term do we use to refer to a combination of movements including Chorea and athetosis?

Choreoathetosis

What is one of the earliest symptoms of parkinson's disease?

Decreased or loss of smell perception (anosomia)

What is anosomia?

Decreased or loss of smell perception, one of the earliest symptoms in parkinson's disease

_____________ are involuntary , unwanted movements that range from contractions of only. few muscles to violent contractions of large portions of the body. Most of these unwilled movements disappear when__________

Dyskinesias / asleep

The term_________ refers to slow sustained contractions that lead to abnormal positions

Dystonia

Primary idiopathic torsion dystonia also known as_D______________M____________D_____________is an inherited generalized dystonia that usually appears in childhood. In the advanced form there is marked grimacing of the face and contorted posture.

Dystonia musculorum deformans

What are some parkinson's -like diseases?

Exposure to MPTP Pugilistic Parkinsonism or dementia Following infections like Von Economo's encephalitis lethargica (1014-1930) Genetic mutations Lewy body disease Progressive supranuclear palsy

What nuclei form the lentiform or lenticular nucleus?

Globus pallidus and putamen

What are the output nuclei of the basal ganglia?

Globus pallidus, Substantia nigra

Tardive dyskinesia can be seen in Parkinson's patients that have been exposed to long term treatment with antipsychotic like ______. Involuntary movements of the _______ and ________often appear in these patients.

Haldol / face / tongue

___________ is a term that describes sudden, quick, violent flinging movements of the contralateral limbs

Hemiballism

___________________ is characterized by violent, flinging movements of an arm and/or leg.

Hemiballism

_________________ - This autosomal dominant disease appears at 30-50 years of age. In this progressive and fatal disease, the neurons in the striatum (especially the caudate nucleus) and cerebral cortex degenerate.

Huntington's disease

Parkinson's is a _____________ disorder whereas Huntington's disease is a ____________ disorder. (hyper or hypo kinetic)

Hypokinetic / Hyperkinetic

Basal ganglia is divided into____________ and ____________ disorders

Hypokinetic and Hyperkinetic

The overall clinical picture of Parkinson's disease is a decreased or poverty of movements, hence its classification as a ______________________

Hypokinetic disorder

In the Primary motor loop, the basal ganglia projects to the areas of the frontal lobe, most directly involved in planning and initiating movements. What are these areas of the frontal lobe?

Primary motor cortex Premotor cortex Supplementary motor cortex

__________ is described as a rhythmic, oscillations of the hand at rest.

Resting tremor

What are the main classical motor symptoms in Parkinson's disease?

Resting tremor (pill-rolling) Rigidity (cog-wheel or lead-pipe rigidity) Bradykinesia Difficulty initiating voluntary movements Akinesia ( causes masked face) Impaired postural reflexes Dysphagia Low monotonous voice Micrographia

What is the main input nuclei of the basal ganglia?

Striatum

Huntington's disease- This autosomal dominant disease appears at 30-50 years of age. In this progressive and fatal disease, the neurons in the _________________ (especially the _________ nucleus) and ______________degenerate.

Striatum / caudate / cerebral cortex

________________(St. Vitus dance) - occurs more commonly in girls following an untreated streptococcal infection, self-limiting or herpes

Sydenham's chorea

_______________- refers to the appearance of abnormal movements due to long term treatment with antipsychotic drugs like haldol. Involuntary movements of the face and tongue often appear in these patients.

Tardive dyskinesia https://www.youtube.com/watch?v=FUr8ltXh1Pc

What are examples of chorea related disorders?

Tardive dyskinesia Huntington disease Sydenham's chorea Disorders with Athetosis Dystonia Hemiballism Tourette's syndrome Wilson's disease

In Basal ganglia disorders, there are dyskinesias and generalized changes and muscle tone. Depending on the disease, there can be increased or decreased muscle tone. However, the ___________ are intact

Tendon reflexes

________ are brief stereotyped repetitive movements (twitches, face, eyelid, etc)

Tics

__________________ - is an inherited disease associated with stereotyped motor and frequently vocal tics. The motor tics usually involve the face and neck. Vocal tics include brief grunts, coughing, howling, barking sounds, or obscene words. Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviors are often present.

Tourette's syndrome (Gilles de la Tourette's) https://www.youtube.com/watch?v=JD_sGl6Rbzk

_________________ (hepatolenticular degeneration) - autosomal recessive disease caused by a disorder of copper metabolism. A variety of dyskinesias may be present, including "wing-beating." Behavioral disturbances such as uncontrollable laughing or crying, and dementia can appear if the patients if not treated with copper chelating agents.

Wilson's disease https://www.youtube.com/watch?v=jOMqjbNhtkY

Per favore!, cite the types of localized or focal dystonia that you know

Writer's cramp Blephospasm Torticollis

What could cause Hemiballism?

a small vascular lesion, usually deep branches of the posterior cerebral artery in the contralateral sub-thalamus

_______________ are recurrent, slow and continual writhing, or worm-like movements usually the limbs.

athetosis

Huntington's disease is characterized by __________movements that include _____________ and _________________.

choreiform / milk-maid grip / trombone tongue.

PARKINSON"S DISEASE (paralysis agitans, idiopathic Parkinson's disease). The motor symptoms in this slowly progressive disease are primarily caused by degeneration of the pigmented _____________ neurons in the _______________ (pars compacta). Abnormal acidophilic structures called ___________ usually are present in the neurons.

dopaminergic/ substantia nigra / Lewy bodies

Currently it is thought that the earliest signs of Parkinson's appear in the _____________ nervous system (Auerbach's and Meissner's plexus), the __________ and the _________________. Eventually the disease progresses to the substantia nigra and cerebral cortex.

enteric / medulla / olfactory bulb

In the Primary motor loop, the basal ganglia projects to the areas of the _______________ lobe, most directly involved in ______________ and __________________ movements.

frontal/ planning / initiating

The role of the Basal ganglia is to modify the activity of the __________ cerebral cortex.

ipsilateral

Damage to the basal ganglia results in ___________ disorder, also called extrapyramidal disorders. There is NO significant weakness or paralysis with these disorders. Why?

movement. / Because the UMNs and LMNs are still intact.

Hemiballism can be caused by a small vascular lesion, usually deep branches of the __________________ in the contralateral _________________.

posterior cerebral artery/ Sub-thalamus