运动障碍疾病方法技巧.pptVIP

运动障碍疾病Movement Disorders Neurology Department The Second Affiliated Hospital Harbin Meical University Extrapyramidal Disorders General Conception: The dysfunction of basal ganglia putamen globus pallidus   lentiform nucleus caudate nucleus subthalamus corpus striatum substantia nigra basal ganglia General Conception Two types of symptoms Muscular hypotonus associated with hyperkinesia(F1) Muscular hypertonus characterized with hypokinesia(F2) Parkinson’s disease---conception Also called paralysis agitans. a common degeneration disease in nervous system becomes increasingly common with advancing age characterized by rest tremor, bradykinesia, rigidity, abnormal gait and posture dopamine acetylcholine Parkinson disease’s---Clinical findings Over middle aged insidious onset and gradual progression. Tremor: often appear as the first sign. Characters: 4~6Hz, conspicuous at rest, increase at times of emotional stress, improves during voluntary activity, stop during sleep, begin from hand , “N” progression. Parkinson disease’s---Clinical findings Rigidity(F1/F2): lead pipe / cogwheel phenomenon. Minimal rigidity: move the contralateral limb, head dropping test, road mark sign Parkinson disease’s--Clinical findings Bradykinesia: slowness and reduction of voluntary movement, difficult to initiate, masked face, hypophonia, micrographia. Abnormal gait and posture: flexed posture; difficult to get up, start walking, turn or stop. Shuffling gait and absence of the arm swing. Festinating gait(late sign).  Parkinson disease’s--Clinical findings Other features: Myerson’s sign, oily face, intractable constipation, postural hypotension, cognitive disturbance, hallucination, depression Parkinson’s disease---Differential diagnosis Parkinsonism: postencephalitic parkinson