锥体外系疾病（2-运动障碍性疾病）.pptxVIP

运动障碍疾病Extrapyramidal diseases ( movement disorders)神经病学教研室Department of Neurology Zhijian Zhang;运动障碍（锥体外系）疾病, 主要表现为随意运动迟缓，不自主运动、肌张力障碍、姿势步态障碍等运动症状。肌力、Extrapyramidal diseases mainly impair the regulation of voluntary motor activity（sluggish），involuntary movement，myodystonia，without ;感觉及小脑功能不直接受影响。运动障碍疾病源于基底节功能紊乱。directly affecting strength, sensation, or cerebellar function. Movement disorders result from dysfunction of deep subcortical gray matter structures termed the basal ganglia.;解剖：Anatomy:基底节：尾状核、豆状核（壳核、苍白球）、屏状核和杏仁复合体（丘脑底核与黑质为相关结构）。Basal ganglia: caudate nucleus, lentiform nucleus ( putamen, globus pallidus), claustrum and amygdaloid complex. ;新纹状体：壳核、尾状核。Neostriatum: putamen, caudate.旧纹状体：苍白球Paleostiratum: globus pallidus古纹状体：杏仁复合体Archistriatum: amygdaloid complex;相关结构：红核、黑质、丘脑底核、中脑间质核、大脑皮质的4、6区。Dependency structure: red nucleus ( corpus rubrum), substantia nigra, mid brain interstitial nucleus, 4 and 6 regions of cerebral cortex;神经环路：Neuronal circuitry: 1.皮质-皮质环路：大脑-皮质-尾状核、壳核-内侧苍白球-丘脑-大脑皮质(直接通路,间接通路)1.? Corticortical loop: cerebral cortex-caudate, putamen-the internal segment of the globus pallidus-thalamus-cerebral cortex;(direct path, indirect path ) 2 .黑质-纹状体环路：黑质与尾状核、壳核之间的往返联系纤维2.? Nigrostriatal loop: connecting the substantia nigra, caudate and putamen;3. 纹状体-苍白球环路：尾状核、壳核-外侧苍白球-丘脑底核-内侧苍白球3.? Striaropallidal loop: projects from the caudate and putamen to the external segment of the globus pallidus, then to the subthalamic nucleus, and finally to the internal segment of globus pallidus.;书本简约：大脑皮质-基底核-丘脑-大脑皮质;;神经递质：乙酰胆碱（Ach）、多巴胺 (DA)、去甲肾上腺素 (NE)、5-羟色胺 (5-HT)、γ-氨基丁酸 (GABA) 、谷氨酸等。Neurotransmitter(NT): acetylcholine, dopamine, noradrenaline, 5- hydroxytryptamine(serotonin), gamma-aminobutyric acid, aminoglutaminic acid, etc.;椎体外系症状;临床分类：Clinical classification:1．运动过多：震颤、肌张力障碍、舞蹈症、手足徐动症、抽搐1. hypercinesia: tremor, dysmyotonia, chorea, posthemiplegic chorea, tic2．运动减少：帕金森病和帕金森综合征。2. hypokinesia: Parkinson’s disease a