Objectives of Lecture
By the end of this lecture, the student will be able to:
1. Describe different extrapyramidalcenters and tracts.
2. Define parkinsonism, chorea, athetosisand dystonia.
3. List causes of extrapyramidal disorders.
4. Explain clinical picture of different extrapyramidal diseases.
5. List treatment of extrapyramidaldisorders.
6. Differentiate between involuntary movement in chorea, athetosis and dystonia.
ExtrapyramidalDisorders
Ref.Elwan H : Principles of Neurology . University Book Center , Cairo , 2007.
Extrapyramidal System• Definition .
Pontine
Mesencephalic
Diencephalic
Telencephalic
Cortical level
Cerebellarlevel
Centres
BASAL GANGLIA
Pyramidal and Extrapyramidal tracts
Connections of ExtrapyramidalCenters
• Functions .
Disturbance of Function
Static Tremors Rigidity Bradykinesia
PARKINSONISM
• Definition .
• Causes .I – Idiopathic .II – Symptomatic .
Substantia Nigra
Clinical Picture
• Tremors.
• Rigidity.Differences between rigidity & spasticity .
• Loss of emotional and associative movements .
• Other clinical manifestations .
Manifestations of Parkinsonism
Differentiation between types of parkinsonism according to cause:
• Paralysis agitans.
• Post-encephalitic.
• Atherosclerotic.
Treatment
Medical Aim• Anticholinergic drugs.• Levo-dopa.• Levo-dopa + Carbi-dopa (sinemet).• Dopaminergic agonists.SurgicalPallidectomy or Thalamotomy.
Chorea
• Definition.• Causes.• Types.1. Rheumatic chorea (Sydenham’s).2. Huntigton’s chorea .
Dancing involuntary movements
Athetosis
Different hand movements in athetosis.
Dystonia
• Types :Generalized Partial *Writer cramp.
*Oromandibular.*Blepharospasm .*Cervical dystonia.
Cervical Dystonia