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Neuro > Extrapyramidal System > Flashcards

Extrapyramidal System Flashcards

1
Q

Pyramidal

A

primary pathway for voluntary movement

direct activation pathway

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2
Q

Extrapyramidal

A

responsible for the regulation of reflexes and maintenance of tone and posture

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3
Q

Extrapyramidal System Comprised of:

A

(subcortex structures)

  • basal ganglia (nuclei of the EPS)
  • corpus striatum (globus pallidus, putamen, caudate nucleus)
  • subthalamic nucleus
  • substantia nigra
  • red nucleus
  • brainstem
  • reticular formation
  • associated complex interconnecting pathways
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4
Q

Basal Ganglia

A
  • nuclei (main part)
  • behind the eyes
  • contributes to control of the body’s posture, overall muscle tone, and facilitation/coordination of muscle movements (works w/cerebellum)
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5
Q

Corpus Striatum

A

(basal ganglia and internal capsule)

initiates and regulates gross, intentional movements of the body

-stimulation of parts of the corupus striatum produce stereotyped movements such as flexion of an entire limb

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6
Q

ESP also controls….

A
  • automaticity of walking and/or running
  • cooperation of independent movements of the extremities
  • freedom of movements
  • suppress unwanted involuntary movements including tremors
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7
Q

Movement Disorders

A

disprders involving the EPS

examples: 
Parkinson's disease 
Sydenham's chorea 
Huntington's chorea
Athrtosis 
WIlson's disease 
Tourette's syndrome
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8
Q

Lesions in the basal ganglia my produce:

A
  • various abnormal postures
  • confliction between flexion and extension
  • facial tics, lip-smacking
  • abnormal deglutition
  • flailing of the arms
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9
Q

Diffuse lesion in Globus Pallidus and and Corpus Striatum

A

may result in Athetosis

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10
Q

Degenerative changes in Subthalmic Nucleus

A

may result in Ballism

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11
Q

Lesions involving Caudate Nucleus

A

may result in Chorea

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12
Q

Diffuse Basal Ganglia pathology

A

may result in Dyskinesia

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13
Q

Degenerative changes in Substantia Nigra

A

may result in tremor

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14
Q

Athetosis

A

slow twisting and writing movements in muscles of the UE (includes speech muscles; tongue)

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15
Q

Ballism (Hemiballisum) (quick form)

A

wild flinging movements that usually involve one side of the body (violent)

Quick Form of Dysarthria

  • forceful, swinging, jerky, and sudden movements of arms/legs
  • one side ofthe body (hemiballism) and is associated with subthalamic nucleus contralateral to the side w/the dyskinesia
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16
Q

Chorea (quick form)

A
  • rhythmis,quick involuntary movements of the muscles in distal extremities (head, neck, face, limbs, and trunk)
  • rapid and appear coordinated but are purposeless
  • muscles tone can var from hypo to hyper and include extremities and speech musculature
  • fatigue can bring on chorea movemnets so rest can help
  • movement can increase with increased fatigue and emotional distress
  • appears gracefull (dance like)
17
Q

Dyskinesia

A

accessory movements associated with a desired motor act

18
Q

Tremor

A

rhythmic movements associated with either resting or intention types

resting=substantia nigra
intention=cerebellar

19
Q

EPS Biochemisrty

A
  • neurons in substantia nigra produce neurotransmitter dopamine
  • dopamine=inhibitory
  • depletion of domamine results in parkinsonsim
  • levadopa or L-dopa may help replenish dopamine and reduce s/s of parkinsonism
  • other neurotransmitters may be affectsed by disorders of ESP
20
Q

Hypokinetic Dysarthria

A

Perceptual Characteristics- monopitch, reduced stress, monoloudness, inappropriate silences (freezes), short rushes (parkinsons disease)

Localization- ESP

Etiologies- PD, drug induced

Neuromuscular Conditions- slow movements limited ROM, paucity of movements, rigidity, loss of automaticity, resting tremors, pill rolling, immobility

21
Q

Primary Parkinsonism

A

idiopathic, degenerative disease of middle age (40-60y)

the term primary refers to the structure or organ

22
Q

Symptomatic Parkinsonism

A

occurs secondary to encephalitis, arteriosclerosis, and/or various toxicities such as carbon monoxide and manganese drugs

sympotmatic= “as a result of”

23
Q

Wilson’s Disease

A
  • inherited disorder, results from excessive amounts of copper collecting in the brain, liver, cornea
  • progressive disease of early life
  • ataxic-spastic-hypokinetic dysarthria
  • impaired muscle tone is usually followed by tremor or athetoid movemnets
  • tremors will often precede rigidity or impaired muscle tone
  • voluntary movements and deglutition are impaired early and to severe degrees
  • can have masked facies, lose emotional control and mild dementia
  • psychiatric illness may be present
24
Q

Kayser-Fleischer Ring

A

are dark rings that appear to encircle the iris of the eye

25
Q

Hyperkinetic Dysarthria

A

occurs secondary to lesions at various sites within the ESP (often involves the corpus striatum)

three forms

  1. Quick forms
  2. Slow forms
  3. Tremor forms
26
Q

Hyperkinetic “Quick” Dysarthria

A

(chorea movements)
Perceptual Characteristics- CI, prolonged intravals, variable pitch, monopitch, harsh voice quality

Localization - EPS

Etiologies- Huntingtons Chorea, Ballism, Terets syndrom, infection

Neuromuscular Conditions- quick, involuntary, jerking, tics, variable muscle tone

27
Q

Hyperkinetic “Dystonia” Dysarthia (slow)

A

Perceptual Characteristics- CI, Distorted vowels, Harsh voice, Monopitch and monoloud, Strained-strangled quality

28
Q

Sydenham’s Chorea (QIick Form)

A
  • movement disorder that occurs in childhood secondary to inflammation or infection
  • a lot of time after rheumatic fever(strep throat)
  • recovery usually in a few months but may persist
  • jerky movements in peripheral parts of limbs (hands and fingers) w/grimacing, fidgeting and clumsiness
  • often in prepubescent femals but can occur in males
  • tx:antibiotics for rheumatic fever
29
Q

Huntington’s Chorea (Disease) (Quick Form)

A
  • disease passed down throught families where nerve cells in brain (cerebral cortex and corpus striatum) degenerate
  • genetic defect on chromosome #4
  • adut onset (30-50y) or early onset
  • abnormal/unusual movemnets; behavior change in some
  • dementia may co-occur and get progressively worse
  • quick, sudden, jerky movements in arms, legs , face and other body parts; unsteady gait
  • no tx; treat symptoms w/compensation and maintenance
30
Q

Tourette’s Sundrome (Quick Form)

A
  • disorder of nervous system causing a person to produce involuntar sounds anf movements (tics)
  • symptoms usually appear b/w ages 7-10y
  • facial tic is most common tic
  • intensity levels are situational and may change
  • dx:a person must have had may motor tics and at least one vocal tic over the course of a year (occuring most every day)
  • antispychotis, antiepileptics, clonidine, tetrabenazine
  • DBS (Deep Brain Stimulation)
  • strong evidance that is it passed down in families
31
Q

Dystonia (Slow Form)

A
  • movement disorder
  • may affect single body area or be generalized troughout multiple muscle groups
  • often leads to abnormal posturing and/or sustained muscle contractions (spasms)
  • dystonias that last for minutes or hours are known as dyskinesias
  • torsion is applied to the term when there is a twisting, contraction of the muscle or muscle group
32
Q

Torsion Dystonia (Dystonia Types)

A
  • spasmodic plantar flexion of he feet
  • rotation of the UE and trunk
  • lordosis (sway back) and scoliosis
33
Q

Torticollis (Dystonia Types)

A

-dystonia that affects the head and neck

34
Q

Tardive Dyskinesia (Dystonia Type)

A
  • irregular, quick-jerky to slow undulating movemnts
  • uncontrolled movements ofthe tongue
  • intermittent strangled phonation
  • transient breathiness
35
Q

Essential Voice Tremor (EVT)

A
  • disease of invountary movements
  • can result from a lesion affecting the ESP
  • occurs with or without tremors of hands and other body parts
  • -regularity and relative smoothness of movements (distinguished from PD and ataxia)
  • type of dystonia
  • tremors can involve: larynx, pharynx, velum, base of tongue (can impact the entire speech mechanism)
  • tremors are regular
  • ST not usually effective; some meds help; botox is often used
36
Q

Spasmodic Dysphonia

A
  • voice arrests that are irregular and representative of laryngeal spasms
  • irregular voice arrests on vowel prolongation
  • choking, strained-pitch, effortful phonation
  • 2 primary types of SD
    1. Adduction- VT closing
    2. Abduction- open irregularly (breathy)
    - arresting of voice and irregular
  • diane rehm(NPR) has it

Neuro (4 decks)

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