Pyramid & Extrapyramidal disorders & Parkinsons

Pyramidal System Where are the pyramids of the brain?

Anterior potion of the medulla oblongata

Pyramidal System. What is its structure? What is it function?

The pyramidal tract (aka Corticospinal) travels between the cerebral cortext of the brain & the spinal cord (via the pyramid of the medulla). The Corticospinal tract is concerned specifically with discrete voluntary skilled movements, especially of the distal parts of the limbs. Wiki

motor system which is used to make conscious movement.

What is pyramidal pattern weakness? Extra Pyramidal System Generally speaking what is the Extra Pyramidal system? What is the function of the extra pyramidal system ? Name the Extra Pyramidal

Mm weakness with anti-gravity muscles (extensors of the lower limb & flexors of the upper limb) are spared. Pt can develop posture of flexed & pronated arms with clenched fingers & extended & abducted legs w plantar flexion of the feet - Turner
Extrapyramidal tracts are mainly found in the Reticular Formation of the pons and medulla, The system is called "extrapyramidal" to distinguish it from the tracts of the motor cortex reflexes, locomotion, complex movements and postural control

Extra Pyramidal tracts are background helpers Reticulospinal (sets mm tone via the spindles)
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Tracts ROVeR

Rubrospinal (It is one of the pathways for the mediation of voluntary movement. Responsible for large and fine movement. Originates from red nucleus to midbrain) terminates in the CSp which suggests it is used in control of the UEx but not LEx) Oliviospinal Vestibulotract

How do Extrapyramidal disorders present? What are the 2 categories of extra ExtraPyramidal Disorders? Clinical features of Decreased Movement

As more or less UMNL Seen as movement disorders these days Decreased Movement Increased Movement Postural disturbance: failure to make quick postural adjustments. Patient often falls. Flexion of limbs and trunk is associated with this Bradykinesia: a loss or slowness of voluntary movement
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Mask like face Reduced blinking Reduced adjustments of posture when sitting Clinical features of Increased Movement MR T BCD Myoclonus (shock like jerks) Rigidity stiffness of limbs (During passive movement can be felt throughout the ROM & equally in flexors & extensors = Plastic/Lead Pipe Rigidity) Tremor Ballisimus (explosive, violent movements) Chorea (repetitive, irregular, jerking movements) Dystonia (slow, sustained, abnormal voice) Parkinsons Progressive degeneration of cells within the pars compacta of Substantia Nigra in the midbrain- causing a loss of dopamine. Disorder of basal ganglia Latin for Black substance. Appears dark due to high levels of melanin in dopaminergic neurons. Its a brain structure located in the mesencephalon (midbrain) that plays an important role in reward, addiction & movement. Parkinson's disease is characterized by the death of dopaminergic neurons in the substantia nigra pars compacta.

Whats the most common eg of Ext Pyrmd Disease? PARKINSONS DISEASE Pathology What is Substantia Nigra?

Aetiology Clinical Features BRiT

Cause unknown. Possibly genetic Classic triad of Bradykinesia (especially decreased ability to start & continue movements) Rigidity i Tremor & associated changes in posture and gait
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Signs PS DRHR

Pill rolling tremor Spidery, small handwriting Difficulty starting movements Resting tremor (especially early in the morning) Hypertonia (Cogwheel type timed jecky) Rigidity stiffness of limbs (During passive movement can be felt throughout the ROM & equally in flexors & extensors = Plastic/Lead Pipe Rigidity). Passive movements are jerky

Symptoms

Symptoms asymetrical to begin with (if symmetrical its unlikely that they have parkinsons) Face is like a mask unexpressive. Reduced blinking Voice quiet & monotonous - think of muhammed ali Gait- stiff, shuffling Speech monotonous, hypophonic dysarthria due to a combination of bradykinesia & rigidity and tremor Depression Increased Walking on paper or Counting steps: uses conscious movement tiring. uses pyramidal system (corticospinal tract) Drugs (attempting to restore dopamine levels) only work for a short period of time

What will their reflexes be like? Therapy

What is chorea? What can cause it What is Huntingtons Disease? What is Hemiballismus? What can cause it

Involuntary, irregular, jerking, movement affecting limb and axial muscles. These movements can be suppressed with difficulty (resulting in semi-purposeful appearance eg. Crossing and uncrossing of legs) Huntingtons, Hyperthyroidism, Hypocalcaemia, SLE, PAN Heriditary condition characterised by personality changes and movement disorders Movement characterised by unilateral, violent flailing of the limbs. Involuntary movement is occasionally severe enough to throw the patient off balance Caused by infarction or haemorrhage in the conralateral subthalamic nucleus - turner
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Prognosis What are Tics?

Vascular disease Multiple Sclerosis Drug TTT is ineffective the condition often settles spontaneously A brief contraction of a muscle or group of muscles. Simple tics (eg. Twitching of eyelids) Complex tics are: abrupt, transient, coordinated movements or vocalisations.. Can be voluntarily suppressed & often takes the form of winking, grimacing, shoulder shrugging, sniffing & throat clearing. Characterised by Giles de la Tourette Syndrome Sudden occurrence of multiple motor tics accompanied by sudden explosive grunting
In Tourettes syndrome the basal ganglia are either no longer inhibiting or more likely stimulating some of the vocal centres directly so that you get this string of scantalogical language

Giles de la Tourette Syndrome

Differentiate between Pyramidal vs. Extrapyramidal structures + functions Predict possible sources of confusion in relation to UMNL Outline of management strategies: what do you tell the patient? Give an overview of their part in the control of movement and gait Describe Parkinsonism, choreo-athetosis, hemibalismus, tics Describe (explain?) typical features of extrapyramidal dysfunction
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