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BG Fxn/Dysfxn

Clinical Notes for Basal Ganglia

Where is activity of the BG initiated? Cortical Levels
Nigral input to striatum provides what, & why? Continuous damping effect, so that cortical commands will be focused
Striatum integres & feeds info where? This influences activity of what? Globus Pallidus & SN-Pars Reticulata; Influences thalamus & other targets (superior colliculus, RF)
Thalamus projects where? Appropriate cerebral cortex loci
BG responsible for? Automatic execution of a learned motor plan
Damage to BG results in? Slower, less automatic & less accurate cortical mechanisms for motor behavior
During preparation & execution of mvmt, separate neurons within motor loop discharge selectively in relation to what? Target location in space; Direction of limb mvmt; Mm pattern
In oculomotor loop, neurons discharge in relation to? Visual fixation; Saccadic eye mvmt; Passive visual stimuli
Getting Hypothesis In normals, dopamine (inhibitory) & cortical sensorimotor (excitatory) inputs to striatum are in balance
What do cerebellum & BG have in common? BG= context encoders, info useful in planning & gating of action sent to cerebral cortex; Cerebellum = pattern generator/executor; Both work seamlessly with cerebrum to provide "perfect" automatic mvmt
Cerebral cortex does what? Acts as a repository to receive diverse info via ascending tracts, compute it & share it with BG & cerebellum
More cerebral cortex function Acts in executive fxn to implement action emanating from its collective computation processes for output via the SC
Are lesions of the BG & cerebellum UMN? NO
Pre-frontal Loop deals with? Spatial memory; Different from memory mediated by hippocampus & diencephalon; Appropriate switches in behavior
Limbic System Emotional & Motivational processes
Diseases of BG characterized by? Abnormal involuntary mvmts at rest; Disappear in sleep (non-intention tremor)
BG dysfunction can be either ___ or ___? Hypo- or Hyperkinetic
Most common mvmt disorder of the BG? Dystonia
Most common behavioral disturbance of BG? Abulia
What is abulia? Apathy, loss of initiative, & of spontaneous thought & emotional response
Hyperkinetic Disorders Chorea (Huntington's, Sydenham's); Athetosis; Ballism; Dystonia; Akathasia; Tourette's
Chorea Sudden, Frequent, involuntary, purposeless & quick jerks of trunk, extremities & head associated with facial grimaces
Huntington's Disease Hereditary; Choreiform mvmts beginning @ extremities/face that progress to more mm; Mental deficiency (progressive deterioration); Combination of hyperhypokinetic (pt becomes immobile & unable to speak/swallow)
Sydenham's Disease Childhood; Rapid, irregular, involuntary mvmts of limbs, face, trunk; Associated with rheumatic fever (pretty rare now); Transient results with full recovery
Athetosis slow, writhing, sinuous, continuous, wormlike mvmts of distal parts of extremities which show bizarre posturing; can have choreoathetosis
Ballism (Hemiballism) Vascular lesion, sub-thalamic nucleus (indirect motor loop); Mvmts of limbs, sudden, quick, continuous, unusually violent & flinging (contralateral to lesion usually); Proximal extremity mm usu involved (exaggerated chorea)
Dystonia twisting, slow, contorting, involuntary mvmt that is somewhat sustained & often repetitive; fixed abnormal posture develops in affected part; Focal, segmental, generalized; sometimes discrete lesion can be found
Akathasia Inability to be still, constant motion of limbs; Common SE of many neuroleptic drugs
Tourette's Motor tics (sudden, brief involuntary mvmt preceded by urge to perform, followed by sense of relief; eye blinking/shoulder shrugging); vocal tics; ADD/compulsive behaviors; condition of late childhood, can be outgrown; counseling is important!
Hypokinetic Disorders Parkinson's
What are the 3 classic s/sx of Parkinson's? Tremor, Rigidity, Bradykinesia
Parkinsonian Tremor non-intentional
Parkinsonian Rigidity- Plastic if pt doesn't also have tremor, mvmt to passive resistance is continuous throughout PROM
Parkinsonian Rigidity- Cogwheel if pt also has tremor, mm resistance can be overcome by a series of jerks (like a ratchet)
Parkinsonian Bradykinesia Diminution/loss of assoc mvmts, difficult to initiate mvmt, slow mvmt; Masked face; Slurred & monotonous speech
Postural disturbances in Parkinsonism Festinating gait; Kyphotic posture
Is there loss of power of sensation with Parkinson's? No, should test normal but be aware that patient may be de-conditioned due to sedentary lifestyle
What is the most consistent pathology in Parkinson's? Loss of dopamine; Leads to poverty of mvmt & difficulty in switching to new behaviors
What may be used to treat Parkinson's? Drugs, sometimes surgery
Can Parkinson's be cured? No, only treated. It is ceaselessly progressive, eventually bilateral (even when medicated)
Is Parkinson's strictly hypokinetic? No, inclues both types of motor disturbances (hyper [tremor, too much motion] or hypo [bradykinesia])
Created by: 1190550002
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