It is a term often used to describe the movements of someone with cerebral palsy CP. Blepharospasm is a focal dystonia of the muscles surrounding the eyes which can result in rapid blinking or even sustained or forceful eye lid closure. Bradyphrenia means slowed thinking. People with bradyphrenia often rely on others to speak for them. It is important to differentiate slowed thinking from being passive or depressed which are also common in parkinsonism as depression can be treated.
Chorea refers to involuntary, irregular, purposeless, non-rhythmic, abrupt, rapid or unsustained movements that seem to flow from one body part to another. A characteristic feature of chorea is that the movements are unpredictable in timing, direction and body parts affected.
Chorea may be suppressed when mild and infrequent and often can be incorporated into movements that appear purposeful. When infrequent, the movements appear as isolated, small, brief, somewhat slow dance-like movements. Chorea is usually accompanied by an inability to maintain a sustained grip or posture. CBGD is an uncommon form of parkinsonism that affects one side of the body more than the other.
A person with CBGD may have rigidity, dystonia, tremor at rest and on action and difficulty demonstrating a particular task playing charades , such as combing hair with an imaginary comb, brushing teeth with an imaginary toothbrush, or cutting a loaf of bread with an imaginary knife and fork.
Some people will report their arm or leg acts on its own without the person realizing there is movement. For more information, visit Cure PSP. A condition in which the pathologic changes seen in Parkinson disease have spread beyond the brainstem to involve the cerebral cortex.
The symptoms include a decline in cognition and episodes of hallucinations. It is debated whether diffuse Lewy-body disease is a continuum of Parkinson disease or a distinct disease entity. Dyskinesia is a general term for any abnormal involuntary movement. Tardive dyskinesia sometimes resembles chorea, dystonia, myoclonus, tics or tremor. Therefore, it is important that dyskinesias are very precisely described by the examiner in terms of rhythm, speed, duration and pattern.
It is very important for the individual to tell the examiner what brings on or helps control the dyskinesia and when during the day the dyskinesia is easier or more difficult to control. Dystonia refers to twisting movements and postures that tend to be sustained at the peak of the movement, often patterned and repetitive. Opposing muscles contract simultaneously to produce the sustained quality of dystonic movements. When dystonia first appears, the movements typically occur only with a voluntary movement of the affected body part action dystonia.
As dystonia worsens, dystonic movements can appear in the affected body part at rest even when other parts of the body are moving voluntarily overflow dystonia. When a single body part is affected, the condition is referred to as focal dystonia.
Generalized dystonia indicates involvement of one or both legs, the trunk, and some another part of the body. Care4Dystonia, Inc. Essential tremor is the most common movement disorder among adults as well as the most common cause of tremor.
An estimated thirteen million people of all ages and ethnic groups are affected by essential tremor in the United States alone. In essential tremor, hand or head tremor occurring with voluntary movements action tremor is most common.
For more information visit: International Tremor Foundation at www. Freezing refers to being stuck in one place, usually lasting seconds. It is one of the possible signs of parkinsonism. After a few seconds, the freezing clears spontaneously, and the patient is able to move at a normal pace again, until the next freezing episode occurs.
Freezing most often affects the legs while walking, however speech and arm movements can also be involved. Freezing often occurs in crowded spaces, before reaching a chair or obstacle or when pressured for time such as at the top of the escalator or just before the elevator door closes.
Hemifacial spasm refers to muscle contractions involving only one side of the face. Generally these are rapid, brief, repetitive spasms but can also be mixed periods of sustained or absent spasms. Often the movements are triggered by voluntary facial movements such as smiling. Hemifacial spasm usually affects both upper and lower parts of the face at the same time.
In some cases, it may be due to pressure on the facial nerve by a nearby blood vessel. The classic sign of HD is a dance-like involuntary movement, called chorea.
Other problems resemble dystonia , myoclonus , motor restlessness or tremor. Multiple System Atrophy MSA is a sporadic, progressive disorder affecting multiple parts of the nervous system hence the term. These systems include the basal ganglia parkinsonism , cerebellum balance problems , motor neurons spasticity and weakness and autonomic function problems impotence, noisy breathing or snoring, low blood pressure when standing up, urinary problems, dizziness, cold pale hands.
Myoclonic jerks are sudden, brief, shock like involuntary movements caused by muscle contractions positive myoclonus or sudden loss of muscle tone negative myoclonus. Myoclonic jerks are usually irregular, but can be rhythmical and may occur in only one part of the body or in several different body parts.
Myoclonus rarely if ever can be suppressed by the person. The jerks may be triggered by sudden stimuli such as sound, light, visual threat, or movement. Myoclonus can occur in isolation or along with other neurologic symptoms. Myokymia is a fine persistent quivering or rippling of muscles. Myokymia occurs most commonly in facial muscles and can continue during sleep.
Synkinesis is the occurrence of involuntary movements in one part of the face when there is voluntary movement is another part of the face. For example, when a person smiles, the eyelids will close involuntarily. With orthostasis, orthostatic hypotension or postural hypotension a person reports the sensation of lightheadedness when changing postures from lying to sitting or sitting to standing.
Orthostasis is commonly seen in parkinsonism but can also occur as a side effect of medications commonly used to treat parkinsonism. Parkinson disease is the most common form of parkinsonism a collection of motor signs. People with Parkinson disease have bradykinesia and at least two of the following signs: tremor at rest , rigidity , and loss of postural reflexes. They often also have a shuffling gait, a flexed posture, small handwriting, a soft voice and decreased facial expression.
Later in the disease freezing and cognitive decline can occur. Parkinson disease is more common in men. In the United States there are about a million people with Parkinson disease more than the combined numbers of multiple sclerosis, muscular dystrophy and ALS combined and about 10 million worldwide.
Approximately 60, Americans are newly diagnosed each year. The incidence of Parkinson disease increases with age. Occurs due to damage to the cerebellar hemispheres Tremor postural, action, intention tremor : patients with tremor perform the finger-to-nose test with shaking fingers Dysdiadochokinesia Inability to perform rapidly alternating agonistic-antagonistic movements Positive rapid alternating movement test : the patient is unable to rapidly screw in an imaginary large light bulb using both hands slow, uncoordinated movements Rebound phenomenon Stewart-Holmes sign The patient is asked to flex their elbow against resistance applied by the examiner pulling the forearm in the opposite direction; sudden release of the arm by the examiner results in an overshooting movement.
Pendular knee jerk Abnormally increased patellar reflex Leg movement persists beyond initial reflex triggering Cerebellar drift : the patient is asked to extend their supinated arms at shoulder level ; the arm ipsilateral to the lesion will pronate and drift upwards. Diagnostics Cerebellar syndromes are primarily a clinical diagnosis , based especially on the evaluation of posture, gait, and movements.
References Daroff RB, et al.. Bradley's Neurology in Clinical Practice. Updated: June 18, Accessed: October 31, Acute alcohol intoxication Wernicke encephalopathy thiamine deficiency Posterior cerebral artery stroke limb ataxia Brain tumors involving the cerebellum e. Gait ataxia : abnormal wide-based and unsteady gait Truncal ataxia Limb ataxia with dysmetria Tremor postural, action, intention tremor Dysdiadochokinesia Dysarthria scanning speech Oculomotor dysfunction including nystagmus.
Unable to perform. Disorders of the dorsal columns e. Gait ataxia : wide-based , high-stepping gait with a stooped posture Postural instability and impaired proprioception that worsen in poorly lit conditions. The anatomic basis for this phenomenon is obscure. The principal disease affecting the cerebellum in cats is cerebellar hypoplasia due to in utero infection with the panleukopenia virus. This disease will be discussed here.
Neurologic signs of cerebellar involvement also may be seen in association with those diseases that affect the CNS multifocally.
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