Síndromes Extrapiramidais

Prof. Felipe Barros

24 Oct 202107:40

Summary

TLDRThis video script discusses extrapyramidal syndrome, clarifying it is not synonymous with Parkinson's disease but rather a set of symptoms related to movement control disruptions. It explains the role of the extrapyramidal pathways in modulating movement, contrasting involuntary movements with those seen in pyramidal lesions. The script highlights key symptoms like rigidity, bradykinesia, and tremors at rest, which are characteristic of Parkinson's, but also mentions other movement disorders like ataxia, chorea, and dystonia, emphasizing the complexity of diagnosing and treating these conditions.

Takeaways

😀 Extrapyramidal syndrome is not synonymous with Parkinson's disease but refers to a set of signs and symptoms related to damage to the extrapyramidal motor pathways.
🏥 The term 'extrapyramidal' relates to the indirect motor pathways that modulate movement, in contrast to the 'pyramidal' system which is the direct motor pathway.
🧠 The extrapyramidal system involves structures such as the basal ganglia, including the claustrum, putamen, globus pallidus, and the substantia nigra in the brainstem.
🤔 Patients with extrapyramidal syndrome may exhibit involuntary movements and difficulties in initiating or controlling voluntary movements.
🚶‍♂️ Parkinson's disease, or parkinsonism, is characterized by extrapyramidal symptoms including bradykinesia (slowness of movement), rigidity, and postural abnormalities.
🔄 Parkinson's patients often show a 'pill-rolling' tremor at rest, which typically subsides during voluntary movement.
🧘‍♂️ The posture of a Parkinson's patient can be described as a 'skier's posture' with flexion at the knees, hips, and spine due to a shift in the center of gravity.
🔁 Parkinson's disease is not the only cause of extrapyramidal syndrome; other neurological conditions can also lead to similar symptoms.
🤷‍♂️ Other extrapyramidal symptoms can include dystonia, chorea, athetosis, ballism, myoclonus, and tics, which are related to rapid, involuntary movements.
🔄 The involuntary movements in extrapyramidal syndrome are often fast and exaggerated, unlike the slowness seen in Parkinson's disease.
👨‍⚕️ The diagnosis of extrapyramidal syndrome involves assessing the patient's movement patterns and distinguishing between the various neurological conditions that can cause these symptoms.

Q & A

What is the extrapyramidal syndrome?
-Extrapyramidal syndrome is a set of signs and symptoms related to damage in the extrapyramidal motor system, which is involved in the modulation of movement rather than the initiation of voluntary movement.
Is extrapyramidal syndrome synonymous with Parkinson's disease?
-No, extrapyramidal syndrome is not synonymous with Parkinson's disease. Although Parkinson's disease can present with extrapyramidal symptoms, the syndrome refers to a broader range of conditions affecting the extrapyramidal motor system.
What are the main structures that comprise the extrapyramidal motor system?
-The main structures of the extrapyramidal motor system include the basal ganglia, such as the claustrum, the putamen, the globus pallidus, and the substantia nigra of the mesencephalon.
What is the role of the basal ganglia in movement?
-The basal ganglia play a crucial role in modulating movement, including controlling the speed, intensity, and coordination of movements, as well as preventing involuntary movements.
How do involuntary movements manifest in patients with extrapyramidal syndrome?
-Involuntary movements in patients with extrapyramidal syndrome can manifest as tremors, dystonia, chorea, athetosis, ballism, myoclonus, and other abnormal movements that are often rapid and uncontrolled.
What is the difference between the movement disorder in extrapyramidal syndrome and pyramidal (corticospinal) lesions?
-In extrapyramidal syndrome, movements may be performed with difficulty, resulting in fragmentation or tremors, whereas in pyramidal lesions, movements may be characterized by spasticity and a 'clasp-knife' sign where the limb initially resists movement and then suddenly yields.
What are the typical symptoms of Parkinson's disease, which is a form of parkinsonism?
-Typical symptoms of Parkinson's disease include bradykinesia (slowness of movement), rigidity (stiffness), postural abnormalities like the 'skier's posture', and tremors at rest.
What is bradykinesia and how is it related to Parkinson's disease?
-Bradykinesia refers to a slowing down of movement, which is a characteristic symptom of Parkinson's disease, where patients may have difficulty initiating or maintaining voluntary movements.
What is the 'skier's posture' and why is it associated with Parkinson's disease?
-The 'skier's posture' is a term used to describe a characteristic postural abnormality in Parkinson's disease, characterized by a forward lean of the body, flexion at the knees, hips, and spine, often due to a shift in the center of gravity.
What is the difference between hyperkinesia and hypokinesia in the context of movement disorders?
-Hyperkinesia refers to excessive or overactive movements, often rapid and involuntary, while hypokinesia, as seen in Parkinson's disease, refers to a reduction in the speed and amplitude of movements.
Can you provide an example of another disease that can cause extrapyramidal symptoms?
-Yes, Huntington's disease is an example of another condition that can cause extrapyramidal symptoms, often characterized by chorea, which is a type of involuntary movement.

Outlines

00:00

🧠 Understanding Extrapyramidal Syndrome

This paragraph discusses the concept of extrapyramidal syndrome, clarifying that it is not synonymous with Parkinson's disease. It explains the extrapyramidal system as an indirect pathway for movement control, involving structures like the basal ganglia and the substantia nigra. The paragraph highlights the symptoms associated with this syndrome, such as involuntary movements and difficulties in initiating voluntary movements. It also differentiates between extrapyramidal symptoms and pyramidal symptoms, noting that while Parkinson's patients exhibit extrapyramidal symptoms, not all extrapyramidal syndromes are due to Parkinson's disease.

05:01

🔍 Exploring Other Extrapyramidal Syndromes

The second paragraph delves into the involuntary movements that can occur in extrapyramidal syndromes, specifically mentioning the rest tremor characteristic of Parkinson's disease, where the patient trembles at rest but the tremor subsides during voluntary movement. It also touches on other diseases that can cause extrapyramidal syndromes, such as ataxia, chorea, athetosis, ballism, and dystonia. The paragraph emphasizes the importance of movement control and modulation by the basal ganglia and the resulting clinical expressions of these diseases, which can vary from patient to patient.

Mindmap

Keywords

💡Extrapyramidal Syndrome

Extrapyramidal Syndrome refers to a set of signs and symptoms related to damage in the extrapyramidal motor system. It is not synonymous with Parkinson's disease, which is a common misconception. The term is central to the video's theme as it discusses the characteristics and implications of this syndrome. For example, the script mentions that patients with extrapyramidal syndrome may exhibit involuntary movements and difficulties in movement execution.

💡Extrapyramidal Motor System

The extrapyramidal motor system is involved in the modulation of movement and is distinct from the pyramidal motor system, which is responsible for voluntary movement control. The video emphasizes the importance of understanding this system as it plays a crucial role in the manifestation of movement disorders. The script explains that the extrapyramidal system includes indirect pathways that pass through various nuclei, such as the basal ganglia, to modulate movement.

💡Basal Ganglia

Basal Ganglia are a group of nuclei located deep within the brain that are critical for modulating movement, including the initiation, speed, and intensity of movements. The video script uses the term 'Basal Ganglia' to describe the structures involved in the extrapyramidal syndrome, highlighting their role in movement modulation and how their dysfunction can lead to various movement disorders.

💡Involuntary Movements

Involuntary movements are movements that occur without conscious control and are a key feature of extrapyramidal syndromes. The video script explains that these movements can be a sign of dysfunction in the extrapyramidal system and are often associated with conditions like Parkinson's disease. An example from the script is the tremor that occurs at rest, which is a characteristic involuntary movement in Parkinson's.

💡Parkinsonism

Parkinsonism is a term used to describe a clinical syndrome that has features similar to those of Parkinson's disease, including tremors, rigidity, and bradykinesia. The video script clarifies that Parkinsonism is not synonymous with extrapyramidal syndrome but is a condition that presents with extrapyramidal symptoms, such as the characteristic resting tremor and bradykinesia.

💡Bradykinesia

Bradykinesia, also known as slowness of movement, is a symptom of Parkinsonism and extrapyramidal disorders. The video script describes bradykinesia as a reduction in movement amplitude and speed, which is a common feature in patients with Parkinson's disease. It is used as an example to illustrate the impact of extrapyramidal dysfunction on movement.

💡Rigidity

Rigidity, or increased muscle tone, is another symptom of Parkinsonism and is associated with the extrapyramidal syndrome. The video script mentions 'hypertonia plastica' as a form of rigidity where the patient's muscles feel like they are cogwheels, indicating the characteristic tremulousness in muscle tone.

💡Postural Instability

Postural instability refers to the difficulty in maintaining balance and posture, often seen in Parkinson's disease. The video script describes a typical posture known as the 'skier's posture,' characterized by flexion at the knees, hips, and spine, which is a result of altered center of gravity due to the disease.

💡Freezing

Freezing is a phenomenon where a patient with Parkinsonism experiences a temporary inability to initiate or continue movement, often when trying to walk. The video script uses the term to illustrate a common issue faced by patients with extrapyramidal disorders, where the initiation of movement becomes challenging due to the loss of automatic movements.

💡Atetosis

Atetosis is a type of movement disorder characterized by slow, writhing movements that can be seen in some extrapyramidal syndromes. The video script mentions atetosis as one of the possible conditions related to the extrapyramidal system, indicating that it is a symptom of a broader category of movement disorders.

💡Dystonia

Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that cause abnormal postures or movements. The video script includes dystonia as one of the conditions that can lead to extrapyramidal syndromes, emphasizing its role in causing involuntary movements and postural abnormalities.

Highlights

Síndrome extrapiramidal is not synonymous with Parkinson's disease but refers to a set of signs and symptoms related to the extrapyramidal motor system.

The extrapyramidal system is involved in the modulation of movement, in contrast to the pyramidal system which is involved in voluntary movement control.

Key structures of the extrapyramidal system include the basal ganglia, claustrum, and substantia nigra of the mesencephalon.

Patients with extrapyramidal syndrome may exhibit involuntary movements and difficulties in executing voluntary movements.

Parkinsonism, which includes Parkinson's disease, presents with extrapyramidal symptoms such as hypertonia, also known as lead pipe rigidity.

A characteristic posture in Parkinson's disease is the 'skier's posture' with triple flexion indicating a change in the center of gravity.

Bradykinesia, or slowness of movement, is a typical feature of Parkinson's disease.

Festination and freezing are phenomena where patients have difficulty initiating movement and experience fragmented movements during walking.

Resting tremor is a common involuntary movement in Parkinson's disease where the patient trembles while at rest but stops when performing a movement.

Other diseases that can cause extrapyramidal symptoms include ataxia, chorea, athetosis, ballism, and dystonia, which involve rapid and exaggerated movements.

The basal ganglia play a crucial role in the modulation of movement, including speed and intensity, which can be affected in extrapyramidal syndromes.

Diseases causing extrapyramidal symptoms are not limited to Parkinson's but include a range of movement disorders.

The clinical expression of extrapyramidal diseases varies depending on the specific region affected and the type of movement control failure.

Involuntary movements in extrapyramidal syndromes can be rapid and uncontrolled, contrasting with the slowness seen in Parkinson's disease.

Understanding the role of the basal ganglia and their circuits is essential for diagnosing and treating extrapyramidal syndromes.

The video aims to clarify misconceptions about Parkinson's disease and its relationship with extrapyramidal syndromes.

The presenter hopes to provide valuable insights to help viewers better understand extrapyramidal syndromes and their impact on movement.