椎体外系疾病Extrapyramidal disease神经病学双语课件.ppt

Extrapyramidal diseases Ⅰ.Formation of basal ganglia *Corpus striatum:/caudate nucleus \ neostriatum \lentiform/putamen nucleus / nucleus\globus pallidus- paleostriatum *Red nucleus *Substantia nigra *Subthalamic nucleus Ⅱ Function Regulation of voluntary motor activity Ⅲ.clinical features 1.Poverty of movement-hypertonia syndrome position: substantia nigra ;globus pallidus ex : Parkinson’ s disease 2.Increasing of movement-hypotonia syndrome position: caudate nucleus ;putamen nucleus ex : Chorea minor Parkinson’s Disease Ⅰ.Definition It is also called paralysis agitans. It is a slowly progressive degeneration disease of the extrapyramidal system. It is characterized by tremor、rigidity、bradykinesia 、abnormal gait and attitude. Ⅱ.Etiology and Pathogenesis 1.age:40years old \ 2.Environmental factors :MPTP degeneration of DA neurons 3.Genetic factor / (50%) Ⅲ.Pathology and biochemical pathology  1.Pathology (1)Macroscopic changes: no special changes (2)Microscopic changes:widespread cellular degeneration, in substantia nigra, Lewy’s body 2.Biochemical pathology HVA ? tyrosine ↓ dopadecar ↓ decomposition hydroxylase - boxylase ↑MAO,COMT Levo-tyrosine →→→→ Levodopa →→→→ dopamine ↓ ↓↘ Caudate nucleus ←←←←←←←←←↓ ↘ ↙Substantia nigra- Ach ↑ putamen ↙ corpus striatum path ↓ nucleus ↓ clinical features Ⅳ.Clinical Features 1.tremor:usually first occur(60-70%) “pill-rolling” static tremor : the trem