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PENDAHULUAN

(movement disorders)
Motoric System
EXTRA PYRAMIDAL SYSTEM
Influences spinal motor activity
Consists of : the cerebral cortex
the basal ganglia
the mid brain
Basal ganglia
1. globus pallidus
2. putamen
3. caudate nucleus
4. substantia nigra
5. subthalamic nucleus ( corpus Luysi )
6. red nucleus (substansia rubra)

1 = paleotriatum = palaeostriatum
1 + 2 = lentiform / lenticular nucleus = nc.lentiformis
2 + 3 = neostriatum = striatum
Lesion in extrapyramidal
The main sign :
Disorders of muscle tone ( dystonia )
Involuntary movement disorders ( hyper / hypo / akinesia )
absent during sleep

2 syndromes (clinical) :
1. Hypokinesia hypertonia ....................substansia nigra
2. Hyperkinesia hypotonia .....................neostriatum
A. Hypokinesia hypertonia syndrome

a. Parkinsons disease = paralysis agitans = shaking palsy


Degeneratif process hereditary
Loss of melanin containing neurons of substantia nigra & of
dopaminergic neurons that connect with the striatum
Bilateral, unilateral

b. Parkinson syndrome = parkinsonism


- Neuronal loss in the substantia nigra
- caused by postencephalitic parkinsonism, cerebral arteriosclerosis,
trauma, tumors, intoxication by Co, Mg, etc
3 cardinal sign :

a. Brady / akinesia

starting a movement becomes very difficult, the mobility decreases, the


entire body anteflexed position, no swing during walking, Hypo / amimia (a
mask face) , speech monotonous, dysarthic

b. Rigidity

Cogwheel phenomenon, postural refleks


c. Tremor
Passive tremor : 4 8 movements / sec , Pill rolling = money counting
movement, resting tremor
B . Hyperkinetic hypotonic syndrome

Lesion in neostriatum, occasionally globus pallidus, thalamus,cerebral cortex

1. Chorea
short, fast, jerky movements
distal proximal portion of the extremities
Chorea minor = Sydenhams chorea = St Vitus dance
- in children, linked to rheumatic fever ( = chorea infectiosa )
- acute, self limiting
Chorea gravidarum

- acute chorea, early pregnancy

Chorea major = Huntingtons chorea

- middle age, dominant, hereditary, degenerative disease

- cortical neuron degenerate dementia


2. Hemiballism = ballistic syndrome
lesion of the subthalamic nucleus ( Luysi ) contralateral
the muscle of shoulder & pelvis out reaching & hurling movements

3. Spasmodic torticollis, torsion dystonia


biochemical abnormallity of the putamen, thalamus (centro median nucleus
& in other extrapyramidal nuclei)

4. Athetosis
Continuous, arrhytmic, slow, wormlike movements
Distal portion of the extremities
Posture & movement are bizarre
Caused by perinatal damage to the striatum
Sistem Koordinasi
A. ANATOMI DAN FAAL
Lobus flocculonodu = Archicerebellum
Mempertahankan keseimbangan

Lobus anterior = Paleocerebellum = spinocerebellum


Regulasi tonus otot dan mempertahankan sikap badan

Lobus posterior = Neocerebellum = Pontocerebellum


bagian terbesar
Koordinasi berbagai gerakan lincah
Gejala gangguan pada neocerebellum

A. Dismetri
Salah menafsir jarak
Karena kontraksi otot tidak direm oleh otot antagonis
B. Intentio tremor = tremor ataksik
Tremor saat hendak melakukan suatu gerakan bertujuan
Gangguan dalam koordinasi gerakan , penderita sadar dan berusaha
untuk mengkoreksinya
C. Gangguan sikap tubuh
D. Adiadochokinese
Ketidakmampuan melakukan gerakan berubah-ubah dengan cepat
Karena adanya kontraksi dan relaksasi yang lambat atau berlebihan
E. Hipotoni yang bersifat ipsilateral dengan lesi
Karena hilangnya pengaruh fasilitas cerebellum terhadap strech reflex
F. Gangguan pada mata
Skew deviation : deviasi keatas dan keluar dari bola mata pada sisi
yang berlawanan dengan lesi , deviasi kebawah dan kedalam dari bola
mata pada sisi lesi
Nystagmus horisontal atau rotatory
G. Gangguan artikulasi dan fonasi (bicara rero, meletus-letus)
H. Gangguan langkah
Bila berdiri atau berjalan hendak jatuh ke sisi lesi ............ataxia
cerebellaris
Gejala gangguan pada paleocerebellum
Gangguan sikap tubuh
Gangguan tonus otot

Gejala gangguan pada archicerebellum


Ataksia trunkal : bila penderita disuruh duduk, badannya tampak
bergoyang
Kadang disertai vertigo

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