Extrapyram system

1. EXTRAPYRAMIDALEXTRAPYRAMIDAL
SYSTEMSYSTEM
In human anatomy, theIn human anatomy, the extrapyramidal systemextrapyramidal system is ais a
neural network located in the brain that is part ofneural network located in the brain that is part of
the motor system. The pyramidal pathwaythe motor system. The pyramidal pathway
(corticospinal and some corticobulbar tracts) may(corticospinal and some corticobulbar tracts) may
directly innervate motor neurons of the spinal corddirectly innervate motor neurons of the spinal cord
or brainstem (anterior horn cells or certain cranialor brainstem (anterior horn cells or certain cranial
nerve nuclei), whereas the extrapyramidal systemnerve nuclei), whereas the extrapyramidal system
centers around the modulation and regulationcenters around the modulation and regulation
(indirect control) of anterior horn cells.(indirect control) of anterior horn cells.

2. FUNCTIONSFUNCTIONS
The physiological functionsThe physiological functions of theof the
extrapyramidal nervous system areextrapyramidal nervous system are
- realization of the automated motions,realization of the automated motions,
- myostatic regulation,myostatic regulation,
- regulation of pose,regulation of pose,
- regulation of muscular tonus.regulation of muscular tonus.

3. WHAT STRUCTURES BELONG TO THEWHAT STRUCTURES BELONG TO THE THETHE
EXTRAPYRAMIDAL SYSTEMEXTRAPYRAMIDAL SYSTEM
 Cortex of frontal lobeCortex of frontal lobe
 Basal ganglia. There are corpus striatum, nucleusBasal ganglia. There are corpus striatum, nucleus
caudate (caudate (a tail kernel)a tail kernel), nucleus lenticularis, nucleus lenticularis
(consists of putamen and g(consists of putamen and globus pallidus medialeslobus pallidus mediales
and laterales),and laterales), substantia nigrasubstantia nigra, subthalamic, subthalamic
nucleus of Luys, nucleus ruber. There is rnucleus of Luys, nucleus ruber. There is reticulareticular
structure of brain stem. There are manystructure of brain stem. There are many
connections between these structures.connections between these structures.
 Anterior horn cells and at last – musculesAnterior horn cells and at last – muscules
 TheThe structures of bstructures of basal ganglia connect withasal ganglia connect with
opposite extremetes.opposite extremetes.

5. There are palleostriatum andThere are palleostriatum and
neostriatum.neostriatum.
 Nucleus caudate and putamenNucleus caudate and putamen belong tobelong to
neostriatumneostriatum (striatum).(striatum).
 Globulus pallidum, nucleus ruber, suGlobulus pallidum, nucleus ruber, substantiabstantia
nigra, subthalamic nucleusnigra, subthalamic nucleus belongbelong toto
palleostriatumpalleostriatum ((pallidonigral or pallidum)pallidonigral or pallidum)..
 There must be balance between these two parts.There must be balance between these two parts.
The mediator of palleostriatumThe mediator of palleostriatum systemsystem isis
dopamin, that synteses in sudopamin, that synteses in substantia nigrabstantia nigra,,
neostriatum - acetilcholin.neostriatum - acetilcholin.

6. The palleostriatum syndrom defeat.The palleostriatum syndrom defeat.
 Loss of dopamine neurons in the substancia nigra isLoss of dopamine neurons in the substancia nigra is
one of the main pathological features of Parkinson’sone of the main pathological features of Parkinson’s
disease.disease.
 The symptoms of the disease typically do not showThe symptoms of the disease typically do not show
themselves until 80-90% of dopamine function hasthemselves until 80-90% of dopamine function has
been lost.been lost. This neurological syndrom is characterizedThis neurological syndrom is characterized
byby
 TremorTremor
 HypokinesiaHypokinesia
 RigidityRigidity
 Postural instability.Postural instability.

7.  The resting tremorThe resting tremor, which is classically seen as a “pill-, which is classically seen as a “pill-
rolling” action of the hands that may also affect the chin,rolling” action of the hands that may also affect the chin,
lips, legs, and trunk, can be markedly increased by stresslips, legs, and trunk, can be markedly increased by stress
or emotions.or emotions.
 HypokinesiaHypokinesia refers to slow or diminished movement ofrefers to slow or diminished movement of
body musculature.body musculature. BradykinesiaBradykinesia: this is a: this is a slowness ofslowness of
movement.movement.
 RigidityRigidity: stiffness; increased muscle tone. In: stiffness; increased muscle tone. In
combination with a resting tremor, this produces acombination with a resting tremor, this produces a
"cogwheel" rigidity when the limb is passively moved."cogwheel" rigidity when the limb is passively moved.
 Postural instabilityPostural instability: leads to impaired balance and falls.: leads to impaired balance and falls.
There are some names of Parkinson syndromThere are some names of Parkinson syndrom --
hypertonichypertonic--hypokinetic syndrome, akinetic syndrome.hypokinetic syndrome, akinetic syndrome.

8. Gait and posture disturbances:Gait and posture disturbances:
 Shuffling: gait is characterized by short steps, with feet barelyShuffling: gait is characterized by short steps, with feet barely
leaving the ground, producing an audible shuffling noise.leaving the ground, producing an audible shuffling noise.
 Decreased arm-swing (Decreased arm-swing (acheirokinesia).acheirokinesia).
 Stooped, forward-flexed posture. In severe forms, the head andStooped, forward-flexed posture. In severe forms, the head and
upper shoulders may be bent at 90 degree relative to the trunk.upper shoulders may be bent at 90 degree relative to the trunk.
 PropulsiaPropulsia
 Festination: a combination of stooped posture, imbalance, andFestination: a combination of stooped posture, imbalance, and
short steps. It leads to a gait that gets progressively faster andshort steps. It leads to a gait that gets progressively faster and
faster, often ending in a fall.faster, often ending in a fall.
 Gait freezing: "freezing" is a manifestation of akinesia (anGait freezing: "freezing" is a manifestation of akinesia (an
inability to move). Gait freezing is characterized by an inabilityinability to move). Gait freezing is characterized by an inability
to move the feet which may worsen in tight, cluttered spaces orto move the feet which may worsen in tight, cluttered spaces or
when attempting to initiate gait.when attempting to initiate gait.

9. Speech and other disturbances.Speech and other disturbances.
 Monotonic speech.Monotonic speech. BradylaliaBradylalia – is slowing of speech.– is slowing of speech.
 DroolingDrooling: (also known as: (also known as ptyalismptyalism oror sialorrheasialorrhea) is when) is when
saliva flows outside the mouth. Most likely caused by asaliva flows outside the mouth. Most likely caused by a
weak, infrequent swallow and stooped posture.weak, infrequent swallow and stooped posture.
 Masked faces (a mask-like face also known as hypomimia,Masked faces (a mask-like face also known as hypomimia,
with infrequent blinking;with infrequent blinking;
 Difficulty rolling in bed or rising from a seated position;Difficulty rolling in bed or rising from a seated position;
 Micrographia (small, cramped handwriting);Micrographia (small, cramped handwriting);
 Impaired fine motor dexterity and motor coordination;Impaired fine motor dexterity and motor coordination;
 BradipsychizmBradipsychizm – the slowing of mental processes.– the slowing of mental processes.
 Akayria means obtrusive (one asks the same questions).Akayria means obtrusive (one asks the same questions).
 Pose of the patient is hunched.Pose of the patient is hunched.

11. The neostriatum syndrom defeat.The neostriatum syndrom defeat.
 This syndrom is called aThis syndrom is called a hypotonichypotonic--
hyperkinetic syndromehyperkinetic syndrome
 Hyperkines - is aHyperkines - is a involuntaryinvoluntary, irregulative, irregulative
motionsmotions

12. HYPERKINESESHYPERKINESES
There are such hyperkineses.There are such hyperkineses.
1.1. AthetosesAthetoses -- dyskinesia characterized by andyskinesia characterized by an
inability to maintain the fingers, toes,inability to maintain the fingers, toes,
tonguetongue in a stable position, resulting inin a stable position, resulting in
continuous slow, sinusoidal, and flowingcontinuous slow, sinusoidal, and flowing
involuntary movementsinvoluntary movements..

13.  ChoreaChorea is characterized by brief, irregularis characterized by brief, irregular
contractions that are not repetitive orcontractions that are not repetitive or
rhythmic, but appear to flow from onerhythmic, but appear to flow from one
muscle to the next. These are 'dance-like'muscle to the next. These are 'dance-like'
movements (from the same root word asmovements (from the same root word as
"choreography")."choreography").
 It can be the sign of rheumatism.It can be the sign of rheumatism.

15.  HemiballismHemiballism is a rare condition characterizedis a rare condition characterized
by wild movements, usually of the upperby wild movements, usually of the upper
limb, when the patient tries to move.limb, when the patient tries to move.
 It is usually abrupt in onset, followingIt is usually abrupt in onset, following
haemorrage, infarction or damage of thehaemorrage, infarction or damage of the
subthalamic nucleus of Luys.subthalamic nucleus of Luys.

16.  TorticollisTorticollis, or wry neck, is a condition in which the, or wry neck, is a condition in which the
head is tilted toward one side, and the chin ishead is tilted toward one side, and the chin is
elevated and turned toward the opposite side. Theelevated and turned toward the opposite side. The
head is typically tilted in lateral bending towardhead is typically tilted in lateral bending toward
the affected muscle and rotated toward the oppositethe affected muscle and rotated toward the opposite
side.side.
 Torsion dystoniaTorsion dystonia is the hyperkinesesis the hyperkineses
characterized by painful muscle contractionscharacterized by painful muscle contractions
resulting in uncontrollable distortions.resulting in uncontrollable distortions.

17.  BlepharospasmBlepharospasm: a type of dystonia causes: a type of dystonia causes
involuntary contraction of the eyelids. Theinvoluntary contraction of the eyelids. The
main concern for this dystonia is that it canmain concern for this dystonia is that it can
cause the eyelids to close involuntarily andcause the eyelids to close involuntarily and
for indefinite periods of time.for indefinite periods of time.
 MyokymiaMyokymia: spontaneous, transient or: spontaneous, transient or
persistent movements that affect apersistent movements that affect a
bundle of muscles.bundle of muscles.