2. Hemiballismus :
• Definition: neurological sign that present as hyperkinetic involuntary
movement disorder.
• Basal ganglia syndrome resulting from damage to the subthalamic
nucleus in the basal gangli
• Characteristic : intermittent, sudden, violent, involuntary, flinging, or
ballistic high amplitude movements involving the ipsilateral arm and
leg
• Cause by: dysfunction in the central nervous system
3. Cause
• Stroke : causes injury die due to lack of oxygen resultIng impaired blood
supply. In the basal ganglia, this can result in the death of tissue that helps
to control movement. As a result, the brain is left with damaged tissue that
sends damaged signals to the skeletal muscles in the body
• Traumatic brain injury
• Amyotrophic lateral sclerosis : neuronal loss or gliosis (glial cell damage) in
basal ganglia, potential to cause hemiballismus
• Neoplasms : abnormal cell growth
• Vascular malformations : abnormal blood supply to brain
• Tuberculomas : tumor due to meningitis Infection
4. Diagnosis
• Brain imagining : MRI ,CT scan
• Hemorrhage, ischemic infarction, or mass lesion We can see in MRI
• Patient’s abnormal movements. These must be from other
hyperkinetic movement disorders such as tremor, akathisia, and
athetosis.
8. Biceps reflex
• Ask the patient to relax their arms in their lap. Identify the biceps
tendon within the antecubital fossa and strike it with a tendon
hammer.
• There are multiple innervations to the biceps via C5 and C6, primary
innervation is associated with C5.
• Sensory : Lateral deltoid
• Motor : Rhomboidsa (elbow extends backward with hand on hip) In
raspinatusa (arm rotates externally with elbow exed at the side)
Deltoida (arm raised laterally 30–45° rom the side)
• Pain distribution : Lateral arm, medial scapula
9. • Motor : Thumb/index nger; Dorsal hand/lateral forearm
• Sensory : arm exed at the elbow in supination
• Pain sensation : Lateral Forearm, thumb/ index fingers
10. Triceps reflex
• Lift the patient’s shoulder into abduction and internal rotation, with
the arm flexed to 90°. Identify the triceps tendon on the posterior
aspect of the arm proximal to the olecranon, and strike it with a
tendon hammer.
• triceps muscle is innervated by the radial nerve primarily C7.
• Motor : Middle Fingers Dorsal Forearm
• Sensory : Triceps ( Forearm extension, Flexed elbow) Wrist/ Finger
extensorsa
11. Bronchoradialis reflex
• Other name : Supinator reflex & Inverted supinator reflex
• Striking the brachioradialis tendon directly with a reflex hammer
when the patient’s arm is relaxing. This reflex is carried by the radial
nerve The reflex should cause slight pronation or supination and
slight elbow flexion
• There are multiple innervations to the Brachioradialis via C5 and C6,
primary innervation is associated with C6.
12. Finger flexor reflex
• C8 & T1 nerve root
• Motor : Palmar surface of little finger Medial hand and Forearm
• Sensory : Abductor pollicis brevis (abduction of thumb) First dorsal
interosseous (abduction oF index Fi nger) Abductor digiti minimi
(abduction of little Finger)
• Pain distribution : Fourth and fifth fingers, medial hand and Forearm
13. Types of movement
• Arbitrary & non arbitrary
• Arbitrary movement : the expression of thought through action.
Virtually all areas of the central nervous system are involved in this
process. The main flow of information may begin in cognitive cortical
areas in the frontal lobe, or in sensory cortical areas in the occipital,
parietal and temporal lobes.
• Non arbitrary :occurs when you move your body in an uncontrollable
and unintended way. These movements can be anything from quick,
jerking tics to longer tremors and seizures. You can experience these
movements in almost any part of the body, including: neck. face
