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said involuntary movements or involuntary movements, as a part of voluntary muscles, an involuntary muscle contraction hardly everme muscle. Patients with clear consciousness is not self-control skeletal muscle movements. There is a common clinical muscle bundle trembling, muscle twitching, cramps, convulsions, myoclonus, tremor, dance-like movements, athetosic and reverse the spasm.
About the cause and mechanism of pathogenesis of clinical manifestations of convulsive seizures tremor myoclonus dance-like movement athetosis torsion spasm involuntary movements other studio diagnostic tests to identify other laboratory examinations related diseases About Chinese name: English name involuntary movement: involuntarymovement
Alias: involuntary movements, involuntary movements (involuntarymovement) when the patient is aware (and sometimes may also occur in mild perturbation of consciousness or light coma) occur beyond the control of skeletal muscle is not normal movement, many forms, usually when the increase in the emotional, sleep, stop; the disease occurs mostly in extrapyramidal cerebral cortex motor area of brain stem, cerebellum, spinal cord or peripheral nerve muscle lesions may also cause. Extrapyramidal system involving all cone outside the structure and norm of movement and downlink outlets, including the basal ganglia, cerebellum and brain stem nuclei in a number of extrapyramidal symptoms usually refers to the basal ganglia lesions due to posture, movement abnormalities. With basal ganglia lesions on the involuntary movement of anatomical and physiological basis as contoured beneath Pok: basal ganglia and motor function in the main structure of the striatum and its makeup as shown in Figure 1 lesion syndrome. Striatum and the cerebral cortex and other brain zones of the fiber interlock intricate (Figure 2), the correlate with motor cortex basal ganglia circulate is adapted to effect movement of the main structural features, including: 1. Cortex – neostriatum – pale cones (inner) – thalamus – cortex loop. (2) cortex – neostriatum – pale cones (external) – subthalamic nucleus – pale cones (interior) – thalamus – cortex loop. 3 leather – neostriatum – substantia nigra – the hypothalamus – leather loop. And through different neurotransmitters such as glutamate, γ-aminobutyric acid and dopamine norm of sports to achieve the cause and mechanism of cortical motor area and the downstream fibers, basal ganglia, brain stem, cerebellum, spinal
essence, peripheral nerve and muscle disease can cause various ministries of the involuntary movements. Such as the dance-like movements, athetosic, twisting spasm caused by the fashionable striatal lesions; rhythm and limitations of myoclonus and inferior olivary nucleus, dentate nucleus and ruddy beam damage to the olive: dance movement to the contralateral cerebral lesions caused by nuclear; tremor by striatum, cerebellum and cerebellum-related frameworks or cause frontal lobe lesions; muscle bundle fibrillation seen in motor neuron disease and so on. Involuntary movements may be due to physical or mental factors, but mostly due to organic disease, mainly seen in the infection, poisoning, degeneration, genetic and familial disorders such as developmental abnormalities, also seen in cerebrovascular disease, trauma, tumors, etc. . In recent years, the pathogenesis of the nervous system neurotransmitters (Pok delivery of stuff) of research has made large progress that the material stored in the nerve axon extremities in synaptic vesicles, including acetylcholine, norepinephrine, dopamine, 5 – hydroxytryptamine, γ – such as GABA and glycine to taboo dopamine-based facilitation of acetylcholine the main areas. Extrapyramidal neurons depends on the functional status of the balance of neurotransmitters, dopamine
amine and acetylcholine is more important, such as decreased striatal dopamine and acetylcholine arose out of balance tremor paralysis, 5 – serotonin and histamine and also the generation of the tremor. Another instance is the promoted character of dopamine in the facilitation occurs involuntary dance now the one hand, this mechanism is not fully understood extrapyramidal disease caused by posture, movement abnormalities, there is not the type of irregular movement include: 1. Pa Parkinson disease may be resting tremor (statictremor). 2 Parkinson’s disease are at increased extensor and flexor muscle tension can cause muscle stiffness (rigidity). 3 small chorea Huntington’s chorea and neural permanence etc., can often guide to chorea (chorea); Hemichorea (hemichorea) restricted to the side of the body, common in stroke brain tumors. 4.Huntington chorea Wilson disease, hepatic encephalopathy, Hallervorden-Spatz disease, phenol plug Qin class and haloperidol may cause continuing poisoning athetosis (athetosis); unilateral athetosis more common in stroke . 5 side of the body darting motion (hemiballismus) of the subthalamic kernel and its related pearly lesions caused by sensitive lateral cones. 6. Extrapyramidal disease (such as liver degeneration) may be more dystonia (myodystonia). 7 tics – Tourette’s Syndrome who tend to meditation that a great many Pok is a special type of epilepsy. Variety of clinical manifestations of clinical manifestations is now on its type and characteristics are as with: 1. Tremor is a chapter of the body according a definite intention and importance of rhythmic wag among colossal and small involuntary movement in the hands of the most common, followed by eyelid head and tongue. Tremor can be divided into physiological, functional and pathological
of three varieties. (1) physiological tremor: tremor lesser extent, eye movement is more difficult to see apparently common in the hand, the frequency of 8 to 13 times / s. (2) functional tremor: This type of tremor may be enhanced physiological tremor. This is a small and hasty without the decree of vibration amplitude tremors ranging in size and often irregular and varied. More common in the fingers is often no change in muscle tone and mental factors. Hyperthyroidism caused by misgiving and fatigue, hand tremor also fall into this category this is because the adrenaline to enhance its role in muscle spindle sensitivity and sympathetic activity increased results. (3) pathological types of tremor can be divided into the following Ji: convulsions (a) hemifacial spasm (facialtic, Beu’sspasm) due to pain stimulation reflex spasm of facial muscle contractions are called . When the onset of pain often associated with risk of recurrent seizures side muscle, mouth led to the ipsilateral, conjunctival hyperemia, tearing and other symptoms. There are also general hemifacial spasm, mostly on one side, the performance of the eyelid twitching, accompanied frown muscles, nasal various muscle, impudence muscle contraction, rapid and frequent eyelid was twitching, such as long period, can be repeated tonic contraction caused by the eyelid, the levator muscle, palpebral fissure tapering. Hemifacial spasm and hemifacial spasm clinical manifestations of the same. (B) hand-foot-pumping provoke disorder (tetang) or poisoning caused by low blood calcium. More common in infants, kid and lactating women. Performance breach occurs bilateral tonic spasm, upper limb significantly. Typical Involved lower extremity, there are bent toe and ankle plantar and knee straight. Can have serious mouth, the orbicularis muscle spasm. A explicit sense of attack. Chvostck sign and beam arm test assured. Hypocalcemia may also produce hand-foot-pumping take hold and epileptic convulsions. (C) tetanus (tetanus) tetanus patients by external stimulation, often of systemic tonic or clonic convulsions, which lasted a few seconds. Conscious, in pain, intermittent muscle does not relax, palpation can still find hard tonic state, with the most meaningful masticatory muscle. History of trauma, spasm morbid laugh, opisthotonus other diagnosis can be reminded to tetanus. (D) neonatal convulsions (neonatalconvulsion) neonatal convulsions are epileptic seizures. Light was limited or laterality clonic spasm, EEG showed sharp wave foci or normal side. Be severe was the whole body tonic spasm or myoclonus, or teeny cones of the eye or limb tonic or clonic movements, associated with multiple sharp waves on EEG foci, diffuse paroxysmal activity or low ping potential. (E) grand mal epilepsy (grandmalepilpsy) clinical manifestations of sudden loss of feeling, head to the side or back, side eye movement up or cones, straight or arm flexion and extension, hand grip, straight or table leg flexion. Contraction due to respiratory muscle rigidity, apnea can occur, face and skin tight cyanosis, amplified pupils, light responses disappear. Followed by a sustained muscle contraction to a relaxation of the clonic contractions, head, trunk and limbs showed a strong contraction. As the abdominal muscle and bladder contraction, may have urinary incontinence, seizures stopped after the turn to sleeping state. In addition to get up up after the sign outdoor, not via the memories of the attack. Since the attacks began to recover consciousness experience 5 to quarterutes. Gap period onset epileptic EEG may have a variety of payout. (F) limitations epileptic seizures (localiedepilepsy) for a array of regional
clonic seizures, mostly found in the mouth, eyelids, fingers or feet. Convulsions, mostly short, the general consciousness. EEG showed the limitations of rhythm spikes, sharp wave or spike – slow wave. (G) of febrile seizures (hyperpyreticconvulsion) children under the age of 3 undergoing from diseases resulting from a high fever, which is due to children of a dysfunctional neural regulation performance. Generally in the temperature suddenly mushrooms to above 38 ℃, which lasted 2 to 6 hour period, was the form of grand mal epilepsy, is generally in agreeable condition after the attack, neurological examination found no abnormalities. Febrile seizures in a heating process only once, after the high fever can also attack. Children to 6 to 8 years of age, is rarely attack. (H) A few days antecedent of hysterical convulsions (hystenicalconvulsion) before the onset of mental factors, the presence of disease than others, sudden onset of fall, head thrown back, body stiffness, trismus, fist time outside of the thumb in the palm . Tonic spasm, the following irregular foot dancing. Often mixed with calling in the turn, smiling and wailing called the Ma and other emotional reactions. Unconscious loss, such as pupil and plantar reflex change no change. The usual color or flushing, mostly non-biting tongue, falls and incontinence, each episode perpetual tens of minutes to hours, by others, solace or handling length. Patients can narrate the attack through. Spasm (a) writer’s cramp (writingspasm) nerve disease are mostly functional diseases. In writing when the muscular tension because of the hand and motor abnormalities caused by writing dysfunction. Patients in the holding pen or start writing when difficulties. This spasm occurs mainly in the fingers, wrist or even the whole upper limb. Some cases were caused by intrinsic extensor spasm tonic contraction, followed by gradually spread along the concordance finger and medium finger to the natural thumb long extensor muscle contraction, resulting in thumb abduction. The most important feature of the disease is the paperback time cramps, not to write when the symptoms disappear. (B) spasmodic torticollis (spasmodictorticollis) which is characterized by involuntary neck muscle exercise
, sternocleidomastoid, trapezius and other involuntary shrinkage, resulting in spasmodic torticollis. Showed a tonic brawn abbreviation, sometimes showing clonic alternatively tonic-clonic contractions, so the premier rotate accompanied by torticollis and small shook his pate. Attack brain tilted sideways, and corner slightly to the contralateral jaw ascent. Spasmodic torticollis in a sitting location, standing position, feelingful and disposed to the influence of the surrounding surroundings, while the mattress quiet time apt decrease, blink away, free to discipline increased. Sometimes give rival movement namely checking into the vanish of torticollis, the sternocleidomastoid muscle and nerve compression can be evoked. (C) the cramps (cramp) in the tonic muscle contraction accompanied by pain. Peripheral nerve and muscle disease can reason. Often raging activities during the day behind the night, generally more common in lower limb gastrocnemius. 1. Neurogenic myotonia (neuromyotnia): the cause is unknown, from old 5 to 60 years antique Jie disease. Disease constantly months or years gradually progress and amplify. In the recess, active contraction of the muscles showed a continuing, accompanied by severe pain. Often the first violation of hand, foot, face and pharynx after the muscles, tongue, limbs, trunk muscle spread, accompanied by widespread muscle twitching, choking often occurs, and for of ambition pneumonia and death. 2.MCArdle’s syndrome (MCArdlessymdrome): As the muscle enzymes alternatively a lack of phosphorus acid, phosphorus acid, leaving fructokinase irregular muscle contractions, spasmodic contraction was due to tonic spasm, passive tension to pain, the pain increased with the degree of manoeuvre exasperated, objective checkup found not abnormalities. 3 rigid male syndrome (stiffmansyndrome): common in men, there is a sense of axial needle-like muscle pain, and the continued incidence of symmetry of skeletal muscle stiffness, cramps, bitter muscle spasms. Ocular, cardiac and smooth muscle are no affected, muscle stiffness without slumber, spinal anesthesia and barbiturate narcotics. Tremor (a) asleep tremor (statictremor) in the case of the muscle entirely loosened, quiet state namely appeared below the name tremor rest tremor. This tremor disappears in sleep, training to decrease or perish. Rhythmic tremor of 4 to 6 times / second, more tempo. Rest tremor was found in the head with arms covered in recent cross-site lesions. 1. Parkinsonism (paralysisagitans): likewise understood for Parkinson’s syndrome (parkinson’ssyndrome) in patients with Parkinson rest tremor often a inferior amplitude, there is tempo (4 to 6 times / sec). General tremor after the array is issued aboard an side, emulated by the ipsilateral lower terminal, upper terminal and is anew spread to the additional side of the lower limbs. Jaw, lips, tongue and head were finally involved. Upper than lower extremity tremor often massive. Rhythmic tremor of the fingers to form the so-called: Associated with decreased muscle rigidity and action. Resting tremor is an of the characteristics of the disease, but disease progression, its either all motionless or movement tremors, the tremor is often cumbersome in the morning, early morning light, disappeared during sleep. And a quondam remedial history and the corresponding state, such as encephalitis syndrome after Parkinsson past history of encephalitis are common eye emergency, seborrhea, and increased salivation. 2 senile tremor (seniletermor): occurs in the elderly, common in rest tremor. Its frequency, extent and Parkinson syndrome similar. Tremor in head, jaw and lips extra common, was nodding favor tremor or side outlooks. But no muscle traction increased and decreased movement. 3. Liver degeneration (hepatolenticulardegeneration): also understood as Wilson disease. The tremors of the disease and parkinson syndrome generally similar to vigorous muscle and contraction of antagonistic muscles interactive rhythm, when the free movement
to preserve a certain position or when the tremor is very strong, very serious in the case of increased muscle tone combined with the emergence of involuntary movement, was a complex abnormal movement. In stationary conditions on both sides of the body showing the rules of rhythmic tremor, fast, amplitude vary in size, and even the whole body moving. In addition to rest tremor, the tremor appeared when voluntary movement, and tremor in movement speed, amplitude is increased, spread to the whole upper limb. If the hand that is resting tremor, fast, up to 140 knocks / min, as a means neb test, causing severe hand tremors, can not even touch the nose. With extrapyramidal symptoms and Kayser-Flelscher ring. (B) direction tremor (intentionaltremor) appeared in random movement, so called action tremor. Often limb movements appear or start to exercise. Fast reached target is obvious. Mainly seen in the cerebellum and its efferent pathways of the disease, such as cerebellar tumors, vascular disease, multiple sclerosis, diffuse axial weeks encephalitis, disseminated encephalomyelitis, etc. Compared with resting tremor, was no rhythm, large amplitude, enhanced by the emotional impact. 1. Cerebellar disorders: cerebellar lesions mainly purpose tremor, the Department or from the bottom of the dentate nucleus dentate nucleus lesions caused pathway. Still does not appear tremor, slow movement speed tremor, but the amplitude of the thick, irregular. As for the nose test, or a toast, the tremor greatly significant. Associated with movement disorders. (2) multiple sclerosis (multiplesclerosis): The disease cerebellar aim tremor of multiple, often intention tremor and postural tremor combination occurs. Patients with tremor at rest does not appear, and when sitting or standing position when the head is the trunk back and ahead, the amplitude began to small, then gradually increase, combined with the recurrent brain, spinal cord and optic nerve damage characteristic to consider the diagnosis. (C) postural tremor (posturaltrema) for the affected parts of the body to preserve a proactive posture when the tremor. That does not appear in the stationary state, only when the patient’s body in a posture of circumstances tremors. Clinical common diseases are: 1. Tremor (idiopathictrema): early onset and often a family history of tremor. Postural tremor only symptom-based disease. Often seen in the hand, influence fine motor, prose, and chopsticks to eat with a spoon. Followed by the head, the performance of small nodding or shaking action. When patients with upper smooth, showing that both sides refer to the Ministry and the wrist of 5 to 8 times / second tremor, amplitude variable, when the stress increased. Neither of the disease and exercise reduce muscle rigidity, nor hypotonia, ataxia, nystagmus, and drunken gait and tremor, paralysis and other symptoms and easily told cerebellar disorders. 2. Flapping tremor: postural tremor produced the main features. At rest and disappears during sleep, enhanced mental excitement. When patients approach the 2 upper limbs, and maintain a certain posture straight wrist position, wrist flexion suddenly, then speedily straighten the wrist to its native position, so that repeated wrist flexion and extension, like a flapping wing. This tremor with irregular, no rhythm, amplitude is characterized by frequent changes. Mainly seen in systemic metabolic diseases, such as hepatic coma, uremia, chronic pulmonary insufficiency, hypokalemia, center failure of polycythemia, steatorrhea, Whipple disease, and hypomagnesemia. Department of recurrent inhibition of the central nervous system caused by muscle tension and excitement. 3. Poisoning and contagious tremor: a variety of drugs and alcohol, lithium, Qian, phosphorus, magnesium, mercury, carbon monoxide poisoning and a variety of infections (such as typhoid, varicella, smallpox) can occur postural tremor. Such as alcoholism, tremor at rest is not obvious, when the upper approach your fingers to detach and maintain this position clear when the tremor, tremor with its vibration characteristics. Such as occurred in the fingers, and then spread to the tongue, facial and nose muscles. Laughing and talking can be seen when a small tremor. Mercury poisoning caused by the tremor, rhythmic tremor was temperate, when at rest, exercise more emphatic, the nearer the destination into the stronger tremor. The rest tremor and postural tremor appeared merged, when the fatigue and mental excitement increased. (D) mixed tremor also has two or more of the tremor that mixed tremor, such as cerebellar disease, liver degeneration can be combined resting place, postural and intention tremor. Hysterical tremor showed varied irregular tremor, tremor of different sizes. At rest and during exercise there. There are obvious psychological factors, often accompanied by other symptoms of hysteria, when the tremor spread to ease the patient care, focused consideration on the lesion tremor increased. Myoclonus (a) rhythmic myoclonus 1 soft palate, throat muscles and other parts of the rhythmic myoclonus: in the soft palate, throat, larynx muscles and muscle, diaphragm muscle contraction and other produce, were each synchronization sec 2 or 3 times per minute up to 100 times faster. Contraction was sustained to sleep or sedation can not control, acupuncture, or stimulants can cultivate symptoms, exercise can temporarily stop random. The most common type is the soft palate soft palate tremor confined to the Ministry of the soft palate up and down rhythmic vibration, accompanied by the movement back and throat, myoclonus can be amplified until muscle, facial muscles and diaphragm. If hiccups when the diaphragm clonic, myoclonic eye cones when the eye movement prejudice, as the rhythm. Such myoclonus is due to medullary olive, red nucleus in the brain and ipsilateral cerebellar dentate nucleus of the triangle linking three parts of the lesions results. Common in vascular lesions, tumors, and encephalitis. 2 pestilence encephalitis, rhythmic myoclonus: epidemic encephalitis in the acute stage or sequelae, there’s a myoclonus. This myoclonus was fast rhythm, about 10 times per minute around the contraction was sustained,
does not produce physical efficacy, but the fingers exception. Were synchronized, and even cause the plenary muscle meantime contraction occurs in the abdominal muscles, chest, facial or hand muscles, often accompanied by central pain, Dubini’s electric shock-like chorea in this classification. 3. Myoclonic epilepsy: the myoclonus epilepsy known as the cardinal manifestation of myoclonic epilepsy, multiple spikes on EEG or spike – slow wave delivery and other epileptic. Divided according to their clinical manifestations following Ji kinds: (1) hereditary myoclonus (Unverricht’s disease): a home history, chiefly as a sudden, lightning-like muscle contractions, routinely bilateral, one side can also be detected, often violation of neck, shoulder, arm muscle. Reduce the digit of attacks increased with age, ahead the onset of prodromal omens such as palpitations, chest discomfort, etc. Myoclonus often due to emotional factors, sound and light provocation, fatigue, chilly aggravate. The size of incidents may be associated with epilepsy. (2) consistent constraints myoclonus: a muscle or group of muscles caused by clonic contractions, resulting in many parts of the distal limbs. In most cases, was rhythmic tic, and often muddled with Lachson’s epilepsy, the distinction was sustained by the former. (3) cerebellar myoclonic epilepsy: the disease of epilepsy, myoclonus, cerebellar symptoms of the 3 chief symptoms. Does not generate their effect. This type of myoclonus occurs when free movement resistance movement that, due to the role of antagonistic muscles have the inverse direction of movement. Can happen in children hidden neuroblastoma and adult lung cancer patients. (4) other type of myoclonus: In appending to these three types of myoclonus, there are a number of unknown etiology or degeneration caused by myoclonus, such as Schilder’s disease, hereditary ataxia, cerebellar atrophy, pick’s disease are may have myoclonus. (B) non-rhythmic myoclonic 1 multiple vice myoclonus: in 1881, also known as Friedrich’s first reported Frid-erich’s disease. Clonic contraction of muscles, not synchronized, no rhythm, movement generally mini effect, contraction frequency of 40 to 50 times per minute. In keen contraction under the influence of emotions, mostly progressive, quiet time away. Mainly affects the muscles and trunk muscles. Often first appear in the lower limb myoclonus, after spread to other parts of the body, face and respiratory muscles rarely involved. Tendon reflexes, consciousness no abnormalities, seizures and muscle atrophy does not appear. 2 muscle fiber contraction (Morvan’s chorea fiber): patients began first in the waist and lower limb labor and muscle pain. Muscle contraction than in the leg, could later be spread to the trunk and upper limbs, head and face are not violated, the proximal limbs significantly. Muscle fiber contraction in the muscle part of the war showed mini fluctuation, and muscle tremors happen at differ points in the place and frequency of different preference sites of this disease is mainly the lower limbs, and trunk and upper limbs rare. At rest, sleep does not disappear when the contraction, mechanical stimulation can induce. Between the disease and now thatthe brain lesions. 3 symptomatic myoclonus: In viral encephalitis, purulent fertile meningitis, paralytic dementia, severe Alzheimer’s disease, tetanus, strychnine poisoning and metabolic disorders (uremia, hypoxic encephalopathy) and so can be seen temporary or persistent symptoms of myoclonus. Dance-like movement (a) small chorea (xhoreaminor) main pathological changes of the basal ganglia, cerebral cortex, brain stem, cerebellum, etc. dispersed arteritis and nerve compartment degeneration. Often a manifestation of acute rheumatism. 80% of disease in childhood, mostly acute onset, often before the prodromal phase is now taking off. The average term of about a week, a mild increase in body temperature. After the limb and behind pain; awkward hand, foot and movements not working. Hold things settled, followed by emergence of dance-like movement. Start light and limitations, and gradually spread to the whole body, and its dance-like movement of the upper limbs showed alternating straight joint, flexion, torsion and other movements. Finger flexion and adduction stop; hand and arm is heaved also far when a special position, wrist flexion, metacarpophalangeal coupler hyperextension, each finger straight separated from the arm over-pronation, said pronator sign (pronatorsign). Bumps under the muscle performance of gait, and often fall. Trunk approximately the spine can also curl or distort. Facial grimace extravaganza, ruffle volume, blink, pouting, tongue, eyebrow, and so crowded, changing incessantly. Trunk and abdominal breathing may be due to involuntary movements and chance uneven. Dance-like movements may be due to emotional or exacerbated by voluntary movement, reduced supine resting, sleep disappeared. Voluntary movement may be due to decreased muscle tone, ataxia, or true muscle weakness and can not be reconciled, each action are out of a sudden impulse, quite natural, normal muscle strength was significantly reduced. In severe cases like paralysis, known as paralytic chorea (paralyticchorea). Pregnancy and clinical manifestations of chorea Huntington’s similar to small, more common in 17 to 23-year-old primipara, and more in the middle term before the onset of pregnancy, there can be in the pregnancy or after allocation to stop on their own, can also stop quickly after the abortion. (B) chronic ongoing chorea (chronicprogressirechorea) also known as the Hunt-ington’s chorea, after the onset of more than 30 years of age, is an autosomal dominant genetic disease, is degeneration of the thinking cortex and the striatum caused by the clinical traits of dance-like movements and progressive disease to reside. Dance-like movement of the disease moves slowly, a large range, no rhythm, initial symptoms of clumsiness, not for fine motor, and finally developed into the surrounding involuntary dance-like movements or dance athetosis. Dance-like movement in facial wording because the surface cheap muscle intonation, facial relaxation, looks like atheism, the lack of expression in the nervous or talking face appears dance-like movement, mouth half open, pouting, tongue telescopic tamper head is not independent flexion, behind, reverse, or make a face, fingers, a small tremor, sometimes with actual movement, and even can not jot, with clothing, food. Road instability, often dysarthria, nasal voice was monotonous. (C) senile chorea (senilechorea) occurred in 50 years of age or older. Pathological root of warmhearted strewed ecology of malacia, primarily the Ministry of the striatum is more obvious clinical manifestations of disease with Hurtington’s similar to dance, but the incidence of late, no genetic history can be secondhand because diagnosis reference. (D) of hemi-chorea (hemichorea) showed finite side of the upper and lower extremities of the involuntary dance movement. It is a small chorea, chronic progressive chorea part. Basal ganglia may also be the outcome of vascular mar. More common in middle-aged. Incomplete paralysis caused by cerebrovascular disease can occur, dance-like movement can be made swiftly after the occurrence of hemiplegia after, also in a few weeks or months after, more complete hemiplegia, often appear in the paralysis began to revive after the dance action. This involuntary movements normally heavy upper and lower limbs and facial light. (E) symptoms of chorea (symptomaticchorea) brain diseases such as acute or chronic encephalitis, intracranial lesions, cerebrovascular disease, liver degeneration and brain degeneration, hypoxia, poisoning (Qian, mercury , magnesium, carbon monoxide, etc.), and systemic metabolic diseases (such as islet compartment tumor caused hypoglycemia secondary to brain damage), muscular stability, etc. can occur with dance-like movement, shrieked the symptoms of chorea. Athetosis (a) idiopathic athetosis (idiopathicathetosis) of unknown etiology. Characterized by either sides of athetosic, with altering degrees of increased muscle tone and cerebral retardation. Mostly congenital, the disease among a few months after birth, in the face, head and limbs, abnormal movement. Mental retardation, lecture late or can not talk. Walking difficulties, hiking or lower extremity muscle tone was spastic, with Little’s disease is similar. (B) symptomatic athetosis (symptomaticathetosis) 1. Cerebral infantile paralysis: in the prenatal phase or childbirth, and have caused brain damage (precocious birth, trauma during pregnancy, childbirth is cerebral anoxia, severe neonatal jaundice, etc.) caused, in addition to athetosic symptoms, there are a kind of different parts like nerves, psychiatric symptoms, such as athetosic side of hemiparesis, pyramidal tract damage symptoms. Athetosic bilateral spastic limbs associated with lacking paralysis. 2 adult stroke athetosic: Adult stroke after unilateral athetosic extremely infrequent, is part of the hypothalamus syndrome. Other degeneration disease (liver degeneration, Schilder-foix’s disease, progressive atrophy psychosis sallow cones) and inflammatory disease (lethargy encephalitis, whooping cough, measles, diphtheria, etc.) can occur athetosis. Torsion spasm, also known as alteration tables dystonia (dystoniamusculorumdeformans) torsion dystonia (torsiondystonia), the trunk Xu hyperactivity. Clinically, dystonia, and proximal limbs or trunk twisted along the longitudinal axis deformity represented. Torsion in the limb muscle tension increased, reversing the stop is normal. (A) primary torsion spasm (primarytorsionspasm) of unknown etiology, often a family history. The main pathological changes in the basal ganglia and thalamus and other parts of the brain nerve compartment degeneration and gliosis, in the caudate nucleus and putamen the most obvious alteration. More than 5 to 15 years in the slow onset, initial symptoms are mostly mild side of the lower extremity movement muddle, was varus foot plantar anthem, not the heel when wading, the slow continuous involuntary movement to reverse the trunk and limb proximal to the most solemn, causing lordosis and pelvic incline, involuntary movements involving the nape and elbow muscles when there is shrieked spasmodic torticollis torticollis (spasmodictorticollis). Involving the face and throat muscles, causing hemifacial spasm and dysarthria. Intelligence, strength and consciousness are normal, involuntary movements stopped completely after falling dormant. (B) the symptoms of torsion spasm (symptomatictorsionspasm) seen in infection, disease, poisoning (heavy metals, drugs, gas poisoning, etc.), and tumors. Reverse the movement to reverse the involuntary spasm of the nature and athetosis same, but the sometime mainly affects the nape muscle, proximal muscle torso and limbs, and facial or hand muscles or completely spared or merely mildly affected. Symptomatic torsion spasm may increase due to emotional factors, often misdiagnosed as hysteria. Hysterical involuntary movements suggestibility effects, and often have psychological elements as the backdrop. Other involuntary movements (a) unilateral throwing film (hemiballismus) for the violent side of the body’s involuntary movements like throwing, similar to the dance-like movements, proximal limb heaviness, a large range of film, strength, muscular lines to assorted causes the subthalamic nucleus damage caused, also ascertained in the striatum to the conduction tracks of the subthalamic nucleus lesions, such as illness, rheumatism, or inflammation. (B) muscle fibers tremor (myokymia) commonly known as flesh bound. For a number of motor units or a team of muscle fibers of spontaneous transient tetany-like contractions. Now that the creation of fibrous twitching because acting on the anterior horn cells or the excitability of muscle fibers is incongruous due to nutritional effects, or because of spontaneous impulses in motor nerve fiber distribution results. Group of bordering muscle fibers are ordinarily alternating or intermittent contraction of the muscles showed continuous fluctuations of the surface. Such movement more thick and persistent muscle bundle fibrillation, but in common there is no atrophy. Can be physical in nature, seen in fatigue, cold, can also be ascertained in the debilitating neurological disease and patients with other metabolic disorders (such as heavy bleeding after the wastage of salts, uremia) and so on. In motor neuron diseases can occur attach with muscle parcel fibrillation. Single-side persistent twitch muscle fibers found in brain stem disease. (C) bundle vibration and muscle fibrillation (fasciculationsandfibrillations) bundle fibrillation is a small muscle or fast contraction of some muscles. To the nude eye to watch the most shrewd involuntary movements. Usually of the muscles of patients complained almost jumping movement. Muscle fibrillation in the muscle belly of a muscle among a few centimeters on a small example of the rapid vibration or peristaltic. As is also small, the nude eye can not look. EMG on the performance of small, repeated short spike-wave latent. Muscle fibrillation is generally trusted that the anterior horn cells or spinal cord motor nucleus of cranial nerve provocation phenomenon, and muscle bundle fibrillation is the phenomenon of the anterior root stimulation. Fasciculations and muscle fibrillation fibrillation are lower motor neuron damage important signs. Muscle fibrillation in the limbs, face, tongue can occur, but the most obvious tongue. This is because separately from the tongue, all other parts of the rind cover is complicated to detect. Fibrillation associated with muscle atrophy of the muscle bundle can be found in a kind of benefits motor neuron disease, but the most common degenerative diseases, such as progressive spinal strong atrophy, amyotrophic lateral sclerosis and progressive bulbar palsy and other amusements Neuron disease. No muscle atrophy of the muscle bundle fibrillation can also be found in the normal rest, after fatigue and tension, more common in calf and arm muscles, known as spontaneous benign muscle bundle fibrillation. (D) of tardive dyskinesia (tardivedyskinesia) Tardive dyskinesia in long-term antipsychotics after the involuntary movements. The most common cause of the disease the drug is phenothiazine plug Qin (such as chlorpromazine harvest), and C the phenyl ketones (eg, haloperidol). After a year of continuous medicine for at least 5 to 10% have movement disorders. Some cases three months after catching the drug to sick. Generally trusted that long-term blocking of dopamine receptors, the latter due to hypersensitivity responses. Sudden withdrawal can be induced. Because antipsychotic drugs to dopamine neurons in long-term sustainability of the stop, as the adaptive response, increased sensitivity of dopamine receptors, if suddenly out of these drugs, the membrane receptor blocking effect was relieved, also much neurotransmitter is cause or worsen tardive dyskinesia. Mainly It’s about time: the value of wrinkles, wink, bawl mouth, twisted tongue, Su Zhao mouth, tongue and sometimes out, sometimes retracted, and sometimes reverse the left and right, teeth, mouth repeatedly, which must reverse the neck, shoulders, torso , before and after the flexion and enhancement, the distinctive leg movements, sometimes shrug dwindle back like movements, rapid breathing, finger movement maneuvering, and some associated with the dance-like limbs, trunk or athetosic like movement, severe twitching, myoclonus or increased muscle tone caused by reversing the spastic movement disorders, spasmodic torticollis and other symptoms. Symptoms disappear in sleep, increase excitement, spoke reduced. Abnormal movement may be due to walking, movement, percussion and so induce the increase. (E) Acute dystonia (acutedystonias) which is caused by antipsychotic drugs for acute dystonia, pathogenesis and dopamine in the synaptic crevice.