Presentation
The authors present a more detailed review with rich iconography from the own archive. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. [ncbi.nlm.nih.gov]
Similarly, the present report details a patient with nonketotic hyperglycemia and a hyperdense basal ganglion lesion with an unusual clinical presentation. [ceemjournal.org]
A 67-year-old Indian man presented with two days history of acute onset generalized dyskinesia associated with mild confusional state. [annalsofian.org]
Case 2 A 46-year-old male patient presented with sudden onset of slurred speech, slow gait and loss of balance. His medical history revealed insulin resistance and ESRD. [jneuro.com]
Entire Body System
- Asymptomatic
Patients may be initially asymptomatic. FS commonly affects young to middle aged adults in the fourth or fifth decades. However, it may occur at any point in life, including childhood or adolescence. [news-medical.net]
Physiological BGC is an incidental asymptomatic finding on CT, most com-monly seen in elderly patients. [bcmj.org]
Respiratoric
- Pneumonia
Aspiration pneumonia, pulmonary emboli, renal infections, and cardiac disease are common causes of death (953). iii. [neuroophthalmology.ca]
Many patients eventually develop retrocollis (a dystonic extension of the neck) and they often develop severe swallowing troubles (that can lead to pneumonia). [dartmouth.edu]
Gastrointestinal
- Vomiting
One week after surgery, the patient developed nausea, vomiting, diplopia, horizontal nystagmus, and seizures. Laboratory test findings showed anemia (hemoglobin, 8.8 g/dL), but all other findings were unremarkable. [ajnr.org]
Clinical features include headache, nausea, vomiting and changes in mental status, even coma. On MRI (fig. 5) symmetrical T2W and FLAIR hyperintensity involves the globus pallidi secondary to hemorrhagic necrosis [ 12 ]. [em-consulte.com]
Cardiovascular
- Hypertension
Results : A 32-year-old lady with history of type II diabetic mellitus, hypertension, old myocardial infarction post treatment of coronary artery bypass grafting, end stage renal disease under peritoneal dialysis for years. [mdsabstracts.org]
Hypertensive encephalopathy Hypertensive encephalopathy corresponds to a potentially reversible encephalopathy secondary to hypertensive emergency. Clinical symptoms include headaches and seizures in patients with acute hypertensive crisis. [em-consulte.com]
The basal ganglion is a common anatomic site for hypertensive ICH; thus, emergency physicians are familiar with these CT findings. [ceemjournal.org]
The patient had a 7-year history of type 2 diabetes mellitus, hypertension, ischemic stroke and ESRD with regular hemodialysis (thrice a week) since 16 months. [jneuro.com]
Ischemis Stroke Image Source: heart.arizona.edu Risk Factors of Basal Ganglia Stroke Hypertension occurs in 90% of the cases. [healthfixit.com]
Neurologic
- Tremor
[…] restricted to extrapyramidal tract, patients have NO paresis or neuropsychological impairments Characteristic features of basal ganglia (i.e., extrapyramidal) injury involve the following involuntary movement disorders: Parkinsonism – combination of resting tremor [brainaacn.org]
The tremor has been erroneously considered a tremor at rest, but actually it is a tremor of postural or resting muscle tension. [dartmouth.edu]
This distinguishes it from other disorders involving tremor in which the tremor persists during movement (essential tremor) or is specifically associated with movement (intention tremor in cerebellar disorders). [courses.washington.edu]
During follow up the tremor and gait imbalance resolved within 7 days and recurrent episode of hypoglycemia was not observed. [jneuro.com]
- Chorea
In 39 patients, chorea had ameliorated completely. The remaining 14 cases showed some improvement during the follow-up period. The chorea recurred in seven patients. CONCLUSION: C-H-BG is a benign disorder affecting the elderly. [ncbi.nlm.nih.gov]
Hyperglycemia associated unilateral predominant chorea could demonstrate with symmetrical T1–hyperintense lesions in basal ganglia on brain MRI. [mdsabstracts.org]
The model for choreiform disorders is Huntington's chorea. [dartmouth.edu]
Types of Hyperkinesia Chorea: Huntington’s chorea and Sydenham chorea. Wilson’s disease. Athetosis. Dystonia. Ballismus/Hemiballismus. Tardive dyskinesia. [drnajeeblectures.com]
Acute chorea and bilateral basal ganglia lesions in a haemodialysis patient. Kidney Int 2008;73:1087-91. [annalsofian.org]
- Resting Tremor
tremor, rigidity, bradykinesia/akinesia, and postural abnormalities Athetosis – slow continuous, writhing movements of the fingers, hands, face, and throat Chorea – intermittent jerking of limbs and trunk Hemiballismus – intermittent flinging of the [brainaacn.org]
[…] thalamus and cortex rigidity, increased tone, slow reduced movements, bradykinesia/hypokinesia, stooped posture, resting tremor are all symptoms of.... [memorize.com]
Symptoms The disease is diagnosed by observing a set of characteristic symptoms that affect motor control: resting tremor, bradykinesia, and hypertonia. Resting tremor is an oscillating movement that occurs when the patient is trying to be still. [courses.washington.edu]
tremor in jaw, lip, tongue Rigidity - cogwheel rigidity Bradykinesia - freezing Hypokinesia/akinesia - reduced frequency of swallow Hypokinetic Dysarthria: Other Neuromuscular Deficits Resting tremors of head, limbs, pill-rolling Festinating gait Decrease [ucs.louisiana.edu]
Low-amplitude bilateral upper limb resting tremor, bradykinesia and ataxic gait was present. Laboratory investigations indicated raised blood urea, 76 mg/dL (17-43) and serum creatinine, 8.3 mg/L (0.5-1.1) levels. [jneuro.com]
- Dysarthria
CODI 555 Motor Speech Disorders Lecture 4: Basal Ganglia Disorders: Hypokinetic/Hyperkinetic Dysarthria Basal Ganglia Control Circuits Consist of several intertwining loops among the basal ganglia nuclei & thalamic nuclei Striatum (caudate & putamen) [ucs.louisiana.edu]
Neurological examination revealed dysarthria, dysphonia and quadriparesis. Low-amplitude bilateral upper limb resting tremor, bradykinesia and ataxic gait was present. [jneuro.com]
The pseudobulbar signs (948) include dysphagia with hyperactive gag reflex, emotional incontinence, and a severe dysarthria that combines pseudobulbar, parkinsonian and cerebellar features (950,951). [neuroophthalmology.ca]
A single case has been reported who had both the movement disorders co-existing. [4] Other less common neurological features have included mild confusional state, gait disturbances, dysarthria, and dysphagia. [annalsofian.org]
Most of these patients have early gait difficulty and there is often a significant dysarthria early in the course. Voluntary vertical gaze is also affected very early in the course. [dartmouth.edu]
- Myoclonus
May complain of earclicks but usually unaware of speech symptoms Brief voice arrests or myoclonic beats Brief silent intervals Occasional, intermittent hypernasality Hyperkinetic Dysarthria: Action Myoclonus Occasional voice arrests Slow rate, imprecision [ucs.louisiana.edu]
There was no evidence of Parkinsonism More Details, asterixis, or myoclonus. Laboratory investigations revealed evidence of uraemia and mild metabolic acidosis. [annalsofian.org]
Patients present around age 60 with asymmetric focal dystonias or myoclonus in the limbs, sometimes an ‘alien hand syndrome’, and parkinsonism. [neuroophthalmology.ca]
The clinical picture is dominated by extrapyramidal syndrome, myoclonus, and alteration of global cognitive status. Sensory symptoms with dusesthesia and psychiatric abnormalities are more common with nvCJD. [em-consulte.com]
Workup
Other Pathologies
- Gliosis
Pathologically there is widespread neuronal loss and gliosis but not the neurofibrillary tangles of PSP. At least one case (979) has been shown to be a prion disease (980). [neuroophthalmology.ca]
Three-month follow-up showed focal gliosis in the right putamen and extensive cerebellar atrophy. [ajnr.org]
Imaging features on MRI vary with the type of lesion: gliosis, demyelination, iron accumulation, copper accumulation, cavitation [ 14 ]. [em-consulte.com]
Treatment
Li et al. reported that there is no specific treatment for this condition thus we did not prescribed any treatment in addition to insulin injections and hemodialysis [ 10 ]. [jneuro.com]
Each triennial meeting of IBAGS brings together basic research scientists from all disciplines as well as clinicians who are actively involved in the treatment of basal ganglia disorders, to discuss the most recent advances in the field and to generate [books.google.com]
Presently, treatment consists of calcium supplementation and the use of vitamin D analogs, but PTH replacement is under investigation. Treatment is important to prevent progression of BGC. Competing interests None declared. References 1. [bcmj.org]
Lancet Oncology 5, 1-8, 2009 4) Serizawa T, Iuchi T, Ono J et al: Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy. [chiba-neurosurgery.jp]
There is no effective treatment other than palliation. [dartmouth.edu]
Prognosis
Prognosis of Basal Ganglia Stroke Approximately 33% of all stroke cases are deadly. [healthfixit.com]
Treatment and Prognosis FS has no cure and does not have a standardized treatment regimen. Current therapies are mainly targeted towards the symptoms and complications associated with the condition. [news-medical.net]
Secondary progressive disease - gradual neurological deterioration with or without relapses - Primary progressive disease - nearly continuous neurological deterioration from onset of symptoms -worst prognosis - Treatment - acute episodes with corticosteroids [quizlet.com]
[…] symmetric signal-intensity alterations in the mammillary bodies, medial thalami, tectal plate, and periaqueductal area. 1 – 4 Selective involvement of the putamen has been reported only in the pediatric population and is considered an indicator of poor prognosis [ajnr.org]
Although usually symptoms tend to spontaneously regress, it is believed that it might indicate poor prognosis and advanced disease [ 2, 8 ]. [jneuro.com]
Etiology
[…] stop Results from lack of dopamine in basal ganglia circuits Hyperkinesia - involuntary movements Excessive, unpredictable increases in muscle tone and movement Result of excessive activity in dopaminergic nerve fibers Hypokinetic Dysarthria: Common Etiologies [ucs.louisiana.edu]
As such, diagnosis of the underlying etiology may be difficult to achieve at imaging. [em-consulte.com]
Basal ganglion lesions in Psychiatric Diseases• ADHD : – Although the etiology of ADHD yet has to be determined, there is a growing consensus that the condition involves functional and anatomical dysfunction in the brains frontal cortex and basal ganglia [slideshare.net]
This has led to speculation concerning the etiology of parkinsonism and to clinical trials of both entities to determine a possible prophylactic effect in idiopathic parkinsonism. [dartmouth.edu]
Epidemiology
Pagina 15 - Schiffer RB, Babigian HM: Behavioral disorders in multiple sclerosis, temporal lobe epilepsy, and amyotrophic lateral sclerosis: an epidemiologic study. [books.google.it]
Pathophysiology
Cools Springer Science & Business Media, ٠٣/٠٥/٢٠١٠ - 608 من الصفحات The aim of the International Basal Ganglia Society (IBAGS) is to further our understanding of normal basal ganglia function and the pathophysiology of disorders of the basal ganglia [books.google.com]
This research topic aims to bring together the most recent advances related to the pathophysiology of the basal ganglia and movement disorders. [frontiersin.org]
Wichmann T and DeLong MR (1996) Functional and pathophysiological models of the BG. Current Opinion in Neurobiology 6: 751–758. [els.net]
Its pathophysiology remains largely unknown. Uremic toxins, metabolic acidosis and diabetic microangiopathy are among the factors believed to contribute to its pathogenesis. [jneuro.com]
Pathophysiology and Diagnostic Criteria for FS Heterogeneity in FS has been suggested due to three possible chromosomal loci being identified. [news-medical.net]
Prevention
Prevention of Stroke Any forms of CVA are dangerous to face. The best way to never experience stroke is prevention. In order to do that, risk factors (as enumerated in the earlier section of this article) to stroke should be eliminated. [healthfixit.com]
Treatment is important to prevent progression of BGC. Competing interests None declared. References 1. Rumboldt Z, Castillo M, Huang B, et al. (eds). Brain imaging with MRI and CT: An image pattern approach. [bcmj.org]
They are unable to make the appropriate kinetic-postural adjustment necessary to prevent them from falling. [dartmouth.edu]
Or if you have migraines, you can take medicine to both prevent and treat them. If you are anxious or depressed, see your doctor. There are medicines to help with mood issues. [webmd.com]
For motor skills, the basal ganglia are critical in preventing muscular overreactivity. In MS, the basal ganglia don’t deliver neurochemical signals with fluidity. [multiplesclerosisnewstoday.com]