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Juvenile Paralysis Agitans of Hunt
Hunt Corpus Striatum Syndrome

Presentation

Two cases in the same family presented to us with parkinsonian pyramidal syndromes. First case : Male aged 25 years, presented with history of progressive difficulty in walking, hypokinesia, slowness of speech and frequent falls. [neurologyindia.com]

Juvenile Parkinsonism with Marked Diurnal Fluctuation Psychology The Japanese journal of psychiatry and neurology 1989 Abstract: We presented a report on four cases of juvenile parkinsonism with a marked diurnal fluctuation of symptoms and dystonia. [semanticscholar.org]

Up to the present no one has undertaken a detailed evaluation of the quantitative amount of cell destruction in these regions in any case. The purpose of this paper is to present the findings of such a study in [jamanetwork.com]

The tremor may be present at rest and increased by voluntary movement. [neupsykey.com]

PMID: 26864383 (This article is OPEN ACCESS if you would like to read it) The researchers who wrote this article were presented with a 10 member Indian family from Aligarh, Uttar Pradesh. [scienceofparkinsons.com]

Entire Body System

  • Falling

    First case : Male aged 25 years, presented with history of progressive difficulty in walking, hypokinesia, slowness of speech and frequent falls. There was no history of exposure to toxin, infection, or drug intake. [neurologyindia.com]

    […] brain that occurs at or shortly after birth) metabolic disorder (a disorder that interferes with the body's ability to maintain itself) Damage to the spinal cord is most often caused by trauma, such as a fall or a car crash. [medical-dictionary.thefreedictionary.com]

    Definition A progressive, degenerative neurologic disease characterized by a TREMOR that is maximal at rest, retropulsion (i.e. a tendency to fall backwards), rigidity, stooped posture, slowness of voluntary movements, and a masklike facial expression [ctdbase.org]

    A progressive, degenerative neurologic disease characterized by a TREMOR that is maximal at rest, retropulsion (i.e. a tendency to fall backwards), rigidity, stooped posture, slowness of voluntary movements, and a masklike facial expression. [curehunter.com]

    Unhealthy Sensation as falling from Ht. : Vertigo. Falling Sensation of swimming in the temporal region : Vertigo. Swimming Sensation of contraction in head : Head. Ext. contraction Sensation of hollowness in the ear: Hearing. [homeobook.com]

  • Difficulty Walking

    […] with walking and gait. [ncbi.nlm.nih.gov]

    Patients with PD have poor balance, a tendency to fall, and difficulty walking. [neupsykey.com]

Respiratoric

  • Hypophonia

    Hypomimia- “masked facies”,expressionless face, blinking Speech abnormalities- Hypophonia: soft voice Aprosody of speech: monotonous and lack of inflection Tachyphemia: do not separate syllables together, running words together Patients may eventually [slideplayer.com]

Gastrointestinal

  • Muscle Rigidity

    It is clinically characterized by movement disorders such as muscle rigidity, akinesia and tremor. [books.google.de]

    Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) Definition (NCI_NCI-GLOSS) A progressive disorder of the nervous system marked by muscle tremors, muscle rigidity, decreased mobility, stooped posture, slow voluntary movements, and a [fpnotebook.com]

    (Otfrid) Forster (1873–1941) has shown that the change in muscle tone resembles but also differs from spasticity. Rigidity is central in origin; spasticity is a response to peripheral or reflex stimulation. [academic.oup.com]

    Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult. [medicinenet.com]

    Muscle Rigidity in Parkinson's Disease Rigidity reflects an abnormal increase in muscle tone and may be continuous and cause the limb to feel like a “lead pipe” or to be ratchety like the movement of a “cogwheel”. [biotechnologyforums.com]

Musculoskeletal

  • Muscle Spasticity

    When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity. [ncbi.nlm.nih.gov]

Face, Head & Neck

  • Mask-like Facies

    Mask-like facies MedGen UID: 140860 •Concept ID: C0424448 • Finding A lack of facial expression often with staring eyes and a slightly open mouth. [ncbi.nlm.nih.gov]

    Juvenile, of Hunt: 32 (show all 9) # Description HPO Frequency HPO Source Accession 1 dysarthria 32 HP:0001260 2 gait disturbance 32 HP:0001288 3 tremor 32 HP:0001337 4 abnormality of metabolism/homeostasis 32 HP:0001939 5 dystonia 32 HP:0001332 6 mask-like [malacards.org]

    Other conditions to be considered ☞Juvenile Paralysis Agitans of Hunt: Autosomal dominant, this syndrome is characterized by mask-like facies, parkinsonism, tremor, bradykinesia, dysarthria, rigidity, gait disturbance, and flexion dystonia of fingers. [accesspediatrics.mhmedical.com]

    […] homeostasis (代謝-ホメオスターシス異常) [HP:0001939]  Autosomal dominant inheritance (常染色体優性遺伝) [HP:0000006]  Bradykinesia (寡動) [HP:0002067] [02608]  Dysarthria (構音障害) [HP:0001260] [0230]  Dystonia (ジストニア) [HP:0001332] [0240]  Gait disturbance (歩行障害) [HP:0001288] [028]  Mask-like [syndromefinder.ncchd.go.jp]

  • Face Rigidity

    Some of the most common symptoms of Parkinson's disease are: tremor of the hands, arms, legs, jaw and face rigidity or stiffness of the limbs and trunk bradykinesia or slowness of movement postural instability or impaired balance and coordination *from [rosevillepsg.weebly.com]

    Symptoms Young-onset PD is diagnosed similarly to late onset PD with symptoms including: Tremors of the hands, arms, legs, jaw and face Rigidity In Parkinson’s, stiffness of the arms or legs beyond what would result from normal aging or arthritis. [parkinson.org]

  • Hypomimia

    Hypomimia- “masked facies”,expressionless face, blinking Speech abnormalities- Hypophonia: soft voice Aprosody of speech: monotonous and lack of inflection Tachyphemia: do not separate syllables together, running words together Patients may eventually [slideplayer.com]

    Facial immobility and lack of expressiveness is a common feature of PD (hypomimia, masked face). [neupsykey.com]

Neurologic

  • Tremor

    Tremor MedGen UID: 21635 •Concept ID: C0040822 • Sign or Symptom An unintentional, oscillating to-and-fro muscle movement about a joint axis. [ncbi.nlm.nih.gov]

    Human phenotypes related to Paralysis Agitans, Juvenile, of Hunt: 32 (show all 9) # Description HPO Frequency HPO Source Accession 1 dysarthria 32 HP:0001260 2 gait disturbance 32 HP:0001288 3 tremor 32 HP:0001337 4 abnormality of metabolism/homeostasis [malacards.org]

    |On examination - Parkinsonian tremor|On examination - Parkinsonian tremor (finding)|PD - Parkinson's disease|Paleostriatal syndrome|Pallidal atrophy|Pallidal syndrome|Paralysis agitans|Parkinson disease|Parkinson's disease (disorder)|Parkinsonian tremor [averbis.com]

    Postural tremors become evident when the limbs are maintained in an antigravity position (e.g., arms outstretched). Common types of postural tremor are enhanced physiologic tremor and ET. [neupsykey.com]

    In the words of (John) Hughlings Jackson (1835–1911), ‘tremor is rigidity spread thin, and rigidity is tremor run together’. [academic.oup.com]

  • Bradykinesia

    Bradykinesia MedGen UID: 115925 •Concept ID: C0233565 • Sign or Symptom Bradykinesia literally means slow movement, and is used clinically to denote a slowness in the execution of movement (in contrast to hypokinesia, which is used to refer to slowness [ncbi.nlm.nih.gov]

    32 HP:0002067 9 parkinsonism 32 HP:0001300 Symptoms via clinical synopsis from OMIM: 57 Neuro: dysarthria gait disturbance tremor rigidity bradykinesia more Misc: onset in teens or earlier very slow progression Facies: masklike facies Lab: degeneration [malacards.org]

    Slowness of motion (bradykinesia) is one of the classic symptoms of Parkinson's disease. [slideplayer.com]

    Diseases related with Melanoma and Bradykinesia In the following list you will find some of the most common rare diseases related to Melanoma and Bradykinesia that can help you solving undiagnosed cases. [mendelian.co]

    Strictly speaking, akinesia means an absence of movement; bradykinesia, a slowness of movement; and hypokinesia, a decreased amount or amplitude of movement, but the term bradykinesia is often used to encompass all three. [neupsykey.com]

  • Postural Instability

    Other characteristic symptoms of Parkinson disease include rigidity or stiffness of the limbs and torso, slow movement (bradykinesia) or an inability to move (akinesia), and impaired balance and coordination (postural instability). [icdlist.com]

    Another disorder in which a resting tremor is one of the main symptoms, accompanied by slowness and poverty of movement, muscular rigidity, and postural instability is Parkinson's disease Parkinson's disease or Parkinsonism, degenerative brain disorder [encyclopedia2.thefreedictionary.com]

    Some of the most common symptoms of Parkinson's disease are: tremor of the hands, arms, legs, jaw and face rigidity or stiffness of the limbs and trunk bradykinesia or slowness of movement postural instability or impaired balance and coordination *from [rosevillepsg.weebly.com]

    Akinetic, tremor, and postural instability subtypes have been recognized. [neupsykey.com]

    Postural instability Impaired balance and the tendency to fall without explanation, usually when pivoting; a common symptom in the later stages of Parkinson’s. or impaired balance and coordination People with YOPD may experience the same non-motor symptoms [parkinson.org]

  • Resting Tremor

    A triad of features classically characterizes Parkinson disease: resting tremor rigidity bradykinesia (postural instability: sometimes added as a fourth cardinal feature 3 ) Dementia can be a late feature. [radiopaedia.org]

    Another disorder in which a resting tremor is one of the main symptoms, accompanied by slowness and poverty of movement, muscular rigidity, and postural instability is Parkinson's disease Parkinson's disease or Parkinsonism, degenerative brain disorder [encyclopedia2.thefreedictionary.com]

    The relationship to rest or activity is the basis for classification into two primary tremor types: rest and action. [neupsykey.com]

    Symptomatology 20 Parkinson’s disease -Symptomatology Tremor: Rest Fixed frequency 3-6 Hz Not a feature of old age Pill-rolling Usually starts in one limb, and then to other limbs Rarely starts in lower limbs Intermittent for many years They usually [slideplayer.com]

    […] and 50% cases Accelerate your rare disease diagnosis with us Learn more Other less frequent symptoms Patients with Melanoma and Bradykinesia. may also develop some of the following symptoms: Uncommon Symptoms - Between 30% and 50% cases Ataxia Pica Resting [mendelian.co]

  • Dysarthria

    Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed. [ncbi.nlm.nih.gov]

    Human phenotypes related to Paralysis Agitans, Juvenile, of Hunt: 32 (show all 9) # Description HPO Frequency HPO Source Accession 1 dysarthria 32 HP:0001260 2 gait disturbance 32 HP:0001288 3 tremor 32 HP:0001337 4 abnormality of metabolism/homeostasis [malacards.org]

    List of possible causes of Dysarthria or similar symptoms may include: 8 Acanthocytosis (Dysarthria) Aceruloplasminemia (Dysarthria) Achondroplasia (Dysarthria) Adrenomyeloneuropathy (speech difficulties) Alcoholic Cerebellar Degeneration (Dysarthria [familydiagnosis.com]

    Characterized by tremor, bradykinesia, dysarthria, rigidity, and fixed facies. The disorder may be familial (genetically transmitted) or secondary to other heredodegenerative disorders, such as Huntington disease. [accessanesthesiology.mhmedical.com]

    It is characterised by tremor, bradykinesia, dysarthria, rigidity, fixed facies and a tendency to faint. Mental functions are intact and there are no reflex changes. [whonamedit.com]

Workup

In the presence of typical clinical signs and symptoms and the typical age of onset, extensive workup is not required. Imaging studies are usually normal. [neupsykey.com]

Diagnostic challenges We should be particularly careful in applying the label "Parkinson's Disease" to patients presenting with a rigid-akinetic syndrome of early-onset without the necessary thorough imaging and laboratory workup, including the search [bioscience.org]

Treatment

Therapy and Treatment When it comes to medical treatment, people with YOPD have a significantly greater risk of developing the following: Dyskinesias or involuntary movements (most commonly dystonia) as a side effect of carbidopa A medication used together [parkinson.org]

A patient with Juvenile PD developed PG soon after beginning treatment with pergolide, a mixed D1/D2 dopamine agonist that is also supposed to exhibit D3 activity. This behavior remitted upon the discontinuation of the drug. [journals.lww.com]

Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects. [medicinenet.com]

Charcot’s British contemporary, WR Gowers, followed similar treatment strategies. [ncbi.nlm.nih.gov]

At the age of 17 years, the orphenadine treatment was withdrawn. [kundoc.com]

Prognosis

The prognosis and treatment are determined by the disease that caused the paralysis. Among the special methods used to restore the functions of the extremity are massage and remedial gymnastics. REFERENCES Krol’, M. B., and E. A. Fedorova. [encyclopedia2.thefreedictionary.com]

Treatment and prognosis The mainstay of treatment is medical. In patients with refractory symptoms, deep brain stimulation may be useful 15. [radiopaedia.org]

Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol 2012;33(3):313-8. Morishima N, Yagi R, Shimizu K, Ota S. Prognostic factors of synkinesis after Bell's palsy and Ramsay Hunt syndrome. [kjorl.org]

Prognosis The likelihood of recovery from paralysis depends on what is causing it and how much damage has been done to the nervous system. Prevention Prevention of paralysis depends on prevention of the underlying causes. [medical-dictionary.thefreedictionary.com]

What is the prognosis and life expectancy for Parkinson's disease? The severity of Parkinson's disease symptoms and signs vary greatly from person to peson, and it is not possible to predict how quickly the disease will progress. [medicinenet.com]

Etiology

영문 초록 Childhood ataxia with diffuse central nervous system hypomyelination(CACH) syndrome is a recently described leukodystrophy of unknown etiology. The patients show normal development until the age from ... [더보기] [scholar.dkyobobook.co.kr]

Drug induced parkinsonism Hypoxia Tumor Trauma Vascular:Multiinfarct Toxin:Mn, CO, MPTP and cyanide Post-encephalitic parkinsonism (von Economo’s encephalitis) Normal pressure hydrocephalus Wilson’s disease, Hutington’s disease 17 Classification and Etiology [slideplayer.com]

Joseph Jankovic MD : Current understanding of etiology and pathogenesis of Parkinson's Disease. American Academy of Neurology, Annual Courses 1995; 4 : 1271-1272. [neurologyindia.com]

Changes in the internal properties of an organism, caused by environmental factors and firmly fixed (including those fixed by hereditary mechanisms), may themselves eventually play a leading role in the development of disease. (2) Besides the etiological [encyclopedia2.thefreedictionary.com]

Acute retinal necrosis syndrome Necrotizing retinitis with uveitis and other retinal pathology, severe loss of vision, and often retinal detachment; of viral etiology. [scribd.com]

Epidemiology

Current epidemiological and biochemical evidence leads to the hypothesis that the brothers have impaired ability to synthesize dopamine, possibly because of an inherited deficiency of tyrosine hydroxylase enzyme. [jamanetwork.com]

Hereditary juvenile epithelial dystrophy of cornea meesmann corneal dystrophy 遺傳性青少年性角膜上皮營養不良 Analysis of phase - change related endogenous hormone changes in juvenile and mature of phellodendron amurense 黃波羅不同年齡材料微繁苗內源激素的比較分析 Epidemiological analysis [dict.site]

Clinical, pharmacological, evolutive, and epidemiological data were collected on all patients. [onlinelibrary.wiley.com]

Introduction Parkinson’s disease is a chronic neurodegenerative movement disorder affecting voluntary and emotional movements and most commonly seen in the elderly, but is also found in the young and inexorably progresses leading to significant disability. 5 Epidemiology [slideplayer.com]

EPIDEMIOLOGY AND GENETICS There are no systematic epidemiological surveys of parkinsonism of early onset, however, most reports agree that in the western hemisphere, approximately 5 to 7% of patients with PD in referral populations develop their symptomatology [bioscience.org]

Pathophysiology

9 GLOBUS, PARS RETICULATA PATHOPHYSIOLOGY DA SUBSTANTIA NIGRA GLOBUS, PARS RETICULATA ACH GABA STRIATUM CAUDATE, PUTAMEN 10 Chemical Balance in Corpus Striatum Excitatory Cholinergic pathway Inhibitory Dopaminergic pathway BALANCE 11 Chemical Balance [slideplayer.com]

[…] often observed (cerebellar dentate nucleus, degeneration of globus pallidus, elevated cerebrospinal fluid uric acid); muscle biopsy shows the presence of ragged red fibers that probably are caused by mitochondrial abnormalities, which could explain the pathophysiology [accesspediatrics.mhmedical.com]

The pathophysiology of parkinsonism is complex. [neupsykey.com]

In recent years, the contributions made by molecular genetics, pharmacology, physiology, and clinical neuropsychology have allowed us to make significant advances in the understanding of the pathophysiology and pathogenesis of PD as a whole, and of EOPD [bioscience.org]

Initial clinical manifestations of Parkinson’s disease: features and pathophysiological mechanisms. Lancet Neurol, 8(12): 1128-1139. 8. Jankovic J (2008). Parkinson’s disease: clinical features and diagnosis. [biotechnologyforums.com]

Prevention

Prevention Prevention of paralysis depends on prevention of the underlying causes. Risk of stroke can be reduced by controlling high blood pressure and cholesterol levels. [medical-dictionary.thefreedictionary.com]

Prevent hyperventilation (hypocarbia) which may trigger seizures. Monitor carefully the hemodynamics because of MAO inhibitors. There is frequent interaction between drugs commonly used to treat the condition and anesthetic agents. [accessanesthesiology.mhmedical.com]

Genetic factors may contribute to the pathogenesis of Parkinson's disease (PD) by several mechanisms, such as preventing normal development of dopaminergic neurons, delayed programming or accelerated cell death, interfering with normal protective mechanisms [neurologyindia.com]

Therefore, parkin loss of function, as happens in autosomal recessive juvenile Parkinson (AR-JP), prevents degradation of parkin substrates (i.e. GPR37), thus resulting in their toxic accumulation. [ub.edu]

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