Open and closed eyelid apraxia

Introduction Involuntary levator muscle inhibition and orbicularis muscle inhibition are one of the typical signs of Parkinson's disease in the elderly. The diagnosis of typical tremor paralysis is not difficult. According to typical symptoms such as tremor, rigidity, and exercise reduction, combined with the symptoms of sputum-like action, lead tube or gear-like muscle rigidity, mask face, lower case, and gait gait, diagnosis can be made.

Cause

Before the onset of the disease, the patient often has a long period of pre-symptomatic period, that is, the subclinical state. The patient may feel the inflexibility of exercise, which is obviously slower than before. It is easy to be considered as aging and neglect to check the related enzymes and hormones in the body through regular visits. Level changes, if necessary, positron emission tomography (PET) to check whether the early function of the striatum is impaired, etc., protective, preventive treatment, interference etiology, pathological mechanism, that is, interfere with the death of nerve cells, prevent or at least slow down The progress of this disease is aimed at prevention of grade III, with a focus on prevention of comorbidities, and most patients with advanced disease lose their ability to live.

an examination

Related inspection

Eye movement check intraocular pressure

Sign

(1) Early characteristic signs are a reduction in blink rate. Usually, the frequency of blinking in healthy people is 15-20 times/min, and that in PD patients can be reduced to 5-10 times/min.

(2) Typical signs:

1 "striatum hand": flexion of the metacarpophalangeal joint, the proximal interphalangeal joint is straight, the distal interphalangeal joint is flexed; and the foot deformity can also occur.

2myerson: The blinking of the nose or the eyebrow does not inhibit the blinking reaction.

3 Oculogyric crisis: the tonic convulsions between the two eyeballs, usually in the two eyeballs are common, side and lower vision are rare, repeated attacks, often combined with neck, mouth and tendon.

4 opening and closing disability: involuntary lifting muscle inhibition and orbicularis muscle inhibition.

(3) atypical signs: knee reflex variation is large, can be normal, difficult to lead, can also be active, limited to single-measure PD patients, bilateral knee reflex symmetry, buckling reflex, lower forehead and forehead reflex Rarely increased.

The diagnosis of typical tremor paralysis is not difficult. According to typical symptoms such as tremor, rigidity, and exercise reduction, combined with the symptoms of sputum-like action, lead tube or gear-like muscle rigidity, mask face, lower case, and gait gait, diagnosis can be made.

Differential diagnosis

It needs to be differentiated from the symptoms caused by the following reasons:

1. After the encephalitis can occur, the tremor paralysis syndrome can occur, but the onset can occur at any age. If there is a clear history of encephalitis, it can help identify.

2. Poisoning is more common in manganese or carbon monoxide poisoning. Patients often have a history of carbon monoxide poisoning or long-term manganese exposure, and gradually develop symptoms such as tremor and rigidity.

3. Drugs Certain drugs, such as phenothiazines, block the synaptic transmission of dopamine and cause symptoms such as tremors and rigidity. In addition, if reserpine blocks the storage of dopamine at the axon end, the metabolites of methyldopa compete for dopamine receptors, which can produce symptoms of tremor paralysis syndrome. The history of taking the drug and the recovery of symptoms after stopping the drug can be identified.

4. Traumatic concussion, brain contusion and other traumatic brain injury can cause symptoms of tremor paralysis syndrome, and the history of trauma can be identified.

5. Most of the arteriosclerosis is caused by cerebral arteriosclerosis or multiple cerebral infarction. In addition to the symptoms of Parkinson's syndrome, the clinical manifestations are combined with the primary symptoms such as dementia.

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