Volatile spasm

Introduction Vulnerability , also known as acromion or finger movement, is characterized by increased distal and distal migratory muscle tension and reduced movement, with a slow, creepy, wriggle-like peristalsis. Similar to dystonia, it is not an independent disease unit. It is a relatively slow, untargeted, continuous involuntary motor syndrome in the fingers, toes, tongue, or other parts of the body. Hand and athesis can be seen in a variety of encephalopathy, characterized by slow and irregular twisting of the hands and feet. Hand and foot hyperactivity disorder is the increase and decrease of distal muscles of the limbs, and the slow-moving, such as crawling, torsion-like peristalsis, with excessive extension of the distal end of the limb, such as wrist flexion, finger overstretching, etc., and the fingers slowly The buckling is successively performed; the affected part cannot be maintained in a certain posture or position due to excessive spontaneous action. Hand and foot hyperkinesia is seen in Huntington's chorea, Wilson's disease, hepatic encephalopathy, Hallervodern-Spatz disease, phenothiazines and haloperidol chronic co-intoxication. Hemiplegia is more common in patients with stroke, and various sedatives are available. Temporary relief of involuntary movements such as phenobarbital and diazepam.

Cause

The cause of variability:

(1) Causes of the disease:

Common causes of atherososis are: 1 hereditary or familial: mostly autosomal recessive, rare; 2 cerebrovascular accident; 3 intracranial infection; 4 drugs; 5 cerebral palsy: caused by various causes Cerebral palsy can appear hand and foot hyperactivity; 6 high cervical spinal cord lesions.

Different types of causes, such as paroxysmal dystonic choreoathetosis (PDC), are rare hereditary dyskinesias. Paroxysmal kinesigenic choreoathetosis (PKC) is a rare dyskinesia disease that is often induced by exercise and sometimes associated with diffuse or focal brain injury. It is also considered to be epilepsy. In one form, anti-epileptic treatment is effective because of similar causes of seizures.

(2) Pathogenesis:

1. Hereditary or familial: Mostly autosomal recessive, relatively rare, a Japanese onset dystonia dance hand and foot hyperactivity disorder, family genes located in 2q31 ~ 36, and can be further positioned in D2S164 and D2S377 In the meantime, this region encodes the PDC gene, and a new X-linked hereditary disease has been found to cause dance acromegaly, localized in Xp11, accompanied by intelligent developmental delay, behavioral abnormalities, etc.; other minority hereditary neurological diseases, such as the brain White matter malnutrition, spinocerebellar ataxia, hepatolenticular degeneration and familial hypoproteinemia can also be associated with acromegaly.

2. Cerebrovascular accident: Congenital infant Heubner return arterial occlusion can lead to contralateral limb movements of the hand and foot. Adult acute thalamus and globus infarction can cause movements of the hand and foot. The autopsy can show the lacunar-like state of the posterior limb of the internal capsule.

3. Intracranial infection: Creutzfeldt-Jakob disease caused by lentivirus may have dementia, myoclonus and bilateral hand movements, MRI showed bilateral caudate nucleus, atrophy of the putamen and T2WI high signal; herpes simplex virus Intracranial infections of Mycoplasma pneumoniae, Toxoplasma gondii and AIDS can also cause acromegaly.

4. Drugs: Addicts such as cocaine and amphetamine may have danced hand and foot hyperkinesia. Long-term use of antipsychotic drugs such as phenothiazine and haloperidol may cause acute dystonia or tardive dyskinesia. Can show hand and foot akines.

5. Cerebral palsy: various causes of cerebral palsy may appear hand and foot hyperkinesia, such as perinatal hypoxic encephalopathy, premature delivery, birth injury, bilirubin encephalopathy, cerebral cortical dysplasia, brain penetrating malformation, bilirubin encephalopathy, etc. And sudden cardiac arrest in adults, poisoning caused by hypoxic encephalopathy.

6. High cervical spinal cord lesions: such as cervical demyelinating lesions, in addition to causing deep sensory loss, there may also be pseudo-hand and acrodynamics or fingering movements.

Pathological changes: mainly involved bilateral caudate nucleus, putamen and hypothalamus, neuronal degeneration, disappearance, gliosis, medullary fiber bundles significantly increased, irregular distribution, bundled or reticular arrangement, myelin staining It is plaque-like, like marble, called "status marmoratus", showing that the Nissl body disappears and the striatum shrinks. Thalamus, globus pallidus, substantia nigra, internal sac and cerebral cortex can also be degenerated. In the bilateral lateral globus pallidus neurons of both sides of the hand and foot hyperactivity, PES staining positive Bielschowsky body deposition was observed, which was round and located in the nucleus of the nucleus.

an examination

Related inspection

Nervous system examination

Examination and diagnosis of variability :

Hand and foot hyperactivity disorder has involuntary movements in the special posture of the hands and feet, so the diagnosis is not difficult. The dance-like movements of chorea appear in the trunk and head and face of the limbs. They are wide-ranging and more rapid than involuntary movements. They are beating-like, and the involuntary movements different from the intrinsic are mainly limited to the hands and feet. But the intrinsic sometimes coexists with chorea, called dance-chorea-athetosis.

1. The slow and irregular peristaltic twisting action of one or both sides of the hand and the finger is the main sign. Fingers often stretch or separate, and those with lower limbs are rare.

2. The muscle tension of the affected limb is high and low, and the change is impermanent. The muscle tension is increased at the tendon, and the muscle tension is normal when the muscle is relaxed.

3. When the mood is tense, the spirit is stimulated or the movement is free, the symptoms are aggravated, and when it is quiet, it is relieved, and disappears after falling asleep.

4. More common in premature infants and postpartum asphyxia in children (often short-term after birth), various acute and chronic encephalitis, Wilson's disease, lacunar infarction, carbon monoxide, carbon disulfide or manganese poisoning, etc. The patient (usually ill during the course of the disease) has a corresponding history, physical signs and laboratory findings.

Differential diagnosis

Identification of susceptibility to susceptibility to variability:

1, should be different from pseudo-hand and foot akines. The latter is caused by the loss of position of the limb with a combination of frontal, posterior and lateral column damage or peripheral nerve damage.

2, should be similar to twisting sputum, the latter mainly invades the proximal limb, neck muscles and trunk muscles, the typical performance is torsion as the axis of the trunk.

3, should pay attention to the identification of dance - hand and foot hyperactivity and other clinical types, dance - hand and foot hyperactivity disorder patients with a wide range of involuntary movements in the limbs, trunk and face, showing coarse, variable and rapid beating.

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