Myotonia tremor, bradykinesia

Introduction Tremor palsy, also known as Parkinson's disease, is a common neurodegenerative disease characterized by resting tremor, myotonia, and bradykinesia.

Cause

The cause is still unknown, and it is thought to be related to ageing, environmental factors or family genetic factors. Secondary may be due to cerebrovascular disease (such as ventricular infarction), drug-induced (such as taking phenolicazine or butyrylbenzene antipsychotic drugs), poisoning (carbon monoxide, manganese, mercury, etc.), encephalitis, Caused by brain trauma, brain tumors, and calcification of the basal ganglia.

an examination

Related inspection

Brain CT examination of nervous system examination

The disease mostly occurs after the age of 50, about 3/4 patients start from 50 to 60 years old, and the family history has a younger onset age. The onset of the disease is insidious, slowly progressive, with tremors, muscles. Tonic and exercise slowness are the main clinical manifestations.

First, tremor: tremor starts from the upper limb of one hand, showing a rhythmic sputum-like action. As the disease progresses, the tremors gradually converge and the ipsilateral lower limbs and contralateral upper and lower limbs, usually with limbs heavier than the lower limbs, tremors of the lower jaw, lips, tongue and head appear more in the later stages of the disease. Most of the tremors appear when they are at rest, relieved when they are free to move, increase when they are nervous, and disappear after falling asleep.

Second, muscle rigidity: systemic muscle tension increased. Due to the increased tension of the flexor and extension muscles, the limbs have a uniform impedance when they are flexibly flexed and flexed. They are called lead-tube-like tonic. If they are accompanied by tremor, their impedance has intermittent pause, which is called gear-like rigidity. The increase in facial muscle tension appears to be a mask-like face.

Third, the movement is slow: the performance of casual movement is difficult, slow movement and reduced activity. The patient turned upside down, walked, walked, and turned. It was awkward and slow. It was difficult to finish clothes, combing his hair, brushing his teeth, etc. When writing, the handwriting fluttered or the smaller the writing, the smaller the sign was written. Walking slowly, the pace is small, the feet can hardly leave the ground, walking loses the center of gravity, and often goes faster and faster, and can't stop immediately, saying that he is flustered. When walking, due to posture reflex obstacles, there is a lack of coordinated exercise in the upper limbs.

Fourth, other symptoms:

(1) autonomic dysfunction: excessive secretion of sweat, saliva and sebum in patients, often with intractable seizures.

(2) Psychiatric symptoms and mental retardation: Emotional instability and depression are common. About 15 to 30% of patients have intelligent defects, and memory is especially evident in near memory loss. In severe cases, it can be manifested as dementia.

Differential diagnosis

Need to be differentiated from the following diseases:

First, differentiated from secondary tremor paralysis syndrome:

(A) cerebrovascular tremor paralysis syndrome: more often after ventricular infarction or acute stroke, there are hypertension, arteriosclerosis and pyramidal tract palsy, pseudobulbar paralysis, etc., brain CT examination can help diagnose.

(B) after encephalitis tremor paralysis syndrome: history of encephalitis before the disease, seen in any age, common eye movement crisis (involuntary eye muscles in the episodes of both eyes), sebum overflow, increased salivation.

(3) Drug-induced tremor paralysis syndrome: There are medical history such as taking phenothiazines or anti-psychotic drugs or Rauvolfia antihypertensive drugs, which interfere with the metabolism of catecholamines in different links, and the symptoms disappear after stopping the drug.

(4) Toxic tremor paralysis syndrome: mainly based on the diagnosis of poisoning diseases, such as a history of carbon monoxide poisoning before the disease.

Second, the identification of tremor caused by various reasons:

(1) Essential tremor: Although tremor is similar to this disease, it has no symptoms of muscle rigidity and bradykinesia. It may have a family history, a benign course, and a few may evolve into tremor paralysis.

(B) senile tremor: seen in the elderly, tremor is fine and fast, appearing during free exercise, no muscle rigidity.

(C) snoring tremor: There are mental factors before the disease, the form, amplitude and speed of tremor are changeable, the concentration is increased, and there are other manifestations of snoring.

3. Identification of certain central nervous system multisystem degenerative diseases with symptoms of tremor paralysis: such as hepatolenticular degeneration, primary orthostatic hypotension, cerebellar pons, and atrophy of the brain. In addition to the symptoms of tremor and paralysis, these diseases also have other neurological symptoms corresponding to each disease, such as cerebellar symptoms, pyramidal tract signs, and ophthalmoplegia.

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