* The percussion of the muscle belly is followed by a direct response of the fibers to their mechanical stimulation. This idiomusculaire answer is not a reflex; it disappears early in primitive muscle diseases, where it contrasts with the conservation of the tendon reflexes.
* The myotonia is an abnormal relaxation (for anomaly repolarisa-tion); muscle is the seat of a prolonged active contraction that opposes his re-loosely, this is achieved at the price of an effort antagonists. Favored by cold, it will eventually wear during the rehearsal of contraction. It occurs for a voluntary contraction, for idiomusculaire contraction, but does not appear in the tendon reflexes. It must be distinguished from a mere delay of relaxation (myxedema) that appears when recording reflex (ankle réflexogramme).
* Opercular syndrome: lesion Rolandic cover (or the geniculate beam) responsible for central paralysis hemifacial, the hémilangue and hémivoile.
* Signs eyelash Souques: if you ask the patient to close his eyes tight, lashes are much more often exposed to the opposite side
1- pyramidal syndrome:
A- motor deficit:
* In the upper limbs, it prevails on the extensor
* For the lower limbs on the muscles of the anterolateral lodge, hamstrings (flexors).
* Test Barre (subject to the stomach); Mingazzini (on the back)
* Facial paralysis: elective involvement of the lower territory; the achievement of greater facial manifested by the sign Souques
B- Hypertonia:
spastic; elastic ; can suddenly give way in penknife; predominates over the antigravity muscles; nickname steppage walking
C- Reflexes:
* Exaggerated deep tendon reflexes; bright, diffuse, with clonus polycinétiques
* Cutaneous reflex: abolition of the abdominal cutaneous reflexes; the cremasteric reflex; sailing reflex; plantar reflex.
* Babinski sign (appears before the increase of tendon reflexes)
D- synkinesis:
* Exaggeration of any member hypertension, or an entire side of the body during a voluntary movement
* Movements occurring in a country paralyzed during voluntary movements executed in a territory other: combined flexion of the thigh and trunk when the subject tries to sit (Babinski); extension spacing of fingers during voluntary elevation sup members. (Souques)
2- extrapyramidal Semiotics:
A- Parkinsonism:
* Akinesia: decreased motility; loss of spontaneous movement. Delay initiation, progress slowed, inability to perform rapid alternating breaths. The akinesia may assign abruptly -> emotion (paradoxical kinesis)
* Hypertonia: plastic; simultaneously interesting agonist muscles and anta-nists; exaggeration of postural reflexes.general attitude of the sick: slight bending of the knees, bending of ½ sup mbrs. ; trunk flexion and neck.
* Earthquake: rest, regular, fast (4-8 / s); stops during the execution of voluntary movements. Disappears in sleep;increased by emotions …
B- Athetosis:
* Manifests the extremities and face
* Slow Oscillation between the extreme positions of flexion and hyperextension realizing an aspect of crawling
* Cease than during sleep; emotions and fatigue increases this movement
* There aperte of reciprocal innervation (movement Athetoid fact occur simultaneously antagonistic muscles); reached the striatum -> bilateral athetosis
C- Dystonia:
* Attitude extreme contortion; the movement takes place slowly over a tonic fashion
* The dystonic spasms are sudden, repetitive, almost clonic
* Cramps writers; median spasm of the face; spasmodic torticollis (a conjurer gesture allows the patient to temporarily lease spasm).
* Does not occur during sleep;
* Dystonia action; Dystonia attitude; subintrante or dystonia.
* Meige Syndrome (median spasm of the face or blepharospasm)
D- Huntington:
* Movement sudden, explosive, chaotic, unpredictable: grimace of the face, shrugs shoulders, flexion or extension;
* Dim the isolation and disappears during sleep
* Occurring on a background of hypotonia; impaired movement volonaire (start delay, decreased grip strength, fatigue).
* Lesion of the striatum and nucleus-encoded; Mitigated by major tranquilizers
3- cerebellar syndrome:
A- hypotonia:
* Visible and palpable (hand rubbers) Increased passivity increase the sway of the hand; sign of the plague. There are no joints hyperextensibility
* The pendulum swings at the knee jerk
* Abolition of postural reflexes
* Maneuver Stewart Holmes is to seek a voluntary contraction against resistance and then to abruptly stop the resistance -> higher displacement
B- Coordination disorders:
* Asynergie (decomposition of movement, dance tendons …)
* Dysmetria (hypermetria)
* adiadochokinesia
* Dyschronométrie (delay the initiation of an activity or ex-cessive extension of an existing action) -> simultaneously pressed both hands
C- Earthquake:
* Intentional tremor, large amplitude
* If highlighting to measure progress of the gesture; increases when emotions
* When the cerebellar syndrome is unilateral, some deviation of the axis of the body can be observed, but there are no conjugate deviation of the index or sign Romberg lateralized.
* When squatting, peeling heel does not occur; elevation of the lower limb above the level of the bed when the patient tries to move from lying to sitting (asynergie).
* Cerebellar writing is done in large letters, of unequal size; cerebellar speech is drawling, poorly articulated, chanted, explosive. The voice of force is constantly changing.
* The inability to remain standing, eyes closed -> Romberg sign (posterior cordonale reached)
* The lesions of the posterior columns, thalamus, the parietal cortex may result in unilateral ataxia: eye closure -> bad terminal fitting gesture (finger-nose); ataxic unstable hand (trend of falling fingers ….).
* The attitude flapping tremor is a tremor of a particular type. Interesting members, but also the face, tongue. It consists of two components: one slow (lowering the outstretched hand) and the other fast (the subject). Cause: hepatic encephalopathy; metabolic or toxic encephalopathy (CO). It may be associated with sudden postural falls (negative myoclonus = asterixis)
* Twitching: muscular twitching, brief, involuntary, generating or not a movement. Causes: Epilepsy; Lafora disease;Friedrich’s disease; or Alzheimer’s disease; Creutzfeld-Jakob disease; subacute sclerosing subacute; severe cerebral anoxia.
* The optokinetic nystagmus is a visual phenomenon origin (not vestibular)
* Pseudobulbar Syndrome: the paralysis of bulbar innervated muscles resulting from supranuclear reached.
The existence of this syndrome involves bilateral lé-sions of the cortico-nuclear tract (geniculate beam). It combines: disorders of phonation and swallowing; facial diplegia; masticatory deficit; spasmodic laughter and tears (release of automatic mimicry).