sdr neuron motor central
DESCRIPTION
sdr neuron motor centralTRANSCRIPT
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Sindromul de neuron motor central
- piramidal -
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Origine: cortex frontal
• aria motorie principala = 4 – 50%• arii motorii suplimentare = 6, 8 + 3,1,2
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Origine: cortex frontal
• Somatotopie: homunculus motor
• Consecinta:– Leziune corticala:
deficit parcelar, asimetric
– + lez corticale invecinate
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Traiect
• Fascicol cortico-spinal: MS – catre cornul anterior: sinapsa cu pericarionul neuronului motor periferic– Decuseaza (75%) la
jonctiunea bulbo-spinala
• Fascicol cortico-nuclear: sinapsa cu nucleii motori ai nn cranieni din trunchiul cerebral
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Sindrom piramidal: 1. deficit motor
• Numai miscarea voluntara
• topografie extinsa:– 1 membru = monopareza– mb sup + mb inf = hemipareza– ambe membre sup = dipareza– ambe membre inf = parapareza– toate = tetrapareza
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Sindrom piramidal: 1. deficit motor
• Probe pareza mb superior:– proba bratelor intinse
• probe pareza membrul inferior:– Vasilescu
– Mingazini
– Barre
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Intensitatea deficitului motor
• scala British Medical Research Council (BMRC):
0 = nici o contractie1 = contractie musculara vizibila
subcutanat2 = miscare posibila ce deplaseaza
segmente in acelasi plan, nu antigravitational
3 = miscare posibila antigravitational, nu contrarezistentei
4 = miscare posibila contra unei rezistente usoare / medii
5 = forta normalaIntensitate: 2 - 4 = pareza0-1 = plegie
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Tonusul muscular
• Inspectie: relief• Palpare: consistenta• Probe pasive
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2. Tonus muscular
• Initial: (+/-) hipotonie = diaschizis (leziune cerebrala) / soc spinal (leziune spinala)
• Hipertonie piramidala = spasticitate:– pred flexori + pronatori -
mb sup– pred extensori + rotatori
interni - mb inf– cedeaza in lama de briceag
= opozitie initiala– elastica = revine in postura
dominanta
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2. Tonusmuscular
• Mers + postura caracteristice
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3. ROT
Vii:
• ample
• rapide
• repetate
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ROT
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3. R cutanate
• Abdominale:
T5 - mamelon
T10 - ombilic
T12 - inghinal
= abolite / dimin
• plantare: extensie
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4. Semne patologice
• Sincinezii: imitatie, coordonare, globale
• clonus
• semne patologice– linie mediana: oculo-palpebral, Toulouse– mb sup: Marinescu-Radovici, Hoffmann– mb inf: Gordon, Schaeffer, Chadock, Babinski
Mendel-Bechtereev, Rossolimo
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Diagnostic topografic
• Topografia deficit
• semne asociate:– corticale– nn cranieni– sensibilitate
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Cortical
• cortical: hemipareza controlaterala asimetrica + afazie, tulb camp vizual
• capsula interna: hemiplegie egal distribuita
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Subcortical
• TC: sindrom altern = pyr controlat +
nn cran ipsilat
ex.: Millard - Gubler (pyr + VII)
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Spinal