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B of the distal parts of the affected limb Ballistic movements are usually unilateral (hemiballismus) and the result of an acute lesion of the contralateral subthalamic nucleus or immediately surrounding structures (infarction or hemorrhage, rarely a demyelinative or other lesion) Rarely, a transitory form is linked to a subdural hematoma or thalamic or parietal lesion The inging movements may be almost continuous or intermittent, occurring several times a minute, and of such dramatic appearance that it is not unusual for them to be regarded as hysterical in nature Bilateral ballismus is very infrequent and usually asymmetrical; here a metabolic disturbance, particularly nonketotic hyperosmolar coma, is the usual cause When this is found in combination with choreoathetosis, a paraneoplastic process is a rare cause When ballismus persists for weeks on end, as it often did before effective treatment became available, the continuous forceful movements can result in exhaustion and even death In most cases, medication with haloperidol or phenothiazine suppresses the violent movements In extreme cases, stereotactic lesions placed in the ventrolateral thalamus and zona incerta have proved effective (Krauss and Mundinger) Dystonia (Torsion Spasm) (See also Chap 6 for a discussion of focal dystonias) Dystonia, a persistent attitude or posture in one or the other of the extremes of athetoid movement, is produced by cocontraction of agonist and antagonist muscles that place the limb in an unnatural position It may take the form of an overextension or over exion of the hand, inversion of the foot, lateral exion or retro exion of the head, torsion of the spine with arching and twisting of the back, forceful closure of the eyes, or a xed grimace (Fig 4-5; see also Fig 6-2, page 92) De ned in this way, dystonia is closely allied to athetosis, differing only in the persistence or xity of the postural abnormality and the disproportionate involvement of the large axial muscles (those of the trunk and limb girdles) The term dystonia is now generally used in this way, but it has been given other meanings as well Wilson referred to any variability in muscle tone as dystonia This term has also been applied to xed abnormalities of posture that may be the end result of certain diseases of the motor system; thus Denny-Brown speaks of hemiplegic dystonia and the exion dystonia of parkinsonism If the term is to be used in the latter sense, it would be better to speak of the persistent but reversible athetotic movements of the limbs and trunk as torsion spasms or phasic dystonia, in contrast to xed dystonia Dystonia, like athetosis, may vary considerably in severity and may show striking uctuations in individual patients In its early stages it may be interpreted as an annoying mannerism or hysteria, and only later in the face of persisting postural abnormality, lack. asp.net ean 13 EAN - 13 ASP . NET Control - EAN - 13 barcode generator with free ...
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