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Basal Ganglia examinatinMalakouti SK

School of Behavioral Sciences,

Iran University of Medical Sciences

Malakouti SK, Tehran Instutute of Psychiatry, IUMS

B.G component

• Striatum (GABA)

• Pallidum (GABA)

• Sustantia nigra (DA)

• Subthalamic N.(Glutaminergic)


B.G components

• Striatum (GABA)

• Pallidum (GABA)

• Sustantia nigra (DA)

• Subthalamic N. (Glutaminergic)


Frontal areas connected with BG(striato-thalamo circuit), 5 neural loop (Alexander, Crutcher-1990

• Skeletomotor: • Premotor c. (PMC)

• Supplementary motor area. (SMA)

• Motor C. (MC)• Oculomotor: frontal eye field(FEF)

• Supplementary eye field (SEF)

• Prefrontal c.• Dorsolateral f.(DLFC)(9-10)

• Orbitifrontal c (LOFC)

• Limbic circuit• Anterior cingulate area(ACA)

• medial orbitofrontal cortex(MOFC)


Caud.

SNcThal.

GPi

+

-

--

-

++


LCSPT dysfunction and correlated symptoms

• Forebrain DA hypoactivity

• Limbic-striatum disinhibition

• Pallidum over-inhibition

• Decreased inhibition of thalamus

• Disinhibition of

prefrontal, amygdala

• explain characteristic:• emotional

• cognitive

• motor activity

• guilty ruminations

• motor slowing

• would not explain underactivity of • decreased attention

• Executive dysfunction


OMPFC AMYGDALA hippocampal striatumThalamus,

mediodorsal, midline

pallidum

Emotional behavior neuronal pathway


ACA

Ventral striatum

GPi

--

-

OCD reverberation pathway

+

++


BG and Cerebral cortex contributes to:

1. Voluntary movement

2. Skeletomotor

3. Oculomotor

4. Cognition

5. Emotion

6. Motivation

7. Social appropriate response


Movement manifestation of BG dysfunction

• Tremor

• Agitation

• Akatisia

• Shuffling gait

• Striatal hand: ulnar deviation, flexion of fingers at the metacarpal

phalangeal joints

• Pill rolling tremor

• Loss of agility

• Involuntary movements

• chorea


Striatal hand


Cognitive manifestation of BG dysfunction

• Cognitive problem: • mental torpor, • cognitive dilapidation, • apathy,

• Learning, speech and language, praxis, calculation are intact.

• Retrieved material impaired. Required number of prompt indicate the degree of impairment.

• Impersistence and slowed completion of task

• Huntington’s disease

• Parkinson’s disease

• Lacunaire syndrome

• Tumors

• Progressive supranuclearpalsy

• Multisystem atrophy

• Wilson’s disease

• Corticobasal degeneration


feature Cortical subcortical

Language Aphasia Preserved

Speech Normal until late stage Dysarthria early

Recall Impaired Impaired

Recognition cue Ineffective Effective

Encoding ineffective Effective

Priming absent Present

Procedural intact Impaired

Visuoperception Severely impaired Mild impaired

Calculation Acalculia Relatively preserved

Executive function Relative to overall impairment More than overall impairement

Cognitive speed Normal Slowed


Features Cortical subcortical

Personality and mood No insight, unconcerned, infrequent

depression

Insight, apathetic, frequent

depression

Motor speed Normal until late stage Slowed

Posture Normal until late stage Stooped, rigid

Gait Normal until late stage Abnormal

coordination Normal until late stage abnormal

Involuntary movement Normal until late stage Tremor, chorea, tic, dystonia


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