Fast micrographia and pallidal pathology

Quinn, Niall; Kuoppamäki, Mikko

doi:10.1002/mds.10474

Cited by 5 publications

(8 citation statements)

References 9 publications

(11 reference statements)

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“…Regarding the nature of parkinsonism, it appears that, in these published cases, axial motor problems (gait and speech disorder with possible freezing and postural instability) seemed to dominate over brady/akinesia (defined mainly by rapid alternating (distal) limb movements), rigidity, and tremor of the limbs (table 3). This was also the case with our patient, who had a speech problem, ''fast micrographia'', 13 and impaired postural reflexes, but no distal limb akinesia or tremor. However, the clinical picture of parkinsonism of our case differed from that of typical PD, as the main clinical findings in PD are rest tremor, distal bradykinesia, and limb rigidity.…”

Section: Discussionsupporting

confidence: 79%

“…However, alternate supination and pronation of the arms revealed a dramatic deficit with rapid breakdown of rhythm, timing, and amplitude and fatigue over 5-10 repetitions. On writing there was ''fast micrographia'', 13 so that although the size of his writing was extremely small, its speed was normal. He could, however, use his hands normally for doing up buttons, tying laces, and pressing computer keys.…”

Section: Case Descriptionmentioning

confidence: 99%

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Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease

Kuoppamäki

Rothwell²,

Brown³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives: The authors report the results of detailed investigations into the motor function of a patient who, after a heavy drinking binge and subsequent unconsciousness, respiratory acidosis, and initial recovery, developed parkinsonism characterised by hypophonic speech and palilalia, ''fast micrographia'', impaired postural reflexes, and brady/akinesia in proximal (but not distal) alternating upper limb movements. Methods: In addition to brain magnetic resonance imaging (MRI), different aspects of motor function were investigated using reaction time (RT) tasks, pegboard and finger tapping tasks, flex and squeeze tasks, movement related cortical potentials (MRCPs), and contingent negative variation (CNV). Cognitive function was also assessed. The results were compared to those previously reported in patients with Parkinson's disease (PD). Results: Brain MRI showed isolated and bilateral globus pallidus (GP) lesions covering mainly the external parts (GPe). These lesions were most probably secondary to respiratory acidosis, as other investigations failed to reveal an alternative cause. The results of the RT tasks showed that the patient had difficulties in preparing and maintaining preparation for a forthcoming movement. MRCP and CNV studies were in line with this, as the early component of the MRCP and CNV were absent prior to movement. The patient's performance on pegboard and finger tapping, and flex and squeeze tasks was normal when performed with one hand, but clearly deteriorated when using both hands simultaneously or sequentially. Conclusions: In general, the present results were similar to those reported previously in patients with PD. This provides further indirect evidence that the output of globus pallidus is of major importance in abnormal motor function in PD. The possible similarities of the functional status of GP in PD and our case are discussed.T here is considerable interest in the pathophysiology of motor dysfunction in different basal ganglia diseases, especially in idiopathic Parkinson's disease. Preparation and execution of voluntary movements assessed using different reaction time paradigms, 1-3 or through recording of movement related cortical potentials (MRCP) [4][5][6] have been extensively studied in PD. The overall conclusion is that the preparation, initiation, and the execution of voluntary movements are slow or abnormal in patients compared with healthy control subjects.7 It is also known that bradykinesia in PD becomes more prominent by repetitive, simultaneous, or sequential movements.7 Despite these interesting results, it has been very difficult to examine the role of individual nuclei in the pathophysiology of motor dysfunction in PD, as the underlying alterations in different pathways and nuclei are complex in this disease. 8 9 Although the gross morphology of the globus pallidus (GP) is normal, 10 it is widely accepted that the abnormal functional output of GP is one of the major contributors to motor dysfunction in PD.8 9 The renaissance in the surgical treatment of PD ...

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Section: Discussionsupporting

confidence: 79%

Section: Case Descriptionmentioning

confidence: 99%

Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease

Kuoppamäki

Rothwell²,

Brown³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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“…[4] ‘Handwriting is microscopic from the outset, does not (indeed cannot) become progressively smaller, is accomplished at (astonishingly) normal speed, and does not fatigue. This micrographia can be so marked as to resemble a straight line, so that even the patients are often unable to read what they have written.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas the degree of micrographia in Parkinson’s disease is usually proportional to the degree of decrement in rate and amplitude of alternating finger movements in the dominant hand, many patients with fast micrographia have completely normal alternating finger movements’. [4] The authors have observed fast micrographia in case of progressive supranuclear palsy and acquired bilateral lesions of the globus pallidus. [4] They have proposed that ‘the presence of fast micrographia, usually unaccompanied by significant fatiguing or decrement of alternating finger movements, should be considered a useful clinical pointer to the possibility of pallidal pathology’.…”

Section: Discussionmentioning

confidence: 99%

“…[4] The authors have observed fast micrographia in case of progressive supranuclear palsy and acquired bilateral lesions of the globus pallidus. [4] They have proposed that ‘the presence of fast micrographia, usually unaccompanied by significant fatiguing or decrement of alternating finger movements, should be considered a useful clinical pointer to the possibility of pallidal pathology’. We meant the glabellar tap was normal and have changed the sentence accordingly.…”

Section: Discussionmentioning

confidence: 99%

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Fast micrographia: An unusual but distinctive sign

Umaiorubahan

Velmurugendran

Prabash

2013

Ann Indian Acad Neurol

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Fast micrographia is a rare clinical sign, which is reported in patients with pallidal pathology. A 68-year-old male presented with hypophonia and short shuffling gait with decreased arm swing. About 3 weeks before, he had an acute myocardial infarction and a period of hemodynamic and respiratory distress during which he required mechanical ventilatory support. He was found to have a fast handwriting with micrographia from the outset. His rapid alternating hand and finger movements were normal. Magnetic resonance imaging (MRI) of the brain showed features of hypoxic ischemic encephalopathy including hyperintensities on T1 and T2 weighted images in the globus pallidus, and putamen bilaterally.

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