Name: Chico, James Knowell E.

Block: 7

University of Cebu School of Medicine

Department of Physiology

Individual Learning Output

Case 1

A 63-year-old man is brought to his primary care physician because of concern on the part of
his family that he is acting differently. He has been having a worsening tremor at rest and
difficulty walking. His family states that when he walks, he often has difficulty stopping. He has
no personal or family medical history. On examination, he has a mask-like facial expression with
little blinking. He is noted to have a fine tremor at rest in a “pill-rolling” manner. He has
muscular rigidity and a stooped posture. On walking, the patient is noted to have rapid
propulsion forward with an inability to stop. He shows no signs of dementia or depression.

A. What is your diagnosis for this patient? Why?

Parkinson’s disease. Based on observations and examination, the patient must
have Parkinson’s disease. The patient presents with muscle rigidity, resting tremor, and
difficulty in walking – consistent with Parkinson’s.
B. Where would the location of the lesion be found in this patient?
Substantia nigra. The lesion would be located at the substantia nigra, one of the
nuclei composing the basal ganglia. A lesion of the substantia nigra will result in
Parkinson disease, the symptoms of which are produced by a loss of dopamine-
containing nerve cells in the substantia nigra that results in less disinhibition of thalamic
activity and thus decreased facilitation of movements initiated in the cortex.
C. What would be the location of the lesion in a patient with hemiballismus?
Subthalamic nucleus. Lesions of the subthalamic nucleus often result in
involuntary, sometimes violent movements of the contralateral limbs – hemiballismus,
which is a movement disorder characterized by large, spontaneous, uncontrolled, and
throwing motions of the arm and leg (usually unilateral).
D. Describe the organization and functions of the basal ganglia in a concept map.

E. Trace the direct and

indirect
pathways in
the basal ganglia
motor loop.