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Involuntary movement disorders--each has a meaning all its own.

Degenerative processes in the corpus striatum, neuroleptics drugs, thyroid disease, and Parkinson's disease are all causes of abnormal spontaneous movements in the elderly. Differential diagnosis is essential for selecting the proper therapy, and the patient's history often provides the key.

Aged

A different form of "pure agraphia": syntactic writing errors in a patients with motor speech and movement disorders.

Three patients are described who displayed syntactic writing errors in combination with a motor speech disturbance and impaired motor limb function. Two of the patients had bulbar amyotrophic lateral sclerosis (ALS). Agraphia appeared when verbal communication was no longer possible. Autopsy in one patient disclosed only lesions consistent with ALS. The third patient had palilalia and chorea and although not aphasic, his written language showed persistent syntactic errors. We hypothesize that the agraphia in these patients occurred because of the combination of disordered feedback from the motor speech apparatus and limbs.

Adult

Bizarre posture and movement disorder with third ventricle astrocytoma.

An eight-year-old girl presented with a bizarre posture and gait and was diagnosed as having hysterical astasia-abasia. She walked with marked lordosis and head hyper-extended, and would walk backwards across the room to a bed or chair for support. She had a midline astrocytoma and the disorder was relieved with removal of the tumour. The unusual symptomatology accompanying many midline lesions is re-emphasized.

Astrocytoma