B7-020 Weakness and Spasticity Flashcards by Felicia Jones

paresis definition

weakness (partial paralysis)

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-plegia definition

no movement

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UMN weakness in the upper extremities preferentially effects which muscle groups? [2]

extensors
abductors

(will hold affected limb flexed and adductor due to weakness in extensors and abductors)

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UMN weakness in the lower extremities effect which muscle groups? [2]

dorsiflexion
ankle eversion

(why foot drop can be caused by UMN lesion)

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UMN lesion results in more severe weakness [distal/proximal]

distally

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what grades of deep tendon reflexes are considered abnormal

0 and 4

1,2,3 can be considered normal but comparing to the other side is essential

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acute UMN lesions can caused […] reflexes

decreased

(such as large stroke, spinal shock)

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2 most common pathologic reflexes caused by UMN lesions

plantar response
Hoffman’s

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what is considered an abnormal plantar (Babinki’s) response?

extension of big toe and fanning of other toes

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what is considered an abnormal Hoffman’s sign?

1st and 2nd digit flexion after 3rd digit tapping

meaningful if unilateral

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severe denervation atrophy indicates […] lesions

LMN

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mild disuse atrophy indicates […] lesion

UMN

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hyporeflexia indicates […] lesion

LMN

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hyperreflexia indicates […] lesion

UMN

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hallmark of spasticity

more speed, more resistance
different direction, more resistance

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[spasticity/rigidity] is velocity independent

rigidity

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[…] numbers indicate a worse prognosis on the modified Ashworth scale

higher

(higher numbers indicate more spasticity)

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decreased muscle stretch reflexes indicates […] lesion

LMN

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absent pathological reflexes indicates […] lesion

LMN

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normal tone indicates […] lesion

LMN

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increased spasticity indicates […] lesion

UMN

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present pathological reflexes indicates […] lesion

UMN

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increased muscle stretch receptors indicates […] lesion

UMN

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[spasticity/rigidity] is velocity dependent

spasticity

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describe the LMN motor unit

anterior horn cell + all the muscle fibers it innervates

diffuse bilateral weakness without hyperreflexia or pathological reflexes without numbness

diffuse LMN problem

diffuse bilateral weakness without symptoms in the arms/face

think midline structural process

generalized LMN weakness and **numbness**

peripheral neuropathy

generalized LMN weakness with **normal sensation** arreflexia [2]

motor peripheral neuropathy anterior horn cell problem (west nile)

generalized LMN weakness with **normal sensation** preserved reflexes [2]

NMJ disease muscle

UMN has more influence on [...] and [...] in the upper extremities

extensors abductors

standard scale to measure tone

Ashworth scale

severe weakness on one side of the body

hemiplegia

what grade on the MRC scale does this describe: normal power

what grade on the MRC scale does this describe: able to move joint against gravity and some resistance

what grade on the MRC scale does this describe: active movement against gravity but no resistance

what grade on the MRC scale does this describe: able to move joint with gravity eliminated (PROM)

what grade on the MRC scale does this describe: trace contraction, no joint movement

what grade on the MRC scale does this describe: no contraction

what grade on the DTR scale does this describe: no reflex

what grade on the DTR scale does this describe: reflex only with reinforcement (distraction)

what grade on the DTR scale does this describe: reflex without reinforcement (normal)

what grade on the DTR scale does this describe: reflex spreads to other muscles

what grade on the DTR scale does this describe: clonus

UMN + LMN signs with normal sensation asymmetric weakness bulbar dysfunction

ALS

bulbar dysfunction seen in ALS [2]

dysarthia dysphagia commonly of oral pharyngeal muscles

LMN weakness and normal sensation with **preserved reflexes** is an extremely important clue to a lesion at the [...] or [...]

NMJ junction or muscle **can do a CK to differentiate**

often have proximal weakness without pain CK usually elevated

myopathy

LMN signs with absent DTRs indicate a lesion in [...] or [...]

anterior horn cell peripheral nerve **numbness indicates peripheral nerve**

baby with: reduced/abset DTRs severe and diffuse weakness that spares the facial and oculomotor muscles

spinal muscle atrophy 1 (Werdnig-Hoffman)

spinal muscle atrophy 1 (Werdnig-Hoffman) is caused by a deletion in [...] gene on chromosome 5

SMN

treatment for spinal muscle atrophy 1 (Werdnig-Hoffman)

Neusinersen

proximal and distal weakness frontal balding, temporal wasting, ptosis muscle myotonia (hard to relax)

myotonic dystrophy

most common muscular dystrophy in adults

myotonic dystrophy

hemiparesis of: lower face Arm UMN leg UMN where is the lesion?

lesion above the brainstem on contralateral side

pattern: lower face arm UMN brachio facial where is the lesion?

lesion above the brainstem on contralateral side likely in the **lateral cortex** affecting the lateral part of the motor homunculus

pattern: arm UMN leg UMN brachio-crural where is the lesion? [2]

lesion above the brainstem on contralateral side in the **medial cortex** affecting the medial part of the motor homunculus or ipsilateral lesion in cervical spine on

pattern: UMN arm monoparesis where is the lesion?

discrete lesion in contralateral cerebral hemisphere in cortex

pattern: LMN arm monoparesis where is the lesion?

cervical roots brachial plexus nerves of supper extremity (ipsilateral)

pattern: arm LMN ipsilateral leg UMN where is the lesion?

ipsilateral spinal cord & root myeloradiculopathy

pattern: leg UMN where is the lesion?

discrete lesion of contralateral medial cortex or in ipsilateral thoracic cord

patterns: bilateral leg UMN paraparesis where is the lesion? [2]

discrete lesion of parasagittal region or midline thoracic spinal cord

pattern: bilateral arm UMN bilateral leg UMN quadraparesis where's the lesion?

high cervical spinal cord

pattern: bilateral leg LMN where's the lesion?

lumbosacral cord (cauda equina)

pattern: bilateral arm LMN bilateral leg UMN face spared where's the lesion?

central cord lesion in mid to low cervical spinal cord

pattern: bilateral face LMN bilateral arm LMN bilateral leg LMN generalized LMN weakness arreflexia where's the lesion?

diffuse disease affecting the lower motor unit (anterior horn cell or peripheral nerve)

generalized LMN weakness and **numbness**

peripheral neuropathy

simultaneous involvement of both upper and lower motor neurons are hallmarks of

ALS

generalized weakness without numbness preserved reflexes absence of bulbar or ocular symptoms

muscle problem

weakness with preserved reflexes prominent ocular or bulbar symptoms

NMJ problem

IBM most severely affects the [...] flexors and [...] extensors

finger/wrist flexors knee extensors

difficulty releasing his grip after grasping an object

myotonic dystrophy

bulbar symptoms bilateral proximal weakness preserved reflexes absence of numbness fluctuations of symptoms throughout the day

NMJ problem

people that have highly developed fine motor skills can present with

a very discreet lesion affecting a limited area (because larger area of cortex has been allocated to those movements)

overtreatment with Baclofen can cause

severe weakness (lessen dose)

in the internal capsule, UMN serving the [...] are located in the genu

face

in the internal capsule, UMN serving the [...] are located in the posterior part of the posterior limb

leg

in the internal capsule, UMN serving the [...] are located intermediately between the genu and posterior limb

arms

neurogenic claudication relieved with flexion (sitting, leaning forward, or resting) worsens with extension (walking)

spinal stenosis compressing cauda equina