B7-020 Weakness and Spasticity Flashcards
paresis definition
weakness (partial paralysis)
-plegia definition
no movement
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)
UMN weakness in the lower extremities effect which muscle groups? [2]
dorsiflexion
ankle eversion
(why foot drop can be caused by UMN lesion)
UMN lesion results in more severe weakness [distal/proximal]
distally
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
acute UMN lesions can caused […] reflexes
decreased
(such as large stroke, spinal shock)
2 most common pathologic reflexes caused by UMN lesions
plantar response
Hoffman’s
what is considered an abnormal plantar (Babinki’s) response?
extension of big toe and fanning of other toes
what is considered an abnormal Hoffman’s sign?
1st and 2nd digit flexion after 3rd digit tapping
meaningful if unilateral
severe denervation atrophy indicates […] lesions
LMN
mild disuse atrophy indicates […] lesion
UMN
hyporeflexia indicates […] lesion
LMN
hyperreflexia indicates […] lesion
UMN
hallmark of spasticity
more speed, more resistance
different direction, more resistance
[spasticity/rigidity] is velocity independent
rigidity
[…] numbers indicate a worse prognosis on the modified Ashworth scale
higher
(higher numbers indicate more spasticity)
decreased muscle stretch reflexes indicates […] lesion
LMN
absent pathological reflexes indicates […] lesion
LMN
normal tone indicates […] lesion
LMN
increased spasticity indicates […] lesion
UMN
present pathological reflexes indicates […] lesion
UMN
increased muscle stretch receptors indicates […] lesion
UMN
[spasticity/rigidity] is velocity dependent
spasticity
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
5
what grade on the MRC scale does this describe:
able to move joint against gravity and some resistance
4
what grade on the MRC scale does this describe:
active movement against gravity but no resistance
3
what grade on the MRC scale does this describe:
able to move joint with gravity eliminated (PROM)
2
what grade on the MRC scale does this describe:
trace contraction, no joint movement
1
what grade on the MRC scale does this describe:
no contraction
0
what grade on the DTR scale does this describe:
no reflex
0
what grade on the DTR scale does this describe:
reflex only with reinforcement (distraction)
1
what grade on the DTR scale does this describe:
reflex without reinforcement (normal)
2
what grade on the DTR scale does this describe:
reflex spreads to other muscles
3
what grade on the DTR scale does this describe:
clonus
4
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
