Basal Ganglia and Cerebellum

Question 1

Signs of Basal Ganglia Disorder

Answer 1

• resting tremor
• hypokenesia (rigidity, bradykinesia)
• hyperkinesia (chorea, athetosis, akathisia)

Question 2

Signs of Cerebellar Disorder

Answer 2

• synergy (ataxia)
• dysequilibrium
• hypotonia
• action tremor
• nystagmus

Question 3

3 Common Patterns of Pathologically Increased Muscle Tone

Answer 3

1. rigidity- cogwheel or lead pipe feeling
2. spasticity- velocity dependent inc. in tension
3. paratonia- pt seems to actively oppose passive motion despite instruction to relax

Question 4

Appendicular Ataxia

Answer 4

-associated with dysmetria (over and under shooting of a target) and decomposition of movement are seen with appendicular ataxia

Question 5

Diysdiadochokinesia Test

Answer 5

-test by asking pt to flip palm over and back over other palm

Question 6

Differential Diagnosis with Positive Romberg Sign (Swaying While Standing)

Answer 6

• impaired proprioception (DC/spinal cord)
• impaired vestibular function (fall forward lesion)
• impaired Sb1 funciton (mainly vermis or vestibulo Cb1)

Question 7

Tau Associated Diseases

Answer 7

• frontotemporal dementia
• alzheimer’s disease
• progressive supranuclear palsy
• corticobasal degeneration

Question 8

Alpha Synuclein Diseases

Answer 8

• parkinson disease

- lewy body dementia

Question 9

Lewy Body Dementia

Answer 9

• similar to parkinsons
• onset of dementia within a year of parkinson sx
• more diffuse lewy body distribution

Question 10

Progressive Supranuclear Palsy (PSP)

Answer 10

• tau reactive neuron tangles and glial inclusions

- degeneration of nigrostriatal system

Question 11

Corticobasal Degeneration

Answer 11

• tauopathy
• cerebral cortical atrophy
• neuron loss and gliosis
• astrocytic plaques

Question 12

Multiple Systems

Answer 12

• striatonigral degeneration results in putamenal atrophy
• associated loss of corresonding striatopallidal and external capsular white matter tracts
• pontocerebellar atrohpy
• cerebellar atrophy
• olivocerebellar atrohpy
• intermediolateral column degeneration

Question 13

Degenerative Ataxias

Answer 13

• autosomal recessive
• spinocerebellar ataxias
• freidreich ataxia
• severe atrophy of pontocerebellar system
• loss of neurons in basis pontis

Question 14

Cerebellar Cortical Degeneration

Answer 14

• atrophy of cerebellar folia involves both cortex and digitate white matter
• bergmann gliosis
• loss of purkinje cells

Question 15

Freidreich’s Ataxia

Answer 15

• GAA triplet repeat expansion
• sensory neuropathy
• pathological changes are most prominent in spinal cord
• loss of DRG, loss of large myelinated sensory axons in peripheral nerves

Question 16

Inferior Cerebellar Peduncle

Answer 16

• connects cerebellum to medulla and spinal cord
• contains incoming vestibular and proprioceptor fibers and outgoing motor fibers
• input: post. sup. cerebellar tract, inf. olive
• output: cerebellum

Question 17

Middle Cerebellar Peduncle (MCP)

Answer 17

• route where info from cerebral cortex get to cerebellum via pontine nuclei
• climbing fibers come from inf. olive and enter through middle peduncle only
• input: pons (cerebral cortex)
• output: cerebellum

Question 18

Superior Cerebellar Peduncle (SCP)

Answer 18

• route where cerebellum gets info back to cerebral cortex (via the thalamus)
• input: cerebrum
• output: ant. sup. cerebellar tract, red nucleus, thalamus (VA/VL)

Question 19

Interposed Nuclei

Answer 19

• located in cerebellum

- made up of: dentate, globose, and emboliform nuclei

Question 20

Nuclei in Cerebellum

Answer 20

• fastigial neuclei
• dentate
• globose
• emboliform
• last three combined are called interposed nucleus

Question 21

Inferior Olive

Answer 21

• in charge of expectation vs reality

- ex. prism glasses