Central Nervous System 39% Flashcards
What part of the brain controls Sensory and motor interpretation; Language
Stroke (CVA), Cerebral Palsy, Alcoholism, Alzheimer’s, Tumor
Cerebrum
Part of brain for Balance, coordination, dysmetria (past pointing), dyssynergia (lack of coordination), diadochokinesia (rapidly alternating movements), tandem gait
Multiple Sclerosis, Alcoholism, and a form of Cerebral Palsy
Cerebellum
Part of CNS for Two Point Discrimination, vibration, and joint position sense.
MS, Tabes Dorsalis, Leprosy
Posterior Columns
Part of CNS for Voluntary motor, flexors of the hands and feet.
UMNL
Corticospinal (pyramidal)
Pain and Temperature
Syringomyelia
Lateral Spinothalamic
Crude Light Touch
Anterior Spinothalamic
Balances reflexes and postural muscles
Benign positional vertigo and Labyrinthitis
Vestibulospinal
Muscle tone and synergy to proximal flexors of the extremities
Rubrospinal
Muscle tone and synergy to the voluntary extensor muscles
Reticulospinal
Crosses at medullary pyramids and travels to the flexors of the extremities
Lateral Corticospinal
Crosses at the segmental level and then to the flexors of the trunk. UMNL
Ventral Corticospinal
Pathological longitudinal cyst of the central canal of the spinal cord. Fluid filling cavities expand in adult years (congenital weakening usually at C5-C6 area).
*** Loss of sense of pain and temperature over the shoulders and back in a cape-like distribution.
Syringmyelia
Lat Spinothalamic tract
*** Demyelination of the CNS (oligodendrocytes are responsible for myelination in the CNS) producing demyelination of the spinal cord and later the brain.
Both motor and sensory tracts are affected.
MC seen in females 20-40.
Periods of exacerbations and remissions.
Worse when moving from cold to warm climate.
- Diplopia, scotomas, transient blindness, optic neuritis, pain, vertigo, and UMNL in the legs causing distal weakness
- (+) Lhermitte’s test
- Charcot’s Triad: scanning speech, intention tremors, nystagmus (SIN).
- Diagnosis best with MRI
Multiple Sclerosis
Cerebellum or Posterior Columns
Autoimmune disease in which the body makes antibodies against acetylcholine receptors
Females 20-40
Myoneural junction dysfunction
Weakness in cranial nerves then proximal muscles affected.
- Early signs include ptosis, diplopia, dysarthria, & fatigue of muscles (especially following exercise).
- Muscle weakness varies during the day being worse at the end of the day.
- Diagnosed with tensilon test & treated with cholinesterase inhibiting drugs.
Myasthenia Gravis
***Affects the corticospinal tract and anterior horn.
Usually begins in the hands/feet and life expectancy is short.
Seen in males >40.
- Fasciculation’s are present as well as spasticity and increased DTR’s.
- LMNL in the arms & UMNL in the legs
- DDx: Lateral canal stenosis
Amyotrophic Lateral Sclerosis (ALS)
aka Lou Gehrig’s Disease
Corticospinal tract
Degeneration of the posterior column and the corticospinal tracts as a result of a B12 deficiency*** (pernicious anemia).
- (+) Schilling test***
- Neurological symptoms are irreversible
- Glove & Stocking paresthesia
Posterolateral Sclerosis (PLS) aka Combined Systems Disease
Posterior Columns
A hemisection (partially severed) spinal cord usually caused by an injury. - Ipsilateral loss of motor function and dorsal columns (proprioception) with contra-lateral loss of pain and temperature.
Brown Sequard
A non-progressive motor disorder of the cerebral cortex due to anoxia to the brain prenatally or during birth trauma.
- Scissor gait*, spastic paralysis, athetoid (MC) and choreiform movements, normal intelligence levels.
Cerebral Palsy
A chronic progressive condition associated with loss of dopamine in the substantia nigra* causing basal ganglionic dysfunction. Extrapyramidal tract involvement. Gradual onset over age 50
- Resting tremors, mask-like face*, festinating gait, cogwheel/lead pipe rigidity, forward stooped posture, bradykinesia.
Parkinson’s Disease
aka Paralysis Agitans
Inflammatory polyneuropathy of the PNS linked to recent immunizations or seen after recent flu infection. Ascending paralysis*** (beginning in the legs) and sensory symptoms. Can become a medical emergency if it reaches the diaphragm.
Guillain-Barre Syndrome
Clinical condition of tertiary syphilis; wasting away of the posterior columns.
- Irregularities of the pupil (Argyll Robertson’s pupil - accommodates but does not respond to direct light); coordination and balance are disturbed. Slappage gait can be present.
Tabes Dorsalis
Sex linked recessive disorder.
Boys age 3-7.*
- Proximal muscle weakness causing waddling gait; toe walking, hyperlordosis (pot belly stance); pseudohypertrophy of the calves; Gower’s sign.
- Large increase in CPK (CK-MM)*; decreased creatinine.
Muscular Dystrophy (Erb Duchenne)
Hereditary condition that affects both motor and sensory nerves. A typical feature includes weakness of the foot and lower leg muscles which may result in foot drop* and a high-stepped gait* with frequent tripping or falls. Lower leg atrophy (peroneal muscles) will occur after a period of time.
Charcot Marie Tooth Disease
Mental deterioration (cortical degeneration), amnesia. Most definitive dx: Autopsy
Alzheimer’s
