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Adult Neuro One > Cerebellar Disorders > Flashcards

Cerebellar Disorders Flashcards

1
Q

3 lobes of cerebellum

A

anterior
posterior
flocculonodular

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2
Q

what do folias do?

A

increase surface area of cerebellum

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3
Q

what cerebellar peduncle is the main output? which ones are the main input?

A

superior = output
middle and inferior = input

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4
Q

what do the cerebellum do?

A

gathers info about motor plan from the cerebrum, compares the plan to the movement being performed via input from SC and vestibular system and then outputs the refined motor plan back to cerebrum
**fine tunes movement

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5
Q

lateral hemisphere function

A

motor planning for extremities

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6
Q

intermediate hemispheres function

A

distal limb coordination

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7
Q

vermis and flocculonodular lobe function

A

proximal limb and trunk coordination
balance and VOR

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8
Q

3 functional zones of cerebellum

A

vestibulocerebellum
spinocerebellum
pontocerebellum

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9
Q

vestibulocerebellum

A

balance
posture
eye movement

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10
Q

spinocerebellum

A

muscle tone and coordination of proximal limbs and trunk

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11
Q

pontocerebellum

A

motor planning, coordination and temporal sequencing of distal extremities

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12
Q

what kind of deficits would you see with spinocerebellum dysfunction

A

1 - dyssynergia
2 - dysmetria
3 - lack of movement check
4 - gait ataxia

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13
Q

what kind of deficits would you see with pontocerebellum dysfunction?

A

1 - longer reaction time
2 - decomposition of movement
3 - dysdiadokinesia
4 - hypotonia
5 - dysarthria

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14
Q

what kind of deficits would you see with vestibulocerebellum dysfunction?

A

1 - imbalance
2 - disequilibrium
3 - nystagmus
4 - trunk ataxia
5 - increased sway
6 - falls

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15
Q

two main roles of cerebellum

A

coordination and movement quality

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16
Q

T or F: the cerebellum plays a large role in both motor control and motor learning

A

T

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17
Q

intention tremor

A

tremor when trying to accomplish a task
(ex. when reaching for a bottle the hand starts to tremor and gets worse as you approach the bottle)

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18
Q

most common cause of cerebellar dysfunction

A

alcohol poisoning
*can also be traumatic, autoimmune, infectious, neoplastic, or idiopathic

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19
Q

cerebellar ataxia

A

a combo of dysmetria, dyssynergia, dysdiadochokinesia, dysrhythmia and intention tremor

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20
Q

dysmetria

A

force rate inadequacy

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21
Q

dyssynergia

A

decomposition of movement leading to abnormal movement path deviations

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22
Q

dysrhythmia

A

abnormal timing and coupling of movements

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23
Q

what are some compensatory mechanisms you may see with cerebellar ataxia

A
  • decreased cadence
  • increased time in DLS
  • increased BOS
  • decreased step length
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24
Q

6 categories of cerebellar dysfunction

A

1 - hereditary
2 - congenital
3 - degenerative
4 - acquired
5 - inflammatory
6 - metabolic

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25
Q

Spinocerebellar ataxia, friedreich ataxia, and ataxia telangiectasia are what category of cerebellar dysfunction?

A

hereditary

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26
Q

chiari malformation is a ______ cerebellar dysfunction

A

congenital
*may not have symptoms until later though

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27
Q

Parkinson’s, Huntington’s and multiple system atrophy are in what category of cerebellar dysfunction?

A

degenerative

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28
Q

Brain tumor, stroke, and TBI are in what category of cerebellar dysfunction?

A

acquired

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29
Q

Gullain-Barre and Multiple sclerosis are in what category of cerebellar dysfunction

A

inflammatory

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30
Q

friedreich ataxia

A

degeneration of peripheral nerves and nerve fibers in the spinal cord

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31
Q

Friedreich ataxia is autosomal ______________

A

recessive
*25% chance

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32
Q

Patients w/ Friedreich ataxia usually live to be __________ years old

A

40-50

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33
Q

constitutional symptoms

A

fatigue, weakness

34
Q

spinal cerebellar ataxia

A

dysfunction of cerebellum and brainstem

35
Q

spinal cerebellar ataxia is autosomal-__________

A

dominant
*if you get the gene you have the disease
50% chance

36
Q

PD is degeneration of the ______. you don’t have enough what?

A

substantia nigra
*dopamine

37
Q

cardinal signs of PD?

A

TRAP
tremor (resting)
rigidity
akinesia/bradykinesia
postural instability/balance deficits

38
Q

T or F: ataxia is common in PD

A

F: not always. more likely in early onset or severe cases

39
Q

cerebellar signs/symptoms of PD

A

postural instability, tremor, gait disturbances, dyskinesia, dysphagia

40
Q

HD is autosomal ______

A

dominant

41
Q

HD is deterioration of…

A

caudate/putamen

42
Q

characteristics of HD

A

chorea, hypertonic reflexes, abnormal eye movements, dystonia, cognitive decline

43
Q

T or F: there is a known cause for multiple systems atrophy

A

F

44
Q

T or F: MSA progresses rapidly

A

T

45
Q

2 main types of MSA? which is more common

A

MSA-P (more common)
MSA-C
*often overlapping symptoms

46
Q

MSA-P

A

parkinsonian symptoms

47
Q

MSA-C

A

cerebellar signs

48
Q

T or F: dysautonomia is present with both types of MSA

A

T

49
Q

chiari malformation

A

structural deficit in the base of the skull and cerebellum when part of the cerebellum extends below the foramen magnum

50
Q

chiari 1 malformation

A

downward displacement of cerebellar tonsils into foramen magnum

51
Q

chiari 2 malformation

A

downward displacement of the cerebellum, brainstem into foramen magnum

52
Q

chiari 3 malformation

A

parts of the cerebellum and brainstem herniate through abnormal opening in the back of the skull

53
Q

chiari 4 malformation

A

parts of the cerebellum are missing

54
Q

clinical presentation of chiari malformation

A

-headache/neck pain
-hearing loss
-balance issues/dizziness
-weakness, numbness
-fine motor skill deficits
-scoliosis
-insomnia
-difficulty breathing

55
Q

acquired ataxia

A

damage directly to the cerebellum

56
Q

what artery is usually occluded in wallenberg syndrome

A

PICA

57
Q

do cerebellar lesions cause ipsilateral or contralateral deficits

A

ipsilateral

58
Q

wallenburg syndrome clinical presentations

A

-contralateral loss pain/temp in trunk
-ipsilateral horner’s syndrome
-ipsilateral nysatgmus,vertigo
-ipsilateral gait ataxia
-ipsilateral loss of gag reflex & hoarseness
-ipsilateral dysphagia, dysarthria, dysphonia

59
Q

What three tests rule out central causes of vestibular symptoms?

A
  1. positive head impulse
  2. unidirectional nystagmus
  3. negative test of skew
    HINTS
    *if these are all true it is a peripheral cause!
60
Q

test of skew

A

cover one eye and quickly transition to the other eye. Look for correction in the eye you just uncovered. If it has to correct it is positive

61
Q

sensory ataxia involves damage to the…

A

dorsal columns and dorsal root ganglia

62
Q

signs/symptoms of sensory ataxia

A
  • impaired proprioception and vibratory sense
  • positive romberg w/ eyes closed
  • stomping gait
63
Q

Your pt is unstable in Romberg with eyes open and closed. Is it most likely due to cerebellar or sensory ataxia?

A

cerebellar

64
Q

Your pt is unstable in Romberg with eyes closed, but does well with his eyes open. Is it most likely due to cerebellar or sensory ataxia?

A

sensory

65
Q

do pts with cerebellar dysfunction usually have hypo or hypertonia

A

hypotonia

66
Q

cerebellar drift

A

when arms are straight palm up, one arm drifts up and out

67
Q

common cerebellar signs (DANISH)

A

D = dysdiadokinesia, dysmetria
A = ataxia
N = nystagmus
I = intention tremor
S = speech
H = hypotonia

68
Q

What areas might we want to take a closer look at during our exam specific to the cerebellum?

A

1) postural control
2) oculomotor performance
3) coordination
4) static/dynamic balance
5) gait

69
Q

postural control is the product of ______ integration and ______ control

A

sensory
motor

70
Q

Pts with cerebellar ataxia have a _______- cone of stability

A

smaller

71
Q

6 core outcome measures

A

1) Berg Balance Scales
2) Functional Gait Assessment
3) Activities-Specific Balance Confidence Scale
4) 10 meter walk test
5) 6 minute walk test
6) 5 times sit to stand

72
Q

What are two other outcome measures specifically related to ataxia? Which is used more clinically and why?

A

-International Cooperative Ataxia Rating Scale (ICARS)
-Scale for the Assessment and Rating of Ataxia (SARA)
*SARA is used more clinically b/c its only 8 items

73
Q

T or F: it is very important to challenge pts with neurological deficits

A

T: increases brain neurotrophic proteins and enhances neuroplasticity

74
Q

________ practice dosage is needed for automaticity

A

high

75
Q

T or F: task variability improves retention and translation

A

T

76
Q

T or F: you should only focus on static balance for cerebellar dysfunction

A

F: static and dynamic

77
Q

frenkel exercises

A

-series of motion w/ increasing difficulty designed for patients w/ cerebellar ataxia to improve coordination
-goal is to complete the task perfectly before progressing to the next exercise

78
Q

T or F: frenkel exercises help w/ strengthening

A

F

79
Q

gaze stabilization exercise

A

look straight ahead at an object. Stay focused on the object as you turn your head left and right 45 degrees

80
Q

vestibular habituation training

A

in sitting, bring head down with nose towards right knee. Maintain position until symptoms subside. Then, come up diagonally extending head toward the left. Hold until symptoms subside

81
Q

factors known to affect outcomes of cerebellar disorders

A
  • comorbidities
  • age
  • previous living dituation
  • time since injury
  • time of admission to a program
  • medical complications
82
Q

Do younger or older patients typically have a worse prognosis with cerebellar disorders

A

younger, due to the cerebellum’s role in motor learning

Adult Neuro One (10 decks)

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