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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
Spinocerebellar ataxia, friedreich ataxia, and ataxia telangiectasia are what category of cerebellar dysfunction?
hereditary
26
chiari malformation is a ______ cerebellar dysfunction
congenital *may not have symptoms until later though
27
Parkinson's, Huntington's and multiple system atrophy are in what category of cerebellar dysfunction?
degenerative
28
Brain tumor, stroke, and TBI are in what category of cerebellar dysfunction?
acquired
29
Gullain-Barre and Multiple sclerosis are in what category of cerebellar dysfunction
inflammatory
30
friedreich ataxia
degeneration of peripheral nerves and nerve fibers in the spinal cord
31
Friedreich ataxia is autosomal ______________
recessive *25% chance
32
Patients w/ Friedreich ataxia usually live to be __________ years old
40-50
33
constitutional symptoms
fatigue, weakness
34
spinal cerebellar ataxia
dysfunction of cerebellum and brainstem
35
spinal cerebellar ataxia is autosomal-__________
dominant *if you get the gene you have the disease 50% chance
36
PD is degeneration of the ______. you don't have enough what?
substantia nigra *dopamine
37
cardinal signs of PD?
TRAP tremor (resting) rigidity akinesia/bradykinesia postural instability/balance deficits
38
T or F: ataxia is common in PD
F: not always. more likely in early onset or severe cases
39
cerebellar signs/symptoms of PD
postural instability, tremor, gait disturbances, dyskinesia, dysphagia
40
HD is autosomal ______
dominant
41
HD is deterioration of...
caudate/putamen
42
characteristics of HD
chorea, hypertonic reflexes, abnormal eye movements, dystonia, cognitive decline
43
T or F: there is a known cause for multiple systems atrophy
F
44
T or F: MSA progresses rapidly
T
45
2 main types of MSA? which is more common
MSA-P (more common) MSA-C *often overlapping symptoms
46
MSA-P
parkinsonian symptoms
47
MSA-C
cerebellar signs
48
T or F: dysautonomia is present with both types of MSA
T
49
chiari malformation
structural deficit in the base of the skull and cerebellum when part of the cerebellum extends below the foramen magnum
50
chiari 1 malformation
downward displacement of cerebellar tonsils into foramen magnum
51
chiari 2 malformation
downward displacement of the cerebellum, brainstem into foramen magnum
52
chiari 3 malformation
parts of the cerebellum and brainstem herniate through abnormal opening in the back of the skull
53
chiari 4 malformation
parts of the cerebellum are missing
54
clinical presentation of chiari malformation
-headache/neck pain -hearing loss -balance issues/dizziness -weakness, numbness -fine motor skill deficits -scoliosis -insomnia -difficulty breathing
55
acquired ataxia
damage directly to the cerebellum
56
what artery is usually occluded in wallenberg syndrome
PICA
57
do cerebellar lesions cause ipsilateral or contralateral deficits
ipsilateral
58
wallenburg syndrome clinical presentations
-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
What three tests rule out central causes of vestibular symptoms?
1. positive head impulse 2. unidirectional nystagmus 3. negative test of skew HINTS *if these are all true it is a peripheral cause!
60
test of skew
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
sensory ataxia involves damage to the...
dorsal columns and dorsal root ganglia
62
signs/symptoms of sensory ataxia
- impaired proprioception and vibratory sense - positive romberg w/ eyes closed - stomping gait
63
Your pt is unstable in Romberg with eyes open and closed. Is it most likely due to cerebellar or sensory ataxia?
cerebellar
64
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?
sensory
65
do pts with cerebellar dysfunction usually have hypo or hypertonia
hypotonia
66
cerebellar drift
when arms are straight palm up, one arm drifts up and out
67
common cerebellar signs (DANISH)
D = dysdiadokinesia, dysmetria A = ataxia N = nystagmus I = intention tremor S = speech H = hypotonia
68
What areas might we want to take a closer look at during our exam specific to the cerebellum?
1) postural control 2) oculomotor performance 3) coordination 4) static/dynamic balance 5) gait
69
postural control is the product of ______ integration and ______ control
sensory motor
70
Pts with cerebellar ataxia have a _______- cone of stability
smaller
71
6 core outcome measures
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
What are two other outcome measures specifically related to ataxia? Which is used more clinically and why?
-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
T or F: it is very important to challenge pts with neurological deficits
T: increases brain neurotrophic proteins and enhances neuroplasticity
74
________ practice dosage is needed for automaticity
high
75
T or F: task variability improves retention and translation
T
76
T or F: you should only focus on static balance for cerebellar dysfunction
F: static and dynamic
77
frenkel exercises
-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
T or F: frenkel exercises help w/ strengthening
F
79
gaze stabilization exercise
look straight ahead at an object. Stay focused on the object as you turn your head left and right 45 degrees
80
vestibular habituation training
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
factors known to affect outcomes of cerebellar disorders
- comorbidities - age - previous living dituation - time since injury - time of admission to a program - medical complications
82
Do younger or older patients typically have a worse prognosis with cerebellar disorders
younger, due to the cerebellum's role in motor learning

Adult Neuro One (10 decks)

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