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MHD2 Block 2 - Neuro > Cerebellum & Movement disorders > Flashcards

Cerebellum & Movement disorders Flashcards

1
Q

What are the inputs and outputs to the cerebellum?

A

Afferent inputs: vestibular, proprioceptive, skin receptor, sensorimotor cortex
Efferent outputs: Motor systems: vestibular nuclei, thalamus, red nucleus

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2
Q

Describe the general pathway through the cerebellum

A

Afferents are mossy and climbing fibers that enter the cerebellar cortex and then synapse with Purkinje cells. Purkinje cells synapse on deep nuclei before projecting to their targets

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3
Q

Which is the largest cerebellar peduncle?

A

The middle cerebellar peduncle

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4
Q

Which cerebellar peduncles carry afferent information and which carry efferent?

A

Superior: efferent

Middle and inferior: afferent

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5
Q

Describe the afferent pathways to the cerebellum

A

Fibers from the cerebral cortex synapse in the pontine nuclei and enter the contralateral cerebellar cortex through the middle cerebellar peduncle
Fibers from the contralateral inferior olive, and ipsilateral vestibulocochlear nuclei, and spinocerebellar tracts enter through the inferior cerebellar peduncle

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6
Q

Describe the somatotopic organization of the cerebellum

A

The vermis (central portion) controls trunk stability and gait. The hemispheres are responsible for ipsilateral limbs and motor coordination.

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7
Q

What is unique about the anterior spinocerebellar tract?

A

It is the only afferent tract in the superior cerebellar peduncle

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8
Q

Describe the connections to/from the flocculonodular lobe

A

Vestibular afferents and efferents to the fastigial nucleus
The fastigial nucleus projects to the vestibular nuclei, which project bilaterally through the MLF to the abducens nucleus, PPRF and oculomotor nucleus

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9
Q

Describe the connections to/from the vermis

A

The vermis projects to the fastigial nucleus and the vestibular nucleus which has projections forming the descending MLF and lateral vestibulospinal tract. The globose-emboliform nucleus also projects to the contralateral red nucleus which then projects downward as the ipsilateral rubrospinal tract (crosses 2 times).

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10
Q

Describe the connections to/from the cerebellar hemispheres

A

Input from the olive (ICP) and pons (MCP) reach the dentate nucleus, which projects to the contralateral red nucleus and ventrolateral thalamus. The red nucleus projects down the the inferior olive. The VL projects to the cerebellar cortex, which then communicates with the pontine gray as well as the corticospinal tract

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11
Q

What are the 3 microscopic layers of the cerebellum?

A

Molecular: axons and dendrites
Purkinje: the only axons that leave the cerebellum
Granular: Axons from the parallel fibers

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12
Q

Which cells of the cerebellum are excitatory and which are inhibitory?

A

Moss fibers, parallel fibers (granule cells), and climbing fibers are excitatory. Purkinje cells are inhibitory.

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13
Q

What effect do purkinje cells have on movement?

A

When purkinje cells are active, they inhibit movement

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14
Q

What is praxis?

A

A memory or concept put into action on command

Ex: patient with gait apraxia is immobile when asked to walk, despite having all the essentials necessary for walking

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15
Q

What essentials are necessary for normal walking?

A

Strength, coordination, postural control, sensation

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16
Q

What differentiates a posterior column lesion from a cerebellar lesion?

A

Posterior column lesions present as positive Romberg signs. Cerebellar disease causes instability regardless of eyes open/closed.

17
Q

Broad based ataxic gait is associated with lesions where?

A

Posterior columns, sensory nerves, or cerebellum

18
Q

What is a hemiplegic gait?

A

Affected lower limb is stiffly extended and swung/circumducted to walk. Affected ipsilateral upper limb is flexed at the elbow and wrist with decreased armswing
Common in stroke patients

19
Q

What is a tabetic gait?

A

Foot slapping due to impaired sensation

Seen in tabes dorsalis neurosyphilis

20
Q

What is a steppage gait?

A

Foot drop due to peroneal nerve of L5 root lesions

Hip flexed higher to elevate the dropping foot to avoid tripping

21
Q

What is a waddling gait?

A

Weak pelvic/hip muscles cannot support the body on one leg while the opposite foot is lifted. Compensate by swaying of leaning left when right foot is raised.
Caused by myopathy

22
Q

What is a scissors gait?

A

Spasms/tightness of the adductor muscles of the thighs force the knees together when walking. Legs cross over each other
Due to CST lesions

23
Q

What is festination?

A

In parkinsonian gait, leaning further and further forward to walk, the patient runs to catch up with their center of gravity

24
Q

What is dysmetria?

A

Overshooting/undershooting a target

25
Q

What is decomposition of movement?

A

A normally smooth movement becomes jerky

26
Q

What is a check response?

A

Sudden release of contracted biceps leads to striking the face

27
Q

Describe hemispheral cerebellar syndrome

A

Ipsilateral limbs affected (kinetic tremor, dysmetria, dysdiadochokinesia, rebound) due to infarction, hemorrhage, tumor, or MS lesion

28
Q

Describe vermal syndrome

A

Trunk affected (unsteady standing/walking, tremor, postural impairment, gait ataxia) from hemorrhage, tumor, MS or degenerative disorders

29
Q

What is the most common type of spinocerebellar degeneration?

A

Friedreich’s ataxia

30
Q

3 types of tremor

A 
Resting tremor (seen in parkinsonism)
Postural tremor (familial essential tremor)
Kinetic tremor (cerebellar disease)
31
Q

What is choreoathetosis?

A

Slow writing continual limb movements with brief irregular flowing dancelike movements of the limbs, trunk and face.
Caused by a lesion in the caudate nucleus or dopaminergic medications

32
Q

What is hemiballismus

A

Rapid, violent flinging movements of proximal upper and lower limbs on one side caused by a lesion of the contralateral STN

33
Q

2 types of dystonia

A

Focal: torticollis

Generalized

34
Q

What is Tourette’s syndrome?

A

Tics of motor and vocal muscles
Inherited, with variable penetrance, M>F
Associated with ADD and behavioral problems
Lesion unknown

35
Q

What is myoclonus?

A

Rapid shocklike bilateral movement caused by diffuse encephalopathies (CJD) or medical diseases (renal or hepatic failure, anoxia)

36
Q

What is asterixis?

A

Flapping tremor due to diffuse encephalopathies or medical diseases (renal/hepatic failure)

37
Q

Drugs for Essential tremor?

A

Beta blockers

Barbiturates

38
Q

Drugs for choreoathetosis, hemiballismus, tics?

A

Dopamine antagonists

39
Q

Drugs for dystonia?

A

Anticholinergics
Benzodiazepines
BoTox

MHD2 Block 2 - Neuro (26 decks)

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