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Neurology > Control of Movement (cross over with pathology) > Flashcards

Control of Movement (cross over with pathology) Flashcards

1
Q

Role of the prefrontal cortex?

A

-Overall planning of movements
-Specifies goal of movement - not details

Regulates our thoughts, actions & emotions through extensive connections with other brain regions

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2
Q

Role of premotor cortex?

A

Organises sequences of movements

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3
Q

Role of supplementary cortex?

A

-Coordination of complex learned responses (throwing, typing…)
-Coordination of large muscles - for posture

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4
Q

Role of primary motor cortex?

A

‘Intentions’ produce output to spinal cord - yields motor outcomes

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5
Q

Role of primary somatosensory cortex?

A

-Touch input from entire body (homunculus)
-Some output to prefrontal & spinal cord

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6
Q

Role of parietal cortex?

A

-Integrates body position & location of external objects
-Output to prefrontal cortex

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7
Q

Role of primary visual cortex?

A

Identification of:
-Colours
-Lines
-Edges
-Depth
…

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8
Q

Role of brainstem?

A

-Species-specific behaviour
-Origin of motor neurones to spinal cord

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9
Q

Describe the primary motor cortex?

A

Has a ‘map’ (topographic map) of the body on it - different motor neurones supplying different muscles are located in specific parts - number/density of neurones that supply the muscles = proportional to the degree of control of the muscle in that region of the body
-More neurones/higher density = greater degree of control

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10
Q

Describe the corticospinal - pyramidal system?

A
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11
Q

What do 90% of UMNs do?

A

Are contained in the lateral corticospinal tract - which crosses over at the medulla oblongata of the brainstem - & then synapses with LMN when reaches correct spinal level - in the anterior horn of spinal cord

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12
Q

What do 10% of UMNs do?

A

Their axons do not cross at the medulla oblongata of the brainstem - instead travel in anterior corticospinal tract - & only cross over when reach correct spinal level - then synapse with LMN in anterior horn of spinal cord

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13
Q

What is very important to remember about motor neuron activation & stimulation of muscles?

A

The motor neurone activated in the primary motor cortex will be on the opposite side of the body to which the muscle of the body part is that you want to move

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14
Q

What type of control are spinal motor tracts under?

A

Voluntary control

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15
Q

Where do UMNs run/what do they do?

A

Transmit info from brain to spinal cord

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16
Q

Where do LMNs run/what do they do?

A

Transmit info from spinal cord to target skeletal muscle

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17
Q

What is the name of the system which manages all of a mammal or human’s movements?

A

Pyramidal system

18
Q

What can cause UMN lesions?

A

Any injury to brain e.g.,
-Stroke
-Infection
-Tumours

Any injury to brain stem or spinal cord -> specifically the white matter of spinal cord - where UMNs travel through to synapse with LMNs

19
Q

Signs of UMN lesions & why?

A

-Little/no muscle atrophy (if is any = due to muscle disuse)
-Will only be muscle weakness - as other neurons from other areas can still help with muscle movement
-Deep tendon reflexes e.g., patellar = hyper-reflexive
–> as spinal level = unaffected -> so reflexes = amplified - as no use of UMN regulating reflex @ that level
-Diminished/absent superficial reflex - show +ve Babinski’s sign - scrape sole of foot = causes dorsiflexion & fanning of toes = abnormal - shown in image
-Spastic paralysis

20
Q

What can cause LMN lesions?

A

-Any damage/injury along LMN tract - e.g., injury to axons leaving spinal cord
-Injury to spinal cord itself -> particularly to ventral grey matter of spinal cord - as UMN & LMN synapse here

21
Q

Signs of LMN lesions & why?

A

-Muscle atrophy - as actual neurons which supply the muscles = not getting there (to muscles)
-Flaccid paralysis
-Normal/no plantar response -> as no signals are arriving @ muscles
-Absent tendon reflexes
-Can see visible fasciculations -> where single muscle fibres are still stimulated - as still some transmission - some signals from LMNs that aren’t fully injured

22
Q

Compare signs of UMN & LMS lesions.

A
23
Q

Describe the corticobulbar - pyramidal system.

A
24
Q

Give the 3 patterns of paralysis.

A
25
Q

What are the 3 lobes of the cerebellum?

A

-Vermis = has small homunculus

26
Q

Label this image of the cerebellum.

A
27
Q

What are the 3 main parts of the cerebellum?

A

-Corticocerecellum = cortex and pontine connections, thalamus, visually guided movements
-Spinocerebellum = lots of proprioceptive information, vermis and paravermal
-Vestibulocerebellum = equiv of floculonodular lobe – balance and ocular fixation

28
Q

What is the purpose of the cerebellum?

A

-TONE
-POSTURE/BALANCE
-COORDINATION
-Cup of tea-frontal lobe-premotor/supplementary-basal ganglia- refinement-corticospinal tract – hand reaches teacup. ORIGINAL vs INTENDED position corrected by MOTOR PLAN.
All subconscious
-MOTOR LEARNING

29
Q

Movement disorders caused by cerebellar dysfunction?

A

-Impairs motor function of body IPSILATERAL to lesion
-Most apparent on movement not at rest
-No numbness/paralysis
-Ataxia – defect in force/range/direction/rate of movement
-Move more consciously than normal
-PAST POINTING – overshoot touching object with finger
-INTENTION TREMOR – more tremor of hand towards a target
-DYSDIADOCHOKINESIS – difficult repetitive supin/pronation
-Scanning speech/decomposition of movement

30
Q

Where is the cerebellum & what part of the neural tube does it arise from?

A

Post. aspect of brain - immediately inf. to occipital & temporal loves & within post. cranial fossa (is separated from these lobes by the tentorium cerebelli - tough layer of dura mater)
-Lies @ same level of & post. to pons
-Grows from the rhombencephalon - (which divides into metencephalon & myelencephalon - cerebellum grows from metencephalon)
-Has white & grey matter

31
Q

Function of the cerebellum?

A

-Does NOT initiate movement - but contributes to coordination, precision, & accurate timing
-Receives input from sensory systems of spinal cord & from other parts of brain, including the cerebral cortex & integrates these inputs to fine-tune motor activity

32
Q

Give 2 clinical signs of cerebellar dysfunction?

A

-Cerebellar intention tremor & dysmetria = at point of touching object they overshoot - but once hit target - tremor stops - dysmetria = lack of coordination associated with the cerebellum
-Cerebellar gait ataxia = widened base, unsteadiness & irregularity of steps, & lateral veering, & involves ‘dysdiadochokinesia’ = impaired ability to perform rapid, alternating movements
-> aspect of ataxia = ability to control distance, power & speed of an act is impaired - specific to cerebellar disorders
-Falling when close eyes - dysfunctional proprioception (prop. = linked to cerebellum)

33
Q

Label this image of the basal ganglia.

A
34
Q

Functions of the basal ganglia?

A
35
Q

Give some basal ganglia disorders.

A

*HYPERKINETIC = increase in muscular activity = excessive/abnormal movements:
-Athetosis – slow writhing hands and fingers
-Chorea (a type of hyperkinetic disorder) - fidgety distal limb
-Hemiballismus - sudden flinging/chorea
-Resting tremor – rhythmic oscillatory movement

(HYPOKINETIC = decrease in muscular activity = decreased body movements:
-Bradykinesia/slow movements
-RIGID increase in muscle tone

36
Q

What is the classic triad of clinical signs of Parkinson’s?

A

-BRADYKINESIA / slowness
-RIGIDITY / stiffness / increased tone
-TREMOR / pill rolling / 4-6 Hz /resting

(& postural instability)

37
Q

Aetiology of Parkinson’s?

A
38
Q

History of Parkinson’s?

A

-Onset - gradual
-Tremor – at rest, usually first noticed in the hands
-Stiffness and slowness of movement
-Difficulty initiating movements (e.g. getting out of chair, turning in bed)
-Falls – Not usually frequent early on
-Smaller hand writing

39
Q

Signs of Parkinson’s disease?

A

-An abnormal stooped posture leads to festinating gait: shorter stride length and greater speed
-Small steps, shuffling esp on turns
-Marche a petit pieds
-Stooped
-Slow
-Expressionless face
-Reduced blinking

40
Q

Motor features of Parkinson’s?

A
41
Q

Examination for Parkinson’s?

A

-Monotonous speech
-Slurred
-Asymmetrical resting pillrolling tremor
-Increased tone / cogwheeling
-DYSKINESIAS?
-Power normal
-Reflexes normal
-Sensation normal
-Coordination normal (but might be slow)
-Gait
-Stooped posture
-Shuffling
-Reduced arm swing
-Difficulty turning (axial rigidity)
-Draw spiral
-Open and close hands

Neurology (7 decks)

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