coordination and gate Flashcards
compare symptoms of basal ganglia disorder vs cerebellar disorder
basal ganglia: tremor (resting), hypokinetic (rigidity, bradykinesia) or hyperkinetic (chorea, athetosis, akathisia, dystonia). Cerebellar: synergy (ataxia), dysequilibrium, and tone (hypotonia), tremor (action), nystagmus
mnemonic for cerebellar lesions
HANDS tremor: hypotonia, ataxia/asynergia, nystagmus, dysarthria, stance and gait, tremor
How do you examine for coordination
Speech Rapid Alternating Movements, Hand Rapid Alternating Movements, Precision hand movements, Foot Rapid Alternating Movements, Rebound, Check Reflex, FNF, Heel: Shin to Toes
How do you examine for station and gait
Romberg, pull test, tandem gait, forced gait and causal gait
What is Romberg test
the subject stands with feet together, eyes open and hands by the sides.The subject closes the eyes while the examiner observes for a full minute.
Positive Romberg
Swaying or falling over with eyes closed. Can be due to Impaired Proprioception (DC/Spinal Cord), Impaired Vestibular Function (fall toward lesion) or Impaired Cbl function (mainly vermis or vestibulocbl)
What is pronator drift
The patient is asked to hold both arms fully extended at shoulder level in front of him, with the palms upwards, and hold the position. If they are unable to maintain the position the result is positive. Closing the eyes accentuates the effect.
what causes pronator drift
Pyramidal Tract Dysfunction, Cerebellar Dysfunction, Parietal Lobe Dysfunction
What is a hemiparetic gait
The patient has unilateral weakness and spasticity with the upper extremity held in flexion and the lower extremity in extension. The foot is in extension so the leg is “too long” therefore, the patient will have to circumduct or swing the leg around to step forward. This type of gait is seen with a UMN lesion.
paraplegic/paraparetic gait
a gait in which the legs are held together and move in a stiff manner, the toes seeming to drag and catch.
neuropathic gait
This type of gait is most often seen in peripheral nerve disease where the distal lower extremity is most affected. Because the foot dorsiflexors are weak, the patient has a high stepping gait in an attempt to avoid dragging the toe on the ground.
myopathic gait
With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait. hyperlordosis puts the center of gravity behind the hips so the pt doesnt fall forward
bradykinetic gait
slowed movement
choreiform gait
This is a hyperkinetic gait seen with certain types of basal ganglia disorders. There is intrusion of irregular, jerky, involuntary movements in both the upper and lower extremities.
ataxic gait
The patient’s gait is wide-based with truncal instability and irregular lurching steps which results in lateral veering and if severe, falling. This type of gait is seen in midline cerebellar disease. It can also be seen with severe lose of proprioception (sensory ataxia)
Subdivisions of degenerative diseases
dementing, movement disorders and motor neuron diseases
List types of dementing degenerative diseasess
Alzheimers, lewy body disease, frontotemporal dementia, Tauopathies (pick disease), ubiquitin inclusions (frontotemporal lobar dementia)
List types of movement degenerative disorders
parkinsons, mutliple systems atrophy (synucleinopathy), progressive supranuclear palsy (tauopathy), huntingtons, spinocerebellar ataxia
List types of motor neuron degenerative disease
spinal muscular atrophy, ALS, primary lateral sclerosis
For each of the following dementing disorders, list whether it is a tauopathy, ubiquitinopathy or synucleinopathy: alzheimers, lewy body disease, parkinsons spectrum, fronto-temporal dementia
Alzheimers: tauopathy. Lewy body: synucleinopathy. Parkinsons: synucleinopathy. Frontotemporal: tauopathy and ubiquitinopathy (TDP-43)
For each of the following movement disorders, list whether it is a tauopathy, trinucleotide repeat disease or synucleinopathy: Progressive supranuclear palsy, lewy body disease spectrum, multiple system atrophy, huntingtons, spinocerebellar ataxia
Progressive supranuclear palsy: tau. lewy body disease spectrum:synuclein. multiple system atrophy: synuclein. Huntingtons and spinocerebellar ataxia: trinucleotide repeat
What are the symptoms associated with substantia nigra damage and which diseases have these symptoms
Parkinsonism symptoms: seen in Parkinsons, Lewy body disease, multiple system atrophy, progressive supranuclear palsy, picks disease, corticobasal degeneration
Huntingtons - brain area affected, histology
Affects caudate- severe neuron loss, severe gliosis, intranuclear inclusions
Is lewy body disease familial
rarely- PARK1, PARK2, PARK6, PARK 7 genes
Multiple system atrophy- areas affected and familial?
Type of movement disorder. Striatonigral degeneration (parkinsonism), olivopontocerebellar atrophy, shy-drager syndrome (autonomic). Sporadic, no familial form
multiple systems atrophy features
•parkinsonism, cerebellar or corticospinal signs, orthostatic hypotension, impotence, and urinary incontinence or retention, usually preceding or within two years after the onset of the motor symptoms. Respiratory stridor occurs in 1/3
- Distinguish among primary clinical features of dementing diseases, motor neuron disease and movement disorders.
dementing: cognitive. Motor neuron: UMN and LMN signs. Movement: cerebellar, extrapyramidal signs
- Recognize the clinical overlap among the degenerative diseases classifications
for example: Lewy body disease (“Parkinson disease” = movement disorder and “Diffuse Lewy body disease” = dementing disease).
- Recognize that various disease processes affecting specific neuroanatomic site manifest similar symptoms
ok
- Name the key histologic hallmark of the “synucleinopathies”
Parkinson disease/ lewy body disease = Lewy bodies, Lewy neurites. Multiple System Atrophy = axonal and neuronal inclusions; glial cytoplasmic inclusions.
Alzheimers- location, macro and micro features
temporoparietal, cerebral atrophy (macro), plaques and tangles (micro)
Parkinsons- location, macro and micro features
midbrain, pallor of substantia nigra (macro), lewy bodies (micro)
ALS- location, macro and micro features
motor cortex, brainstem and spinal cord. Atrophy of motor neurons and muscles. Inclusions
huntingtons- location, macro and micro
basal ganglia. Neostriatal atrophy. Neuronal loss and astrocytosis
lewy body disease- location, macro and micro
frontotemporal, cerebral atrophy, lewy bodies
frontotemporal dementia- location, macro and micro
frontotemporal, cerebral atrophy, tau deposits, pick bodies
prion disease- location, macro, micro
diffuse corticl, cerebral atrophy, spongiosis, prion deposits
dementia workup
CBC, electrolytes, metabolic panel, thyroid, B-12, folate, syphilis, urinalysis, ECG, CXR
Normal pressure hydrocephalus presentation
triad: progressive gait disorder, urinary incontinence and dementia
