coordination and gate

Question 1

compare symptoms of basal ganglia disorder vs cerebellar disorder

Answer 1

basal ganglia: tremor (resting), hypokinetic (rigidity, bradykinesia) or hyperkinetic (chorea, athetosis, akathisia, dystonia). Cerebellar: synergy (ataxia), dysequilibrium, and tone (hypotonia), tremor (action), nystagmus

Question 2

mnemonic for cerebellar lesions

Answer 2

HANDS tremor: hypotonia, ataxia/asynergia, nystagmus, dysarthria, stance and gait, tremor

Question 3

How do you examine for coordination

Answer 3

Speech Rapid Alternating Movements, Hand Rapid Alternating Movements, Precision hand movements, Foot Rapid Alternating Movements, Rebound, Check Reflex, FNF, Heel: Shin to Toes

Question 4

How do you examine for station and gait

Answer 4

Romberg, pull test, tandem gait, forced gait and causal gait

Question 5

What is Romberg test

Answer 5

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.

Question 6

Positive Romberg

Answer 6

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)

Question 7

What is pronator drift

Answer 7

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.

Question 8

what causes pronator drift

Answer 8

Pyramidal Tract Dysfunction, Cerebellar Dysfunction, Parietal Lobe Dysfunction

Question 9

What is a hemiparetic gait

Answer 9

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.

Question 10

paraplegic/paraparetic gait

Answer 10

a gait in which the legs are held together and move in a stiff manner, the toes seeming to drag and catch.

Question 11

neuropathic gait

Answer 11

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.

Question 12

myopathic gait

Answer 12

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

Question 13

bradykinetic gait

Answer 13

slowed movement

Question 14

choreiform gait

Answer 14

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.

Question 15

ataxic gait

Answer 15

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)

Question 16

Subdivisions of degenerative diseases

Answer 16

dementing, movement disorders and motor neuron diseases

Question 17

List types of dementing degenerative diseasess

Answer 17

Alzheimers, lewy body disease, frontotemporal dementia, Tauopathies (pick disease), ubiquitin inclusions (frontotemporal lobar dementia)

Question 18

List types of movement degenerative disorders

Answer 18

parkinsons, mutliple systems atrophy (synucleinopathy), progressive supranuclear palsy (tauopathy), huntingtons, spinocerebellar ataxia

Question 19

List types of motor neuron degenerative disease

Answer 19

spinal muscular atrophy, ALS, primary lateral sclerosis

Question 20

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

Answer 20

Alzheimers: tauopathy. Lewy body: synucleinopathy. Parkinsons: synucleinopathy. Frontotemporal: tauopathy and ubiquitinopathy (TDP-43)

Question 21

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

Answer 21

Progressive supranuclear palsy: tau. lewy body disease spectrum:synuclein. multiple system atrophy: synuclein. Huntingtons and spinocerebellar ataxia: trinucleotide repeat

Question 22

What are the symptoms associated with substantia nigra damage and which diseases have these symptoms

Answer 22

Parkinsonism symptoms: seen in Parkinsons, Lewy body disease, multiple system atrophy, progressive supranuclear palsy, picks disease, corticobasal degeneration

Question 23

Huntingtons - brain area affected, histology

Answer 23

Affects caudate- severe neuron loss, severe gliosis, intranuclear inclusions

Question 24

Is lewy body disease familial

Answer 24

rarely- PARK1, PARK2, PARK6, PARK 7 genes

Question 25

Multiple system atrophy- areas affected and familial?

Answer 25

Type of movement disorder. Striatonigral degeneration (parkinsonism), olivopontocerebellar atrophy, shy-drager syndrome (autonomic). Sporadic, no familial form

Question 26

multiple systems atrophy features

Answer 26

•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

Question 27

2. Distinguish among primary clinical features of dementing diseases, motor neuron disease and movement disorders.

Answer 27

dementing: cognitive. Motor neuron: UMN and LMN signs. Movement: cerebellar, extrapyramidal signs

Question 28

3. Recognize the clinical overlap among the degenerative diseases classifications

Answer 28

for example: Lewy body disease (“Parkinson disease” = movement disorder and “Diffuse Lewy body disease” = dementing disease).

Question 29

4. Recognize that various disease processes affecting specific neuroanatomic site manifest similar symptoms

Answer 29

ok

Question 30

5. Name the key histologic hallmark of the “synucleinopathies”

Answer 30

Parkinson disease/ lewy body disease = Lewy bodies, Lewy neurites. Multiple System Atrophy = axonal and neuronal inclusions; glial cytoplasmic inclusions.

Question 31

Alzheimers- location, macro and micro features

Answer 31

temporoparietal, cerebral atrophy (macro), plaques and tangles (micro)

Question 32

Parkinsons- location, macro and micro features

Answer 32

midbrain, pallor of substantia nigra (macro), lewy bodies (micro)

Question 33

ALS- location, macro and micro features

Answer 33

motor cortex, brainstem and spinal cord. Atrophy of motor neurons and muscles. Inclusions

Question 34

huntingtons- location, macro and micro

Answer 34

basal ganglia. Neostriatal atrophy. Neuronal loss and astrocytosis

Question 35

lewy body disease- location, macro and micro

Answer 35

frontotemporal, cerebral atrophy, lewy bodies

Question 36

frontotemporal dementia- location, macro and micro

Answer 36

frontotemporal, cerebral atrophy, tau deposits, pick bodies

Question 37

prion disease- location, macro, micro

Answer 37

diffuse corticl, cerebral atrophy, spongiosis, prion deposits

Question 38

dementia workup

Answer 38

CBC, electrolytes, metabolic panel, thyroid, B-12, folate, syphilis, urinalysis, ECG, CXR

Question 39

Normal pressure hydrocephalus presentation

Answer 39

triad: progressive gait disorder, urinary incontinence and dementia