Exam2 material: spinal cord, MS, cerebellar

Question 1

Cerebellar function

Answer 1

• skilled, voluntary movements of extremities and speech
• balance and equilibrium
• VOR
• planning and initiation of movement, rhythm
• timing of neural processes
• cognition and emotion

Question 2

3 lobes of cerebellum

Answer 2

• anterior
• posterior
• flocculonodular

Question 3

middle region of cerebellum

Answer 3

vermis

Question 4

cerebellum outer layer is white or gray matter?

Answer 4

gray is out

flipped from spinal cord

Question 5

What are the 3 deep nuclei in cerebellum?

Answer 5

FID

fastigial
interposed
dentate

Question 6

What are the 3 layers of cerebellar cortex? (superficial to deep)

Answer 6

Molecular layer (superficial)
parking cell layer
granular layer (deep)

Question 7

What cells are for input?

Answer 7

climbing fibers

mossy fibers

Question 8

What cells are for output?

Answer 8

parking cell axon

Question 9

Mossy fibers give input from what?

Answer 9

brainstem nuclei, spinal cord

Question 10

Climbing fibers give input from what?

Answer 10

inferior olivary nucleus in medulla

Question 11

Are purkinje cells excitatory or inhibitory? what what NT do they use?

Answer 11

inhibitory

-uses GABA

Question 12

Vestibulocerebellum output

Answer 12

• output is vestibular nuclei in brainstem

- flocculonodular lobe

Question 13

Spinocerebellum (vermis and intermediate output)

Answer 13

• vermis output to fastigial nucleus ***

- intermediate hemisphere to interposed nuclei ***

Question 14

Cerebrocerebellum (nucleus is)

Answer 14

Lateral part of hemisphere to Dentate

initiation, planning, and timing

Question 15

Vestibulocerebellum function

Answer 15

• equilibrium and balance

- helps with eye stuff

Question 16

Spinocerebellum function

Answer 16

-involved with detailed execution of movement

Question 17

Cerebrocerebellum function

Answer 17

-planning, initiation, timing, visual guidance of movement

Question 18

Overall role of cerebellum (5 things)

Answer 18

• comparator (actual vs intended)
• compensator (predict impact of other joints)
• motor learning (learning new skills)
• role in cognition (thinking, attention)
• role in timing (“forward model” in motor tasks)

Question 19

Cerebellar impairments

Answer 19

• Hypotonia
• Asthenia (general weakness)
• impaired eye movement
• Ataxia (gait, balance, dysmetria, dysdiadochokinesia, asynergia, intention tremor)

*** delay initiation, inaccurate range and direction, irregular alt movements

Question 20

Asthenia def

Answer 20

generalized weakness

Question 21

dysmetria defintion

Answer 21

inaccuracy in range and direction of movement

Question 22

dysdiadochokinesia def

Answer 22

-rapid alt movements

Question 23

asynergia

Answer 23

error in timing of complex movements

Question 24

intention tremor

Answer 24

-tremor at end of movement

Question 25

Cerebellar symptoms and lesion location

Answer 25

- they are ipsilateral - decussates twice! - at superior cerebellar peduncle and then at corticospinal and rubrospinal tract

Question 26

Cerebellar midline lesions affect what?

Answer 26

-axial and trunk control | also speech due to dec facial control

Question 27

Cerebellar lateral lesions affect what?

Answer 27

-motor control of limbs and digits

Question 28

Friedreich's ataxia (spinal ataxia)

Answer 28

- hereditary - early onset - progressive ataxia, weakness, loss of sensation and proprioception - scoliosis, cardiomyopathy, foot deformities typical - life expectance 35-40

Question 29

Spinocerebellar Ataxia (SCA)

Answer 29

- genetic (CAG-trinucleotide repeats) - multiple genes known - causes degeneration of spinocerebellar tracts and the cerebellum occur - *most common is SCA#6 * onset 30-50 - **loss of coordination, gait ataxia, impaired saccades, speech - life ex = close to normal

Question 30

Olivopontocerebellar atrophy (OPCA) -cerebellar ataxia-- What is it, where is it, associated with what?

Answer 30

- degeneration in inferior olives, pons, and cerebellum (look at name) - both inherited and non-inherited neurodegen syndromes - *** primarily associated with MSA (multiple system atrophy with cerebellar predominance)

Question 31

OPCA -olivopontocerebellar. symptoms

Answer 31

- progressive ataxia with involved gait, weakness, incoordination - eventually pyramidal tract signs, autonomic disturbances, dementia - onset 30-5- - poor prognosis.

Question 32

Multiple system atrophy (MSA) -characterized by, cause, survival

Answer 32

- damage to ANS which leads to postural hypotension, dysuria, and/or abnormal breathing during sleep - parkinsonism - ataxia due to OPCA cause = unknown survival less than 10 years after onset

Question 33

Pure cerebellar degeneration -cerebellar ataxias

Answer 33

- atrophy of cerebellum itself WITHOUT spinal involvement - slow progressing - onset =40+ ***ataxia of gait, imbalance, dysarthria (speaking), impaired gaze stabilization

Question 34

Cerebellar ataxias - nutritional disorders

Answer 34

- Vit B1 (1/3 alcoholics) - Vit B12 (leads to pernicious anemia) -treat with vitamin therapy. Some sx may be reversible

Question 35

Cerebellar ataxias - neoplastic and paraneoplastic disorders

Answer 35

- primary - metastatic - benign tumors

Question 36

Cerebellar ataxia - vascular disorders

Answer 36

- Ischemic stroke (PICA, AICA, SCA from basilar artery) ***presents with acute nausea, vomiting, dizziness, unsteady gait - hemorrhagic stroke (less common) ***presents with HA, vertigo, nausea, unsteady gait

Question 37

Cerebellar ataxia - traumatic injuries

Answer 37

-TBI to occipital or frontal region (coup - countercoup)

Question 38

Cerebellar ataxia - demyelinating disorders

Answer 38

- MS | - may have lesion in cerebellum or in spinocerebellar tracts, resulting in cerebellar signs

Question 39

Ataxia rating scales - SARA

Answer 39

- scale for assessment and rating of ataxia | - 8 items, 40 points

Question 40

Ataxia rating scales - ICARS

Answer 40

- international cooperative ataxia rating scale | - 19 items, 100 points

Question 41

Ataxia rating scales - MICARS

Answer 41

- modified ICARS | - 26 items, 120 points

Question 42

Ataxia rating scales - BARS

Answer 42

- brief ataxia rating scale | - 5 items, 30 points

Question 43

MS commonly affects what CNS areas?

Answer 43

- optic nerve - cerebellar peduncles - periventricular white matter - Spinal cord (corticospinal tract, and post columns)

Question 44

In order for a SCI to be incomplete it needs?

Answer 44

- sensory or motor S4-5 AND | - either anal sphincter contraction OR sparing of motor fn. >3 levels below motor level

Question 45

SCI : Type A

Answer 45

-complete

Question 46

SCI: Type B

Answer 46

incomplete. no motor. sensation below level of lesion

Question 47

SCI: Type C

Answer 47

incomplete. at least half of key muscles below level less than or equal to 3/5 MMT

Question 48

SCI : Type D

Answer 48

incomplete. motor, key muscles greater than or equal to 3/5 MMT

Question 49

SCI : Type E

Answer 49

incomplete, normal motor and sensation

Question 50

Autonomic dysreflexia

Answer 50

- overactive sympathetic NS - spinal cord injury ~T5 and above - cause: any noxious stim below level of injury * ascending info reaches major splanchnic sympathetic outflow stimulating a sympathetic response * *results in HTN, pounding HA, visual changes etc.. * **parasympathetic NS is unable to counteract due to spinal cord injury (impulses cannot descend past the lesion)