Examination of coordination and gait Flashcards
give an example of a dementing disease
Alzheimer’s disease
give an example of a movement disorder
Parkinson’s disease
Give an example of a motor neuron disease
ALS
What are EPS signs indicative of basal ganglia disorder?
resting tremor, hypokinesis (rigidity/bradykinesia), hyperkinesis (chorea/athetosis/akathesia)
What are EPS signs of cerebellar disorders?
Ataxia (3D’s), dysequilibrium, hypotonia, action tremor, nystagmus
What distinguishes pyramidal dysfunction from EPS?
pyramidal: arises from cortex/corticospinal tract –> WEAKNESS. Dysfunction of voluntary movement
describe hemiparetic gait
Patient holds one arm to the side, drags affected leg in semicircle. Weakness of distal muscles, extensor hypertonia in lower limb. UMN injury (eg; hemispheric stroke)
describe diplegic gait
walking with abnormally narrow base, dragging legs and scraping toes. Spasticity in lower extremities > upper extremities. Seen with bilateral periventricular lesions (cerebral palsy)
describe neuropathic gait
aka: equine gait. weak dorsiflexion –> pt must lift leg high so foot doesn’t drag while walking.
Unilateral: peroneal nerve palsy, L5 radiculopathy.
Bilateral: ALS, Charcot-Marie-Tooth, uncontrolled diabetes
describe myopathic gait
aka: waddling gait.
unilateral hip girdle weakness –> drop in pelvis on contralateral side while walking (Trendelenburg sign).
Bilateral weakness –> pelvis drops on both sides –> waddling
Seen in myopathies (muscular dystrophy)
Describe bradykinetic gait
aka: Parkinsonian gait. Walks with stooped posture, knee flexion, slow and small steps. Seen in Parkinson’s
Choreiform gait
aka: hyperkinetic gait
Irregular, jerky, involuntary movements in all extremities
Seen in Hungtington’s disease
Ataxic gait
Clumsy, staggering movements with wide-based gait. Standing still –> body swinging back and forth, side-to-side (titubation)
Seen in: cerebellar disease, acute alcohol intoxication, cerebellar vermis disease (truncal instability)
Sensory gait
loss of proprioceptive input when feet touch the ground –> patient slams foot to sense the ground. Exacerbated in the dark.
Seen in dorsal column disorders (B12 deficiency/tabes dorsalis) and peripheral nerve dysfunction (uncontrolled diabetes)
What are the pathological characteristics of Multiple System atrophy
oligodendroglial alpha synuclein-immunoreactive inclusions in limbic system, brainstem, and/or basal ganglia
Describe Shy-Drager syndrome
Multiple System atrophy involving Intermediolateral column degeneration and gliosis. Alpha-synuclein-immunoreactive argyrophilic glial cytoplasmic inclusions
What are the three primary “tauopathies”?
Alzheimer’s disease, Frontal lobe degeneration of non-Alzheimer type, and Pick disease
What tauopathies are associated with EPS?
Progressive supranuclear palsy (PSP) and Cortical Basal Degeneration (CBD)
What are the primary characteristics of Progressive Supranuclear Palsy?
akinesia, rigidity, characteristic supranuclear gaze palsy
What are the primary characteristics of Corticobasal degeneration?
initially clumsy and stiff, later rigid and akinetic
What are the pathological characteristics of Huntington’s disease?
progressive atrophy of neostriatum (anterior caudate and dorsal putamen)
What are the genetic characteristics of Friederich’s ataxia?
autosomal recessive. Chromosome 9q. GAA repeat expansion –> mitochondria dysfunction
How does Friedreich’s ataxia manifest clinically?
limb ataxia, dysarthria, loss of distal position and vibration sense, upper limb wasting
