Gait Cerebellar Function

Question 1

What factors contribute to walking?

Answer 1

1. strength
2. coordination
3. postural control
4. sensation
5. memory or concept of walking

Question 2

What does a positive romberg sign indicate?

Answer 2

impaired proprioception, dosal column pathway

Question 3

What does it indicate if someone has their eyes open but can’t stand with feet together?

Answer 3

cerebellar problem

Question 4

Broad-based ataxic gait

Answer 4

feet spread

-could be dorsal(worse with closed eyes) or cerebellar

Question 5

Tabetic gait

Answer 5

foot slapping

-tabes dorsalis from neurosyphilis

Question 6

Steppage Gait

Answer 6

food drop or weak dorsiflexion
hip flexed

• unilateral foot drop may be from a lesion of peroneal nerve or L5 root
• bilateral food trop with severe polyneuropathy, motor neuron disease, or bilateral L5 root lesion

Question 7

Waddling gait

Answer 7

patient leans or bends the trunk to the left as the right food is raised and vice versa

weakness of the hip girdle muscles, usually in myopathy

Question 8

Scissors gait

Answer 8

advancing leg or foot tends to cross over the opposite lower limb

upper motor neuron (corticospinal lesion) affecting the lower limbs, as in spastic paraparesis
-increased spastic tone and tightness in the adductor muscles of the thigh tends to force the lower limb together when walking

Question 9

parkinsonian gait

Answer 9

slow, shuffling with decreased arm swing and a stooped forward posture
-festination of gait-having to lean forward in order to walk, followed by uncontrollable running to catch up with the center of gravity

Question 10

dysdiadochokinesia

Answer 10

uncoordinated, nonrhythmic, sloppy hand movements

Question 11

tests and indications of cerebellar function

Answer 11

1. finger nose finger
2. heel shin knee
3. rapid alternating movements
4. rebound phenomenon

Question 12

what are indications of cerebellar dysfunction

Answer 12

1. kinetic or action tremor
2. dysmetria
3. dysdiadochokinesia
4. cerebellar dysarthria
5. cerebellar dysarthria
6. multidirectional nystagmus

Question 13

dysarthria

Answer 13

slurred speech
left hemisphere of cerebellum
-thick, erratic, jerky or explosive

Question 14

lesion of cerebellar hemisphere affects what?

Answer 14

ipsilateral limb

unilateral lesions: ischemic infarct, hemorrhage, tumor, ms
bilateral: degenerative or toxic disease

Question 15

Midline lesion of the cerebellar vermis affects what?

Answer 15

trunk

causes: tumor, hemorrhage, ms, and degenerative or toxic disorders, alcoholic cerebellar degeneration

Question 16

alcoholic cerebellar degeneration

Answer 16

atrophy of anterior superior vermis-trunk and lower limbs

-gait ataxia, truncal unsteadiness, and lower limb dysmetria

Question 17

friedreich’s ataxia

Answer 17

autosomal-recessive
begins in school-aged children and gradually worsens

1. spinocerebellar tract lesions
2. patchy loss of cerebellar purkinje cells–limb dysmetria, gait ataxia, dysarthria
3. corticospinal tract lesions-weakness and babinski sign
4. lesions of dorsal root ganglia-absent
5. lesions of dorsal columns
   - loss of vibration, position sense and absent relexes

Non-neurological-scoliosis, high arched feet(pes cavus), cardiac hypertrophy, and potentially fatal cardiac arrhythmias

DIAGNOSIS: blood test-multiple trinucleotide repeats from a deficit in chromosome 9

Question 18

When is choreoathetosis seen?

Answer 18

lesions in the caudate nucleus or its connecting pathways

-Huntingtons

Question 19

What type of lesion causes hemiballismus?

Answer 19

lesion in the contralateral subthalamic nucleus

Question 20

dystonia

Answer 20

continual sustained and often painful contraction of muscles leading to spasms, turning and twisting of the limbs, head, neck or trunk into unnatural positions or fairly fixed postures

• focal: confined to muscles of the neck or shoulder (cervical dystonia or torticollis)
• generalized: hereditary and progressively disabling

Question 21

tics

Answer 21

brief, stereotyped often repetitive, focal muscle contractions that appear purposeful such as an eyeblink, facial twitch or sniff

Question 22

tourette’s syndrome

Answer 22

hereditary commonly seen in boys

-accompanied by attention deficit and behavioral disorders

Question 23

What are movement disorders which accompany encephalopathy?

Answer 23

1. myoclonus-rapid shock like lightning movements or jerks of the limbs and trunk
2. asterixis

Question 24

what is resting tremor of parkinsonism treated with?

Answer 24

anticholinergics

Question 25

essential tremor is treated with what

Answer 25

beta-adrenergic blocker drugs or barbiturates

Question 26

choreoathetosis hemiballismus and tics may be treated with what

Answer 26

dopamine antagonists

Question 27

dystonia may be treated with what?

Answer 27

anticholinergics
benzodiazepines
and botulinum toxin injections

Question 28

what does a deep brain stimulator inhibiting the thalamus help?

Answer 28

essential tremor