Gait, Cerebellar function, and Movement Disorders

Question 1

Destruction of what column leads to a positive Romberg sign?

Answer 1

Dorsal column - lack of proprioception is normally compensated for with vision.

When you remove vision, you are no longer able to balance

Question 2

Destruction of what part of the CNS leads to inability to stand with feet together, even with eyes open?

Answer 2

Cerebellum- visual clues cannot compensate when the cerebellum is destroyed

Question 3

Name 5 systems/components necessary for walking/standing up

Answer 3

Strength (UMN, LMN, NMJ, muscle)
Coordination (cerebellum)
Postural control (extrapyramidal system)
Memory/concept of walking

Question 4

WHat is a hemiplegic gait?

Answer 4

When one half of the lower limbs are affected - the affected half is extended and swung/circumducted.

The ipsilateral arm is flexed at the elbow and wrist and there is decreased armswing

Question 5

Where is hemiplegic gait commonly observed?

Answer 5

Stroke patients

Question 6

What is a tabetic gait?

Answer 6

“Foot slapping” gait

Patient compensates for impaired sensation

Question 7

What disorder might lead to a tabetic gait?

Answer 7

Neurosyphilis (tabes dorsalis) leading to a degeneration of the dorsal column pathway

Severe neuropathy

Question 8

What is a “steppage” gait?

Answer 8

Super high hip flexion to overcome weak dorsiflexion (foot drop)

Question 9

What disease process causes a steppage gait?

Answer 9

Peroneal nerve or L5 root lesions

Severe neuropathy

Question 10

What is a waddling gait?

Answer 10

when walking, weak pelvic or hip muscles cannot support the body “on one leg” while the opposite foot is lifted off the ground;

patient compensates by swaying or leaning to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a waddling duck

Question 11

What disease process causes a waddling gait?

Answer 11

Usually a myopathy

Question 12

What causes a scissors gait?

Answer 12

Corticospinal tract lesions affecting the legs (spastic paralysis)

-Cerebral palsy or multiple sclerosis

Question 13

Describe the Parkinsonian Gait

Answer 13

Slow, shuffling gait with “stooped forward” position and lack of normal arm swing

Turning around is slow and requires many small steps

Question 14

What is the function of the cerebellum?

Answer 14

coordination and regulation of movement

Question 15

What is a kinetic tremor?

Answer 15

rhythmic oscillations during limb movement towards a target

Question 16

What is dysmetria?

Answer 16

overshooting or undershooting a target

Question 17

What is decomposition of movement?

Answer 17

a normally smooth movement becomes jerky, “broken down”

Question 18

What is the loss of check response (rebound)?

Answer 18

sudden release of contracted biceps leads to striking the face; triceps does not normally “check” (protect) this action due to imbalance of agonist/antagonist muscle

Question 19

Differentiate cerebellar hemispheral vs vermal syndromes

Answer 19

Hemispheral: affects ipsilateral limbs
Vermal: predominantly affects the trunk

Question 20

Alcohol predominately affects which part of the cerebellum?

Answer 20

The anterior superior vermis –> gait ataxia and lower limb dysmetria

Question 21

Which is the most common spinocerebellar degenerative disease?

Answer 21

Freiderich’s Ataxia

Question 22

Resting tremors are typical of what disease process?

Answer 22

Parkinson’s disease

Question 23

Postural tremors are typical of what disease process?

Answer 23

Familial essential tremor

Question 24

Kinetic tremors are typical of what disease process?

Answer 24

Cerebellar disease

Question 25

WHat types of medications can lead to choreoathetosis or dystonia

Answer 25

High levels of dopaminergic medications

Question 26

What is hemiballismus?

Answer 26

Rapid, violent (“ballistic”), flinging movements of proximal upper and lower limbs on one side

Question 27

What is the cause of hemiballismus?

Answer 27

A lesion (usually infarction) of the contralateral subthalamic nucleus

Question 28

What is dystonia?

Answer 28

Continual or sustained painful contractions of muscles causing turning and spasms of the limbs or neck, with fixed, unnatural posture

Can be focal or generalized

Question 29

What causes dystonia?

Answer 29

No specific lesion or disorder has been correlated with this disorder

Question 30

What is tourettes syndrome?

Answer 30

INherited with variable penetrance- motor and vocal tics, more often in boys, associated with ADD and behavioral problems

Question 31

What is myoclonus?

Answer 31

Rapid, shock like movements of the limbs or body, usually bilateral, but often asynchronous

Question 32

WHat types of disorders cause myoclonus?

Answer 32

Diffuse encephalopathies from either neurologic (Creutzfeld-Jakob disease) or medical disease (renal or hepatic failure, anoxia)

Question 33

What causes asterixis?

Answer 33

Seen bilaterally in medical diseases (renal or hepatic failure)

Seen unilaterally in structural brain lesions

Question 34

Name three pharmacologic agents used in the treatment of parkinsonian resting tremors

Answer 34

L-Dopa, anticholinergics and dopamine agonists

Question 35

Name two pharmacologic agents used in the treatment of essential (kinetic) tremors

Answer 35

Beta-adrenergic blockers

Barbituates

Question 36

Name a pharmacologic agent used in the treatment of choreoathetosis, hemiballismus and tics

Answer 36

Dopamine antagonists

Question 37

Name three pharmacologic agents used in the treatment of dystonia

Answer 37

Anticholinergics, benzodiazepines, and Botulinum toxin