Gait, Cerebellar function, and Movement Disorders Flashcards
Destruction of what column leads to a positive Romberg sign?
Dorsal column - lack of proprioception is normally compensated for with vision.
When you remove vision, you are no longer able to balance
Destruction of what part of the CNS leads to inability to stand with feet together, even with eyes open?
Cerebellum- visual clues cannot compensate when the cerebellum is destroyed
Name 5 systems/components necessary for walking/standing up
Strength (UMN, LMN, NMJ, muscle)
Coordination (cerebellum)
Postural control (extrapyramidal system)
Memory/concept of walking
WHat is a hemiplegic gait?
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
Where is hemiplegic gait commonly observed?
Stroke patients
What is a tabetic gait?
“Foot slapping” gait
Patient compensates for impaired sensation
What disorder might lead to a tabetic gait?
Neurosyphilis (tabes dorsalis) leading to a degeneration of the dorsal column pathway
Severe neuropathy
What is a “steppage” gait?
Super high hip flexion to overcome weak dorsiflexion (foot drop)
What disease process causes a steppage gait?
Peroneal nerve or L5 root lesions
Severe neuropathy
What is a waddling gait?
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
What disease process causes a waddling gait?
Usually a myopathy
What causes a scissors gait?
Corticospinal tract lesions affecting the legs (spastic paralysis)
-Cerebral palsy or multiple sclerosis
Describe the Parkinsonian Gait
Slow, shuffling gait with “stooped forward” position and lack of normal arm swing
Turning around is slow and requires many small steps
What is the function of the cerebellum?
coordination and regulation of movement
What is a kinetic tremor?
rhythmic oscillations during limb movement towards a target
What is dysmetria?
overshooting or undershooting a target
What is decomposition of movement?
a normally smooth movement becomes jerky, “broken down”
What is the loss of check response (rebound)?
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
Differentiate cerebellar hemispheral vs vermal syndromes
Hemispheral: affects ipsilateral limbs
Vermal: predominantly affects the trunk
Alcohol predominately affects which part of the cerebellum?
The anterior superior vermis –> gait ataxia and lower limb dysmetria
Which is the most common spinocerebellar degenerative disease?
Freiderich’s Ataxia
Resting tremors are typical of what disease process?
Parkinson’s disease
Postural tremors are typical of what disease process?
Familial essential tremor
Kinetic tremors are typical of what disease process?
Cerebellar disease
WHat types of medications can lead to choreoathetosis or dystonia
High levels of dopaminergic medications
What is hemiballismus?
Rapid, violent (“ballistic”), flinging movements of proximal upper and lower limbs on one side
What is the cause of hemiballismus?
A lesion (usually infarction) of the contralateral subthalamic nucleus
What is dystonia?
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
What causes dystonia?
No specific lesion or disorder has been correlated with this disorder
What is tourettes syndrome?
INherited with variable penetrance- motor and vocal tics, more often in boys, associated with ADD and behavioral problems
What is myoclonus?
Rapid, shock like movements of the limbs or body, usually bilateral, but often asynchronous
WHat types of disorders cause myoclonus?
Diffuse encephalopathies from either neurologic (Creutzfeld-Jakob disease) or medical disease (renal or hepatic failure, anoxia)
What causes asterixis?
Seen bilaterally in medical diseases (renal or hepatic failure)
Seen unilaterally in structural brain lesions
Name three pharmacologic agents used in the treatment of parkinsonian resting tremors
L-Dopa, anticholinergics and dopamine agonists
Name two pharmacologic agents used in the treatment of essential (kinetic) tremors
Beta-adrenergic blockers
Barbituates
Name a pharmacologic agent used in the treatment of choreoathetosis, hemiballismus and tics
Dopamine antagonists
Name three pharmacologic agents used in the treatment of dystonia
Anticholinergics, benzodiazepines, and Botulinum toxin
