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Neurology > Impairment of motor control - clinical signs and patterns > Flashcards

Impairment of motor control - clinical signs and patterns Flashcards

1
Q

Within the frontal lobe how does the signal to move start?

A
  • Prefrontal cortex will initiate idea to move (tells premotor cortex steps required to move)
  • Premotor cortex will then organise and sequence movements
  • Primary motor cortex send signals down spinal cord
  • these synapse with motor neurones
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2
Q

How does the signal to move progress after leaving the cortex (descending motor pathways)?

A
  • From cortex signal descends through the internal capsule
  • form upper motor neurones (corticospinal tracts)
  • these neurones pass through the pons
  • at the level of the medulla the neurones cross to form lateral corticospinal tract
  • the lateral corticospinal tracts then synapse with the lower motor neurones or cranial nerves of the brainstem
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3
Q

What makes up a lower motor neurone?

A

peripheral nerve connecting anterior horn of spinal cord /brainstem to muscle

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4
Q

What is the function of Alpha motor neurones?

A

voluntary muscle contraction and myostatic stretch reflex

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5
Q

What is the function of gamma motor neurones?

A

regulate muscle tone and maintain proprioception

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6
Q

What are the possible descending motor pathways?

A

Corticospinal tracts
Rubrospinal
Vestibulospinal
Reticulospinal

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7
Q

What sets the baseline muscle tone?

A
  • Spinal Neurones
  • Brainstem motor areas
    (these are then overridden by cortex exerting inhibitory signals)
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8
Q

What does Arevflexic mean

A

lack of a reflex response

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9
Q

What does Paraparesis and paraplegia mean?

A

Paraparesis - weakness of legs

Paraplegia - Complete weakness of the legs

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10
Q

What does parasthesia mean?

A

Abnormal sensation

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11
Q

What does Hemiparesis mean?

A

weakness in half body

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12
Q

What does Quadra/tetraparesis mean?

A

Weakness of arms and legs

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13
Q

What does Myelo- mean?

A

of the spinal cord

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14
Q

What does radiculo- mean

A

of the nerve roots

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15
Q

What does ataxia mean?

A

lack of co-ordination of limb movements and/or gait

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16
Q

What will result from a lesion above the medulla?

A

contralateral hemiplegia

  • pattern of flexed upper limbs and extended lower limbs
  • arms adduct, foot plantar flexes and leg extends
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17
Q

What will result from a lesion below the medulla?

A

Cervical - quadriplegia
Thoracic/lumbar - paraplesgia
Hemisection of cord - Brown-Sequard syndrome

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18
Q

What are the common signs of UMN?

A
  • Increased tone/spasticity
  • Clonus
  • Hyperreflexia
  • Babinski sign/extensor plantar
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19
Q

Where is the most likely lesion location if there is spastic paraparesis in 4 limbs?

A

above C5 usually complete as very traumatic causes e.g. car crash

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20
Q

Where is the most likely lesion location if there is spastic paralysis in only legs not arms?

A
  • Below T1

- lesion usually incomplete (usually not traumatic)

21
Q

How will a complete lesion differ from incomplete?

A

complete - complete paralysis, loss of all sensory modalities and loss of bowel and bladder
incomplete - weakness, impaired sensory functions, defective bowel/bladder

22
Q

What are the tract signs of spinal cord lesion?

A
  • UMN signs
  • sensory level
  • bladder/bowel/sexual dysfunction
23
Q

What are the segmental signs of spinal cord lesion?

A
  • pain
  • dermatomal sensory disturbance
  • LMN signs
24
Q

What are the conditions with UMN signs?

A
  • Brain tumour
  • Ischaemic stroke
  • IC haemorrhage
  • head injury/trauma
  • MS
  • Spinal cord stenosis
  • prolapsed disc
25
Q

Where are the possible LMN lesion locations?

A

(Between motor neurone and anterior horn of spinal cord)

  • nerve roots
  • nerve plexus
  • peripheral nerve
  • neuromuscular junction
  • muscle
26
Q

What are the LMN signs?

A
  • wasting and flaccid tone
  • waddling gait
  • fasciculation’s
  • muscle wasting
  • hyporeflexia
27
Q

What is a typical presenting symptom in Guillain-Barré syndrome?

A

distal weakness and paresthesia which is ascending and increasing in severity

28
Q

What problems will patients with distal vs proximal weakness experience?

A

distal - difficulty with fine tasks, writing and using phone

proximal - difficulty with rising, stairs and washing hair

29
Q

How will fatiguable weakness present?

A
  • worse at end of day or if more effort
30
Q

What type of weakness is seen in MG (Myasthenia Gravis)?

A

Fatiguable weakness

31
Q

What conditions will present with proximal weakness?

A
  • plexopathy
  • Radiculopathy
  • Muscular dystrophies
32
Q

What conditions will present with distal weakness?

A
  • Focal (radial/ulnar neuropathy)

- widespread (peripheral neuropathy)

33
Q

Where are the common lesions which would have foot drop as symptom?

A
  • peroneal nerve

- possibly sciatic nerve

34
Q

What is the common lesion location for general lower leg weakness (possibly with foot drop)?

A
  • L5 nerve root
35
Q

What lesion will result in Wrist drop?

A

radial nerve - can be caused by penetrating trauma or humeral fracture

36
Q

How will patient with both UMN and LMN lesions present?

A
  • fasiculations
  • atrophy
  • brisk reflexes and extensor and plantar responses
37
Q

What is the most common location of pathology if UMN and LMN signs?

A
  • anterior horn of spinal cord

- usually due to motor neurone disease or lesion

38
Q

What are the parts of the basal ganglia?

A
  • striatum (caudate & putamen)
  • Globus Palidus
  • Sub-Thalamic Nucleus
  • Substantia Nigra
39
Q

What is the function of the basal ganglia?

A
  • sequencing and control of fluid movements
40
Q

What will be the symptoms of basal ganglia damage?

A
  • jerky or tremulous movements

- fragmentory or incomplete movements

41
Q

What are the two types of basal ganglia pathology?

A
  • Hypokinesis (too little move)

- Hyperkinesis (too much move)

42
Q

What are the key features of parkinsons?

A
  • bradykinesia
  • rigidity
  • resting tremor
43
Q

What are the common symptoms of hyperkinesis?

A
  • essential tremor
  • chorea
  • ballism
  • myoclonus
  • dystonia
44
Q

What is the function of the cerebellum?

A
  • co-ordination of muscle activity during learned movements

- uses input from proprioceptors, inner ear and cortex to know where body is in space

45
Q

How can you differentiate ataxia due to alcohol intoxication or lesion in cerebellum?

A
  • if the problem is in dark or when eyes closed more likely due to cerebellum
46
Q

What are the signs of cerebellar dysfunction?

A
  • Nystagmus
  • Dysarthria
  • Intention tremor (tremor induced when going to do something)
  • dysdiadochokinesia (breakdown of rapid alternating movement)
  • wide based unsteady gait due to balance
47
Q

Is cerebellar pathology ipsilateral?

A

YEs

48
Q

What condition is associated with droopy eyelids with fatigue weakness?

A

Myasthenia Gravis

Neurology (53 decks)

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