Neuro Exam III: Cerebellar Coordination & Special Situations Flashcards
Define and differentiate between dizzy and vertigo
Dizzy: vague term; ask pt. to define
Vertigo: false sense of spinning motion
Presyncope: near fainting
Disequlibrium: feeling unsteady/off balance (visual loss, weakness, peripheal neuopathy)
psyhciatric conditions like anxiety and panic attacks can create simialr sensations
3 types of periphearl vertigo
BPPV
acute labryinthitis
meineres disease
Drug Toxicity
Acustic Neuroma
BPPV: triggered by changes in head position, vertigo occurs and lasts < 1 minute
- no hearing loss
- N/V and horizontal nystagus
Acute Labrinthisis: history of preceeding infection with varibale duration in legth (hours to months)
- no hearing loss
- N/V/vertigo
Menire’s Disease
- sudden onset vertigo lasting hours to days
- sensorineuroal hearing loss which progresses to tinnitus
- pressure/fullness in the ear with N/V/nystagumus
Drug Toxicity
- loop diuretics
- aminoglycosides
- ETOH
- salicylates
- +/- hearing loss
Acoustic Neuroma (CN VIII Schawannoma)
- tumor of the nerve sheath; benging
- unliateral sensorineural hearing loss
- tinniuts, HA, numbness of face, vertigo & balance issues
Central Vertigo
due to a brainstem issue
Symptoms
- Vertical nystagumus that is non-fatiguable and continuous
- gait instability
Causes of Central
- cerebellar or pontine tumor
- PCA stroke
- vascular stenosis in the posterior circulation (vertebra or basialr artery)
- MS
Assessing Coordination
ways it is tested
what is balance
Cooridantion invloves many body systems
- motor
- cerebellar
- vestibular
- sensory
Tested through…
- gati
- posture
- balance
- fine motor/sensory awareness
Balance: the ability to maintain the line of gravity in bosy with the base of support with minimum sway
- uses the inner ear vestibu. system
- cerebellum
- vision
- somatoseonsry input
What is Gait: how is it tested
Gait
Normal
- legs narrowly spaced
- symmetrical moving
- moderate arm swing
- no issues turning
Assessing Gait
- observe normal walking without shoes (if safe)
- with eyes open and closed
- observe heel-toe walking (enhances small movements/changes)
- walk on heels: distal muslce weakness
- walk on toes: distal muscle weakness
- hop on each foot: test muscle weakness, cerebellar disaesae or lack of position sense
Hemiplegic Gait
- circumduction of one foot/leg = arc-like movement
- spacticity, flexion hypertonia of the upper limb and extenosry hypertonia of the lower limb (UMN lesions)
- distal (foot) weakness = foot drop
seen in
- MCA strokes of the contralater side as defict
Ataxia
- wide based gait: staggered, clumpsy, unsteady
- pt falls toward the side of teh lesion
- difficult to turn
- unableto stand with feet together (they will sway)
- unable to heel-toe walk
Causes
- cerebellar disorders
- stroke
- cervical myleopathy
Diplegic Gait
scissoring gait
- narrow, stiff gait;hypertonia in the legs
- thigh adductors causing extreme adduction and inability to move hips well
- limbs move slowly
- knees and thighs cross midline each step
- could compenstae with toe walking due tot eh excessive spasticity (hyerptonia)
Causes
- Cerebral palsy
- UMN lesions (stroke, tumor, SC injury)
Parkinsonian Gait
- stooped posture
- shuffling gait
- difficult to initiate step
- slow, short steps that accelerate (falling over)
- unversile flexion of all joints: they will lean forward
- reduced arm swing
Steppage gait
- seen in peripheral motor disease
- foot drop: inability to dorsiflex due to weakness in nerve; so they have to lift up high to compensate
- they will drag foot or lift up high
Causes
- peroneal nerve palsy
- L5 radiulopathy
- ALS
- other peripheraly neuropathies (DM)
- dorsal column isues (nned to eliect pain to feel the step)
Sensory Ataxia
- form of ataxia not due to cerebellar dysfunction
- periphearl nueopathies and dysfunction specifcally in the dorsal column (could be infection or autoimmune pathology)
- lost position sense in legs = wide-based gait & unsteady
- they will double tap the ground to ensure they feel it (cant have proprioception since lost dorsal)
- watch the ground as they walk
+ Rhomberg’s sign: cant stand still; worse coordination when they have eyes closed
PSeudoatheosis: continuous involuntary tapping and moving out outstretched arms/fingers (trying to senes where they are)
Posture Tests for Coordination
rhomberg
pronator drift
Romberg Test
- stand still, eyes closed
- minimal swaying
- arms at sides: 20-30 seconds then eyes closed for 30 more
Outcomes
- maintains posture with eyes open only (not closed) = think dorsal column issue
- unable to maintain posture at all - cerebellar disease
remeber to keep your arms out to catch pt.
(can also assess with hoping on one foot or standing on one foot)
Pronator Drift
- senstive for lesions incorticospinal tract coming from opposite hemisphere & cerebellar dysfunction
- pt. stands with hands out and up : eyes closed
- monitor for a drift down and pronation of the hand
- then quickly tap the arms down: they should return to th orignial location
- drifting instead of returning = lost position sense
- if they go back to position but OVERSHOOT = lost cerebellar function
Rapid Alternation Movement Tests
tests
signs
Hand supanation & pronation on thighs
thumb opposition
ankles (tap ground with foot)
assessing
- speed
- smoothness
- accuracy
dysdiadochokinesia: impaired ability for the rapid alternating movemnets = cerebellary dysfunction
Point to Point tests
- Finger to nose
- Finger to nose to finger
- heel down shin
Suspected Meningitis
Brudzinski
Kernigs
meningitns = fever, neck stiffness & vomiting
test these
Brudzinksi: pt. lays flat
- passive flexion of the neck by provider
- if pt. flexs hip and knees during this thats a + postive sign
- watch neck trauma
Kernig’s Sign
- pt. laying supine
- provider bends knee and slowly lowers it down to extension
- + positive = pain in lowerback with this motion
