Neuro Handouts

Question 1

Location of lesion that causes Spasticity

Answer 1

Upper motor neuron or the corticospinal tract

• Increased muscle tone (hypertonia) is rate dependent.
• Tone increases when passive movement is rapid, & decreases when passive movement is slow.
• Tone is also greater at the extremes of the movement arc.
• During rapid passive movement, initial hypertonia may give way suddenly as the limb relaxes

Question 2

Common causes

of spasticity of upper motor neuron or the corticospinal tract

Answer 2

• Stroke, especially late or chronic stage

Question 3

Location of lesion that causes Rigidity

Answer 3

Basal Ganglia System

Question 4

Describe Rigidity

Answer 4

• Increased resistance that persists throughout the movement arc, independent of rate of movement, is called lead-pipe rigidity.
• During flexion & extension of the wrist or forearm, a superimposed ratchet-like jerkiness is called Cogwheel rigidity & can be due to underlying tremor

Question 5

Common causes of Rigidity

Answer 5

• Parkinsonism

Question 6

Location of lesion that causes Flaccidity (or Hypotonia)

Answer 6

• Lower motor neuron system at any point from the anterior horn cell to the peripheral nerves, & in cerebellar disease

Question 7

Describe Flaccidity (or Hypotonia)

Answer 7

• Loss of muscle tone (hypotonia) causes the limb to be loose or floppy.
• The affected limbs may be hyperextensible or even flail-like
• Flaccid muscles are often weak

Question 8

Common causes of Flaccidity (or Hypotonia)

Answer 8

• Guillain-Barre syndrome; initial phase of spinal cord injury (spinal shock)
• Stoke

Question 9

Location of lesion that causes Paratonia

Answer 9

• Both hemispheres in the frontal lobes

Question 10

Describe Paratonia

Answer 10

• Sudden, irregular changes in tone accompany passive range of motion
• Sudden loss of tone that increases the ease of motion is called FACILITATORY paratonia
• Sudden increase in tone making motion more difficult is called OPPOSITIONAL paratonia

Question 11

Common causes of Paratonia

Answer 11

• Dementia

Question 12

What are the 3 components of the GCS

Answer 12

• Eye opening
• Motor Response
• Verbal Response

Question 13

GCS: Eye opening

Answer 13

4 - Spontaneous: eyes open, not necessarily aware
3 - To speech: nonspecific response, not necessarily to command
2 - To pain: pain from sternum/limb/supraorbital pressure
1 - None: even to supraorbital pressure

Question 14

GCS: Motor response

Answer 14

6 - Obeys commands: follows simple commands
5 - Localizes pain: arm attempts to remove supraorbital/chest pressure
4 - Withdrawal: arm withdraws to pain, shoulder abducts
3 - Flexor response: withdrawal response or assumption of hemiplegic posture
2 - Extension: shoulder adducted & shoulder & forearm internally rotated
1 - None: to any pain; limbs remain flaccid

Question 15

GCS: Verbal response

Answer 15

5 - Oriented: Converses & is oriented
4 - Confused: converses but confused, disoriented
3 - Inappropriate: intelligible, no sustained sentences
2 - Incomprehensible: moans/groans, no speech
1 - None: no verbalization of any type

Question 16

Small or Pinpoint Pupils

Answer 16

• Bilaterally small (1-2.5 mm) suggest damage to the sympathetic pathways in the hypothalamus, or metabolic encephalopathy, a diffuse failure or cerebral function that has many causes, including drugs

Question 17

Pinpoint pupils < 1 mm

Answer 17

• Suggest a hemorrhage in the pons, or the effects of morphine, heroin, or other narcotics

Question 18

Midposition Fixed Pupils

Answer 18

• Pupils that are in the midposition or slightly dilated (4-6 mm) & are fixed to light
• Suggest structural damage in the midbrain

Question 19

Bilaterally Large fixed & dilated pupils

Answer 19

• Severe anoxia & its sympathomimetic effects, as seen after cardiac arrest
• May also result from ATROPINE - like agents, phenothiazines, or tricyclic antidepressants

Question 20

Bilaterally Large reactive pupils

Answer 20

• May be due to cocaine, amphetamine, LSD, or other sympathetic nervous system agonists

Question 21

One large fixed & dilated pupil

Answer 21

• Warns of herniation of the temporal lobe, causing compression of the oculomotor nerve (CN III) & midbrain
• May also be seen in diabetic patients from infarction of CN III

Question 22

Cerebral Cortex lesion Motor signs & symptoms

Answer 22

• Chronic contralateral corticospinal - type weakness & spasticity

Question 23

Cerebral Cortex lesion Sensory signs & symptoms

Answer 23

• Contralateral sensory loss in the face, limbs, and trunk on the same side as the motor deficits

Question 24

What can cause cerebral cortex motor & sensory deficits

Answer 24

• Cortical stroke

Question 25

Brainstem lesion motor signs & signs

Answer 25

- Chronic contralateral corticospinal weakness & spasticity plus CN deficits such as diplopia (from weakness of the extraocular muscles) & dysarthria

Question 26

Brainstem lesion Sensory signs & signs

Answer 26

- Variable depending on the level of brainstem

Question 27

What can cause Brainstem motor and sensory deficits

Answer 27

- Brainstem stroke | - MS plaque

Question 28

Spinal cord lesion motor signs & symptoms

Answer 28

- Weakness & spasticity, but often affecting both sides (when cord damage is bilateral), causing paraparesis or quadriparesis depending on the level of injury

Question 29

Spinal cord lesion sensory signs & symptoms

Answer 29

- Dermatomal sensory deficit on the trunk on one or both sides at the level of the lesion, and sensory loss from tract damage below the level of the lesion

Question 30

What can cause Spinal cord motor and sensory deficits

Answer 30

- Trauma | - Spinal cord tumor

Question 31

Subcortical Gray Matter: Basal Ganglia lesion motor signs & symptoms

Answer 31

- Slowness of movement (bradykinesia), rigidity, & tumor

Question 32

Subcortical Gray Matter: Basal Ganglia lesion sensory signs & symptoms

Answer 32

- Sensation not affected

Question 33

What can cause Subcortical Gray Matter: Basal Ganglia motor and sensory deficits

Answer 33

- Parkinsonism

Question 34

Cerebellar lesion motor signs & symptoms

Answer 34

- Hypotonia, ataxia, nystagmus, dysdiadochokinesis, & dysmetria

Question 35

Cerebellar lesion sensory signs & symptoms

Answer 35

- Sensation not affected

Question 36

What can cause Cerebellar motor and sensory deficits

Answer 36

- Cerebellar stroke | - Brain tumor