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Patho- Neuro > Neuro Mod 4 > Flashcards

Neuro Mod 4 Flashcards

1
Q

“Little Brain” refers to what and why?

A

Cerebellum

  1. 10% of the brain’s volume but contains 50% of the neurons in the brain
  2. Cerebellum plays major role in motor function but DOES NOT initiate motor commands
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2
Q

4 basic functions of the cerebellum?

A
  1. Maintain balance and posture
  2. Coordinated voluntary movements
  3. Motor learning
  4. Cognitive functions
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3
Q

Cerebellum function integrates sensory perception with motor output and includes?

A
  1. maintenance of muscle tone (lesion = hypotonia)
  2. maintenance of posture & balance (lesion = ataxia)
  3. coordination of voluntary motor activity
  4. motor learning
  5. cognition function
    a. role in processing sensory input (language, music)
  6. emotion
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4
Q

What is motor learning?

A

a. feedforward correction (lesion = dysmetria, intention tremor)
b. feedback correction in its comparator role

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5
Q

What is coordination of voluntary motor activity?

A

(eye, speech, limbs, etc…)

a. initiation, planning & timing (lesion = dyssynergia)
b. Ex: when to activate, duration, deactivate

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6
Q

Cerebellar lesions

A

a. DO impair motor activity - equilibrium, balance, coordination and tone
b. DO NOT result in motor paralysis
c. DO NOT impair ability to consciously detect sensory input (visual, auditory, vestibular, somatosensory, etc…)

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7
Q

What is hypotonia?

A

floppy, rag-doll, loose jt appearance, patient looks drunk, pendular reflexes

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8
Q

What are 3 Clinical exam procedures in regards to hypotonia?

A
  • observation
  • pendular DTR’s (deep tendon reflexes)
  • passive ROM
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9
Q

Disequalibrium and 3 clinical exam procedures

A 
loss of balance
a.	Clinical exam procedures:  
•	Tandem walking 
•	Balancing tests
•	Romberg’s test
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10
Q

What is Dyssynergia?

A

loss of coordinated activity

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11
Q

What is Dysarthria?

A

slurring , slowing or “scanning” of speech

(i) Speech scanning - inappropriate/random volume emphasis of syllables or words

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12
Q

What is Dystaxia?

A

lack of coordination in the execution of learned voluntary movement

(i) Clinical exam procedures:
1. observation of gait or activity

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13
Q

What is apraxia?

A

inability to execute purposeful voluntary movement

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14
Q

What is dysmetria?

A

“past pointing”, “overshooting”, inability to stop muscular movement at a desired point in space, performance will deteriorate…may do it first time but can’t repeat

(i) Clinical exam procedures:
1. finger to nose, heel to shin, finger to finger

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15
Q

What is an Intention Tremor?

A

oscillating tremor that is exacerbated with precise voluntary movement

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16
Q

Clinical exam procedures associated with intention tremor?

A
  1. observation with precision activity i.e. finger to nose or clinician uses finger as a moving “target” for patient to try and touch
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17
Q

What is Nystagmus?

A

ocular dysmetria”, rhythmic oscillation of the eyeballs, “spontaneous eye movement”

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18
Q

Clinical exam procedure associated with nystagmus?

A
  1. observation of patients eyes when looking at extremes or focusing in different movement patterns
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19
Q

What is decomposition of movement?

A

breaking down of smooth muscle activity into jerky, awkward fragments, poor timing…Ex: reaching…shoulder, elbow then wrist.

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20
Q

Clinical exam procedure associated with decomposition of movement?

A
  1. observation with specific activity…ask patient to reach for something on the shelf, etc
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21
Q

What is rebound?

A

inability to adjust to changes in muscle tension

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22
Q

Clinical exam procedure associated with rebound?

A
  1. “Arm pull test”….let go and patient hits themselves in the chest
  2. Arms extended test….examiner pushed down on patient’s hands
    (ii) The term “rebound” considered “inaccurate” and really represents overshooting or undershooting movement
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23
Q

Where is the cerebellum located?

A
  1. Location in cranium
    a. located in posterior cranial fossa
    b. separated from telencephalon (cerebral cortex) by tentorium
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24
Q

What is the cerebellar cortex divided into?

A 
a.	R/L hemispheres “divided” by vermis with flocculonodular lobe along inferior surface
•	Anterior lobe
•	Posterior lobe  
•	Vermis 
•	Flocculonodular lobe
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25
Q

What is the Subcortical (deep) region of cerebellum?

A

a. Cerebellar nuclei located within cerebellum
• Dentate nucleus
• Interposed ( globose nucleus and emboliform nucleus)
• Fastigial nucleus

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26
Q

What are the 3 cerebellar peduncles?

A
  • Superior
  • Middle
  • Inferior
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27
Q

What is the schematic of the cerebellum

A

a. Cerebellar inputs → cerebellar cortex → deep nuclei → cerebellar outputs

28
Q

What are the cerebellar inputs (afferents)?

A

(i) Input to cerebellum ascend to cortex via climbing fibers or mossy fibers
(ii) Input from CNS reach cerebellum via the three cerebellar peduncles

29
Q

What is the cerebellar cortex made up of?

A

(i) Purkinje fibers located in cortex

1. All input traveling from Mossy fibers or Climbing fibers terminate in Purkinje fibers

30
Q

What is the deep nuclei of the cerebellum?

A

(i) Purkinje fibers project to deep cerebellar nuclei

ii) Deep cerebellar nuclei associated with regions of cerebellar cortex (vermis, intermediate and lateral

31
Q

What are the cerebellar outputs (efferent)?

A

(i) fibers from deep cerebellar nuclei exit from cerebellum through superior and inferior cerebellar peduncles

32
Q

What are the longitudinal subdivisions of the cerebellum?

A

a. Vermis
b. Paravermis (intermediate)
c. Lateral hemispheres

33
Q

What are the phylogenic subdivisions of the cerebellum?

A

a. Vestibulocerebellum (archicerebellum)
b. Spinocerebellum (paleocerebellum)
c. Pontocerebellum or cerebrocerebellum (neocerebellum)

34
Q

What is the function of the Vermis?

A

• Coordination/postural control of axial/proximal limb movement and postural adjustments to eye movement

(i) plays role in postural control of head neck, trunk, leg, gait, stereotyped movements (locomotion), antigravity postural control
(ii) postural role in gaze control associated with vestibular function
(iii) postural adjustments/orientation to gravity and environment

35
Q

What is the function of the Paravermis?

A

• Distal limb coordination

(i) “feedback” mechanism of planned/active movement from motor cortex with the actual movement that is occurring
1. “fine tuning” mechanism for coordinating purposeful movement in “real time”
(ii) integrates sensory (proprioceptive) input with current motor activity/movement to produce an adaptive motor response to physical circumstances
(iii) respond to proprioceptive (muscle spindles, GTO) sensory input from spine/brainstem tracts

36
Q

What is the function of the Lateral zone/hemisphere?

A

• plays role in planning “learned” skilled movement (connection to and from motor areas in cortex)

(i) “Motor learning”
(ii) plays role in ability to more rapidly and precisely execute a learned movement over time
(iii) coordination of skilled movement, planning movement, learning motor skills
(iv) Also suggested to play role in:
1. Cognitive learning
2. Emotional learning

37
Q

What is motor learning made up of?

A

motor learning has many components: physical skill, cognitive responses, emotional reflexes and habitual responses/patterns
(i) Cerebellum influences all components of motor learning

38
Q

Neuronatomical Connections of the Vestibulocerebellum

A

• Afferent Input:
(i) Inferior peduncle: vestibular input from CN 8 and vestibular nuclei project to flocculolobular lobe
1. Only region of cerebellum to receive input directly from a sensory nerve
• Deep cerebellar nuclei:
(i) none
• Efferent Output:
(i) Inferior peduncle: flocculolobular lobe projects to vestibular nuclei (vestibulospinal tracts)

39
Q

What is the function of the Vestibulocerebellum?

A
  • Postural control: regulate muscle tone to maintain equilibrium (balance)
  • Visual: plays role in coordinating smooth eye movements with postural equilibrium/ positioning via vestibular nuclei connections….i.e. part of vestibuloocular reflex (VOR)
40
Q

A clinical lesion to the flocculonodular lobe may produce?

A

• Dysequilibrium
(i) loss of balance
• Hypotonia
(i) trunk and proximal leg (gait disruption)
• Nystagmus or altered vestibuloocular reflex (VOR)

41
Q

Where is the vestibulocerebellum located?

A

a. Introduction
• Oldest part of cerebellum for visual reflexes and postural control

b. Anatomy:
• Flocculobular lobe

42
Q

Where is the spinocerebellum located?

A

a. Introduction:
• Major input from spinocerebellar tracts and output to descending anteriormedial motor tracts to create “real time” correction of motor activity

b. Anatomy:
• Vermis and paravermis regions

43
Q

Afferent input for the spinocerebellum is?

A

• Afferent Input:
(i) Inferior peduncle: spinocerebellar tracts (GTO/muscle spindle), reticular nuclei and vestibular nuclei project to vermis and paravermis zones

44
Q

Deep Cerebellar Nuclei for the spinocerebellum is?

A

• Deep Cerebellar Nuclei:

i) Fastigial nuclei
(ii) Interposed nuclei (globose and emboliform

45
Q

Efferent output for the spinocerebellum is?

A

(i) Superior cerebellar peduncle
1. Vermis - fastigial nuclei project to:
a. vestibular nuclei
b. reticular nuclei
c. thalamus (VL) and tectum
2. Paravermis - Interposed nuclei (globose and emboliform) project to:
a. red nucleus
b. thalamus (VL)

46
Q

Function of the spinocerebellum Vermis portion is?

A

• motor coordination of ipsilateral extremities and trunk
• Vermis:
(i) Postural: role in regulating muscle tone and antigravity musculature
(ii) Motor movement: proximal limb and trunk coordination

47
Q

Function of the spinocerebellum paravermis is?

A

(i) Motor movement: distal limb coordination
1. “feedback” mechanism of planned/active movement from motor cortex with the actual movement that is occurring
a. “fine tuning” mechanism for coordinating purposeful movement in “real time”
2. integrates sensory (proprioceptive) input with current motor activity/movement to produce an adaptive motor response to physical circumstances
3. respond to proprioceptive (muscle spindles, GTO) sensory input from spine/brainstem tracts

48
Q

Lesion to the spinocerebellum would cause?

A

• Rebound (overshooting) test
(i) anterior lobe involved in rapid motor adjustment necessary for “resisted arm pull” test or extended arm test
• Ataxia
(i) gait, trunk, leg and/or arm ataxia (dystaxia)
• Hypotonia

49
Q

Where is the cerebrocerebellum?

A

a. Introduction
• Largest functional subdivision of cerebellum with major afferent/efferent connections to motor cortex
(i) Afferent connections via pontine nuclei
(ii) Efferent connections via thalamus

b. Anatomy:
• Lateral hemispheres

50
Q

Neuroanatomical connections: provides a “loop” to/from the motor cortex

A

• Afferent
(i) Lateral zone receives input from motor cortex via the pons
1. Cerebral cortex projects to pontine nuclei in the pons
(ii) Middle peduncle: pontine nuclei project to lateral zone
• Deep Cerebellar Nuclei
(i) Lateral zone projects to dentate nuclei
• Efferent:
(i) Dentate nuclei projections
1. Superior peduncle: thalamus (VL) and red nucleus

51
Q

Motor movement function for the cerebrocerebellum?

A

• Motor Movement: Planning, learning and timing of skilled voluntary movements

(i) Regulates descending motor output from cerebral cortex.
1. “procedural learning” – learning to ride a bike, throw a ball, swing a bat, dance, etc….

52
Q

Cognitive function for the cerebrocerebellum?

A

• Cognitive: cognitive and emotional learning

(i) Cognitive aspects of language and speech
(ii) Exact anatomical pathways for these cerebellar function not clearly established

53
Q

Lesions to the posterior lobe may cause?

cerebrocerebellum

A

• Dyssynergia – loss of coordinated of movement

(i) Intention tremor, dysmetria, disdiadochokinesia, nystagmus, dysarthria, decomposition of movement

54
Q

cerebrocerebellum peduncles

A

A. Three cerebellar peduncles “attach” cerebellum to brainstem and transmit input and output to and from cerebellum
superior, middle, inferior

55
Q

Superior peduncle gross anatomy

A
  • connects cerebellum to midbrain (pons/midbrain junction)

* form the “roof” of the 4th ventricle

56
Q

Superior peduncle afferent and efferent fibers

A

• Afferent:

(i) NO AFFERENT input pass through superior peduncle
1. Some resources – a few spinocerebellar afferents pass through

• Efferent: contains major efferent output from cerebellum
(i) Spinocerebellum (interposed nuclei) and cerebrocerebellum project to thalamus and three brainstem nuclei (red nuclei, reticular nuclei and vestibular nuclei)

57
Q

middle peduncle

A

a. largest connection of the three peduncles – major motor pathway of cerebrocerebellar (neocerebellum) entering cerebellum
b. Gross anatomy:
• connects cerebellum to the pons

58
Q

middle peduncle afferent and efferent fibers

A

• Afferent:

(i) Major motor input from cerebral cortex terminate in pontine nuclei which project to the pontocerebellum (neocerebellum)
(ii) Also afferent input from reticular nuclei

• Efferent:
(i) NO EFFERENT output pass through middle peduncle

59
Q

Inferior peduncle gross anatomy

A

a. Gross anatomy:

• connects cerebellum to medulla

60
Q

inferior peduncle afferent and efferent fibers

A

• Afferent:

(i) Proprioceptive input via spinocerebellar tracts project to spinocerebellum (paleocerebellum)
(ii) vestibular input from vestibular nuclei and CN 8 project to vestibulocerebellum (flocculonodular lobe)

• Efferent:
(i) vestibulocerebellum (flocculonodular lobe) projects to vestibular nuclei in brainstem

61
Q

Inferior cerebellar peduncle is divided into two regions

A

• Restiform body:
(i) Spinocerebellar tracts pass through restiform body of inferior peduncle
• Juxtarestiform body:
(i) Vestibulocerebellar tracts pass through juxtarestiform body of inferior peduncle
1. contains both efferent and afferent fibers that connect the cerebellum with the vestibular nuclei in the brainstem

62
Q

Deep cerebellar nuclei is made up of?

A

fastigial nuclei
interposed nuclei
dentate nuclei

63
Q

Location of the fastigial nuclei and what does it connect?

A
  1. Nuclei of vermis
  2. Location/connection:
    a. Vermis projects to fastigial nuclei
    b. Fastigial nuclei connect
    • with thalamus and reticular formation via superior cerebellar peduncle
    • with vestibular nuclei and reticular formation via inferior cerebellar peduncle

**vestibular function

64
Q

What is the function of interposed nuclei?

A

a. coordination/feedback mechanism of planned movement
b. compares intended movement with actual movement
• connections with proprio stretch receptors provide feedback
(i) modifies stretch reflexes of distal extremities to correct movement

65
Q

What is the location/connection of the interposed nuclei?

A

a. Intermediate zone projects to interposed (globose and emboliform) nuclei
b. Interposed nuclei connect with red nucleus and thalamus via superior cerebellar peduncle

66
Q

What is the location/connection and function of dentate nuclei?

A

a. Lateral (hemispheres) project to dentate nuclei
3. Function:
a. Planning, initiating and control of voluntary movement
b. Cognitive/emotional “motor learning”

Patho- Neuro (5 decks)

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