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Patho II Final > Neuro Mod 6 > Flashcards

Neuro Mod 6 Flashcards

1
Q

General functions of the cerebellum?

A

Maintain balance, maintain muscle tone/posture, coordinated movements (corrective forward/backward roles), motor learning/cognitive motor role

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2
Q

Cerebellum plays a major role in motor function but does not initiate what?

A

Motor commands

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3
Q

Cerebellum holds ___% of the brain’s volume and contains ___% of the neurons in the brain

A

10% volume, 50% of the neurons
“little brain”

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4
Q

Pathway of motor planning/learning in the cerebellum?

A

Anterior association area –> premotor cortices –> pons –> cerebellum –> thalamus –> premotor/primary motor cortices

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5
Q

Equilibrium is the ability to maintain what?

A

Balance

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6
Q

Which nuclei in the brainstem play a primary central role in maintaining equilibrium? Which other structure plays a role in equilibrium?

A

Vestibular nuclei in brainstem, also cerebellum

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7
Q

Where is the cerebellum located in the skull?

A

Posterior fossa

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8
Q

How is the cerebellum physically attached to the brainstem?

A

by cerebellar peduncles (incoming/outgoing axons arranged in 3 bundles of white matter)

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9
Q

The cerebellum forms the “roof” of what structure?

A

Fourth ventricle

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10
Q

Structures/landmarks of the brainstem?

A

Midbrain, pons, medulla

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11
Q

Which structure serves as the dural roof that separates the cerebellum and the occipital lobe?

A

Tentorium cerebelli

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12
Q

The fourth ventricle is a CSF cavity located _____ to the ____

A

Posterior to the pons

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13
Q

What structure is a CSF pathway/conduit that connects the third and fourth ventricles?

A

Cerebral aqueduct

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14
Q

What is the vermis?

A

Midline region of cerebellum

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15
Q

Which cerebellar hemispheres make up the medial portion?

A

Intermediate hemispheres (paravermis)

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16
Q

Which cerebellar hemispheres make up the large outer portion?

A

Lateral hemispheres

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17
Q

Which lobe is horizontal and located in the anterior region of the cerebellum?

A

Flocculonodular lobe

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18
Q

The flocculonodular lobe is the ______ part of the cerebellum?

A

“oldest”

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19
Q

Do cerebellar peduncles transmit info (to) or (from) the cerebellum?

A

Both two and from

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20
Q

What are the 3 cerebellar peduncles?

A

Superior, middle, inferior

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21
Q

How many pairs of deep cerebellar nuclei are located within the cerebellum?

A

Three (fastigial, interposed, dentate)

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22
Q

The fastigial deep cerebellar nuclei are associated with which pathways?

A

Vermis pathways

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23
Q

The interposed deep cerebellar nuclei are associated with which pathways?

A

Paravermis pathways

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24
Q

The dentate deep cerebellar nuclei are associated with which pathway?

A

Lateral hemisphere pathways

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25
Q

Which two nuclei form the interposed deep cerebellar nuclei?

A

Emboliform & globose

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26
Q

How does information travel in the lobes of the cerebellum?

A

Outgoing info leaving vermis, paravermis, and lateral hemispheres goes through deep cerebellar nuclei

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27
Q

Which artery supplies the anterior/superior cerebellum?

A

Superior cerebellar artery (SCA) - branch of superior basilar artery

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28
Q

Which artery supplies the anterior/middle cerebellum?

A

Anterior inferior cerebellar artery (AICA) - inferior basilar artery portion

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29
Q

Which artery supplies the posterior/inferior cerebellum?

A

Posterior inferior cerebellar artery (PICA) - branch of vertebral artery

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30
Q

Motor functions of the cerebellum?

A

Balance/vestibulo-ocular control, Trunk/proximal limb coordination, Distal limb coordination/fine motor movement, Coordination of motor planning for complex movement/learning

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31
Q

What motor function is controlled by the flocculonodular lobe?

A

Balance & Vestibulo-ocular control (coordinated eye movement: smooth pursuit, saccades, VOR, etc)

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32
Q

What motor function is controlled by the vermis?

A

Trunk & Proximal limb coordination

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33
Q

What motor function is controlled by the paravermis (intermediate hemisphere)?

A

Distal limb coordination/fine motor movement

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34
Q

What motor function is controlled by the lateral hemisphere?

A

Coordination of motor planning for complex movement/learning

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35
Q

Pathway/connections of the flocculonodular lobe?

A

Input from vestibular nerve (CN8) –> output through vestibular nuclei in brainstem

36
Q

During flocculonodular lobe output, vestibular nuclei have some “upward” projection to control what?

A

eye movements via MLF

37
Q

During flocculonodular lobe output, vestibular nuclei have some “downward” projection to control what?

A

balance/equilibrium

38
Q

What are smooth pursuits (eye movement)?

A

Slow/smooth eye movement to maintain gaze on moving target (vertical or horizontal)

*head remains still

39
Q

What are saccades (eye movement)?

A

Rapid eye movement from one target to another (vertical or horizontal)

*head remains still

40
Q

The vermis pathways/connections receive input from what?

A

Spinocerebellar tracts (unconscious propioreception) from the trunk/proximal limbs, and vestibular nuclei (visual info)

41
Q

The vermis pathways/connections travel through which deep cerebellar nuclei?

A

Fastigial nuclei

42
Q

The vermis pathways/connections have output through what?

A

info travels to vestibular nuclei –> down medial motor tracts of the spinal cord (responsible for trunk/proximal muscles)

43
Q

The paravermis pathways/connections receive input from what?

A

Spinocerebellar tracts (unconscious propioreception) from limbs, and motor cortex via pontine nuclei

44
Q

The paravermis pathways/connections travel through which deep cerebellar nuclei?

A

Interposed nuclei

45
Q

The paravermis pathways/connections have output through what?

A

Red nucleus (influences distal extremities via rubrospinal tract), and sends fibers to thalamus & motor cortex (influences distal extremities vie lateral motor tracts of spinal cord that control distal limb movement)

46
Q

The lateral hemisphere pathways/connections receive input from what?

A

Motor associated cortex via pontine nuclei

47
Q

The lateral hemisphere pathways/connections travel through which deep cerebellar nuclei?

A

Dentate nuclei

48
Q

The lateral hemisphere pathways/connections have output through what?

A

Thalamus/cortex (info allows planning/learning complex movement in motor & somatosensory cortices), and Red nucleus (influences lateral motor tracts to assist in motor learning)

49
Q

What cerebellar gait has circumduction (circling of extremities)?

A

Hemiplegic

50
Q

Which cerebellar gait is observed in cerebral palsy?

A

Spastic diplegic

51
Q

Which cerebellar gait has a “foot drop” aka neuropathy?

A

Neuropathic

52
Q

Which cerebellar gait has “waddling”?

A

Myopathic

53
Q

Which cerebellar gait has shuffling/bradykinesia (slow movements)?

A

Parkinsonian

54
Q

Which cerebellar gait has dance-like movement?

A

Choreiform

55
Q

Which cerebellar gait has a wide BOS (base of support) with arms out?

A

Cerebellar ataxic

56
Q

Which cerebellar gait has high stepping?

A

Sensory ataxia

57
Q

Standing posture with cerebellar ataxic gait?

A

May have postural sway (front to back or side to side), wide base of support

58
Q

Characteristics of cerebellar ataxic gait?

A

Clumsy movement w/ wide BOS, Arms out for balance, Difficulty walking in straight line or tandem gait (heel-to-toe), veering to one side, uncoordination of LE & UE

59
Q

With cerebellar ataxic gait, movement tends to veer to the side ______ to the cerebellar lesion

A

ipsilateral

60
Q

Do cerebellar lesions impair motor activity?

A

Yes: impaired postural tone, loss of balance/equilibrium & coordination

61
Q

Do cerebellar lesions result in motor paralysis?

A

No

62
Q

Do cerebellar lesions impair ability to consciously detect sensory input (visual, auditory, vestibular, somatosensory)?

A

No

63
Q

Are cerebellar lesions easy to detect (localize) during clinical exam?

A

No, prove challenging (not as precise as cortex)

64
Q

Functional motor loss will be ______ to the side of cerebellar lesion

A

ipsilateral

65
Q

What occurs with bilateral lesion of the cerebellum?

A

Bilateral motor function loss

66
Q

What are the motor impairments observed with cerebellar lesions?

A

Hypotonia (reduced muscle tone), disequilibrium (loss of balance), dyssynergia (loss of coordination)

67
Q

Appearance of hypotonia?

A

Floppy, rag doll, loose joint, pts. look drunk

68
Q

Clinical exam procedures for hypotonia?

A

Observation, passive ROM, pendular deep tendon reflexes

69
Q

Clinical exam procedures for disequilibrium?

A

-Standing balance (observe stance, narrow BOS tests, single leg stands)
-Observe gait (loss of balance)
-Tandem walking (heel-to-toe in straight line)

70
Q

Types of dyssynergia?

A

Dysarthria, Dystaxia, Dysmetria, Tremor (intention tremor), Dysdiadochokinesia, Nystagmus, Decomposition of movement, Rebound (overshooting)

71
Q

Features of dysarthria?

A

Uncoordinated speech, difficulty articulating, slur, slow speech, scanning of speech (random inappropriate variation in volume, emphasizing wrong syllable/vowel)

72
Q

Clinical exam procedures for dysarthria?

A

Observation (listening) to speech

73
Q

Features of dystaxia (ataxia)?

A

Lack of coordination w/ execution of learned voluntary movement

74
Q

Sub types of dystaxia (ataxia) used for documentation?

A

gait ataxia, trunk ataxia, leg/arm ataxia

75
Q

Clinical exam procedures of dystaxia (ataxia)?

A

Trunk stability in sitting, standing posture, gait, ADLs (reaching, etc)

76
Q

Features of dysmetria?

A

Past-pointing, overshooting, inability to stop muscle movement at desired point
*performance can deteriorate (maybe do it first time but cannot repeat it)

77
Q

Clinical exam procedures for dysmetria?

A

Finger to nose, heel to shin, finger to finger (point-to-point)

78
Q

Features of intention tremor?

A

Tremor w/ precise voluntary movement (increases as pt approaches target)

79
Q

Clinical exam procedures for intention tremor?

A

Pt. performs precision task (pick up a cup, point to specific spot, etc.), finger to nose, heel to shin, finger to finger (point-to-point)

80
Q

Features of dysdiadochokinesia?

A

Inability to perform rapid alternating (RAM) or repetitive movement, disruption in timing of movement (initiation/stopping)

81
Q

Clinical exam procedures for dysdiadochokinesia?

A

ask pt to perform RAM, rapid supination/pronation, rapid heel-to-toe in seated position, marching in seated position, rapid flat hand tapping

82
Q

Features of nystagmus?

A

ocular dysmetria/spontaneous eye movement, rhythmic oscillation of eyeballs

83
Q

Clinical exam procedure for nystagmus?

A

Observe pt.’s eyes when looking at extremes or moving in certain directions

84
Q

Features of decomposition of movement?

A

Breaking down of SM activity (jerky), awkward fragments, poor timing

ex: w reaching (shoulder, elbow, then wrist w individual steps)

85
Q

Clinical exam procedures for decomposition of movement?

A

Observe pt performing specific activity (reach for something on the shelf, etc.)
*pts movement fragmented in individual steps

86
Q

Features of rebound dyssynergia?

A

Inaccurate return of extremity to start position after forceful resistance
Rebound = reciprocal overshooting or undershooting movement

87
Q

Clinical procedures for rebound dyssynergia?

A

-Arm pull test: hold pt’s arm w elbow flexed and abruptly let go
-“Arms extended” test: have pt hold arms out straight, push down on pt’s hands, observe for rebound response

Patho II Final (4 decks)

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