Neuro Motor Disorders Flashcards
How do the basal ganglia & cerebellum work together in movement coordination? What happens with injury to either? Hint: recall Romberg Test & Finger to Nose test—its why we assess it
the cerebellum contributes to movement by coordinating balance during rapid muscular activities like running, typing and talking. The basal ganglia contributes to movement by coordinating slower activities that are inherited/learned, such as arm swinging during walking.
injury to the cerebellum causes movements to become highly abnormal and uncoordinated.
injury to the basal ganglia causes tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, hypokinetic disorders, and hyperkinetic disorders.
Describe the pathogenesis of Parkinson Disease related to the substantia nigra.
destruction of dopaminergic neuronal cells in the substantia niagra and in the basal ganglia.
leads to depletion of dopamine stores
leads to degeneration of the dopaminergic nigrostriatal pathway
leads to imbalance of excitatory (acetylcholine) and inhibitory neurotransmitters in the corpus striatum.
leads to impairment of extrapyramidal tracts controlling complex body movements.
the depletion of dopamine in the substantia niagra is thought to be responsible for the majority of the symptoms of parkinson’s
- Describe the signs & symptoms of Parkinson Disease, both motor and nonmotor
motor: tremors, rigidity, bradykinesia, postural changes.
non motor: neuropsychiatric disorders and sleep disorders. loss of blinking reflex and inability to express emotion. slow and poorly articulated speech. the tounge, palate and throat muscles become rigid.
Briefly describe the medications used to treat Parkinson Disease. Does it reverse the progression?
TX depends on the person and is highly individualized.
levodopa=dopamine precursor that crosses the blood brain barrier, works well to improve clinical symptoms. but on-off effect (where the medicine stops working randomly)
can give dopamine antagonists to directly stimulate dopamine receptors, can be given in combination with levodopa.
anticholinergic drugs can restore a balance between reduced dopamine and uninhibited cholinergic neurons in the striatum
no treatment will reverse or slow the progression, although many treatments help with symptom management
How does Multiple Sclerosis (MS) affect the myelin sheath?
it eats (demyelinates) it
List the risk factors for MS. How do these relate to viral infection?
family hx: 10-20%
people with antigen HLA-DR2 are at high risk
Data from epidemiological studies (studies that analyze the geographical, socioeconomic, genetic and other factors that may contribute to who gets MS) suggest that exposure to an infectious agent may be involved in triggering the disease.
Describe the signs & symptoms of Multiple Sclerosis
paresthesias are evidenced as numbness, tingling, burning sensations, or pressure on the face or involved extremities. moderate to severe.
abnormal gait, bladder and sexual dysfunction, vertigo, nystagmus, fatigue, speech disturbance.
psych sx/sx represent damage to the white matter in the cerebral cortex.
blurred vision, double vision, any type of vision changes (will be one of the first signs that people notice)
List the causes for spinal cord injury (SCI)
most common: motor vehicle crash, falls, violence (GSW), recreational sporting activities
most injures for SCIs occur due to a combination of writing movements and a compressive force.
Explain secondary events in spinal cord injury
secondary events in spinal cord injury are those events that happen after the initial injury. Most happen as a result of the initial injury.
Explain and differentiate these three important results of SCI: spinal shock, neurogenic shock, autonomic dysreflexia
Spinal shock is the altered physiologic state immediately after a spinal cord injury (SCI), which presents as loss of spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowel, and bladder control, and loss of reflex activity.
Neurogenic shock is a devastating consequence of spinal cord injury (SCI) that can manifest as hypotension, bradyarrhythmia, and temperature dysregulation. It is associated with cervical and high thoracic spine injury.
DIFFERENCE: What is the difference between spinal shock and neurogenic shock?
Neurogenic shock describes the hemodynamic changes resulting from a sudden loss of autonomic tone due to spinal cord injury. It is commonly seen when the level of the injury is above T6. Spinal shock, on the other hand, refers to loss of all sensation below the level of injury and is not circulatory in nature.
autonomic dysreflexia: Autonomic dysreflexia is a condition that emerges after a spinal cord injury, usually when the damage has occurred above the T6 level. The higher the level of the spinal cord injury, the greater the risk, with up to 90% of patients with cervical spinal or high-thoracic spinal cord injury being susceptible. Dysregulation of the autonomic nervous system leads to an uncoordinated sympathetic response that may result in a potentially life-threatening hypertensive episode when there is a noxious stimulus below the level of the spinal cord injury.
