Neuro Review Flashcards
Difficulty in initiation of movement; Problems in preparation of movement
Akinesia
- In PD, Increased preparation needed for movements; Increased reaction time, particularly for simple tasks; Not as great an increase for complex tasks
What will you see in Parkinson’s in terms of movement?
- Akinesia
- Bradykinesia
- rigidity
- Tremors (primarily at rest)
- Freezing
- Difficulty in Walking (narrow based gait, shuffling)
Slow and hesitant movements; Difficulties energizing muscles; may also be associated with rigidity or tremors and depression
Bradykinesia
- Increased reliance on visual feedback
- Movement becomes reliant on cortical control; Movement plans in the basal ganglia cannot be used
- Cannot produce movement forces as quickly, accurately or smoothly as normal subjects
- responds beter to dopamine treatment
Increased, uniform resistance to passive stretch; Due to exaggerated tonic stretch reflexes
rigidity
Involuntary rhythmic movement at rest
Tremor
- Most noticeable in distal extremities; Pill-rolling tremor; Often starts unilaterally; Most evident following movement; May be worse in specific postures
- Resting tremor result of imbalance between basal ganglia and cerebellum
Sudden cessation of movement in the middle of an action sequence
Freezing
- Most often affects walking; Can also affect speech, arm movements, and blinking
- environment can trigger
- Uncommon in early stages, increases over time
In PD, _____ responses are frequently absent for the first step, which may increase instability
Preparatory postural
What symptoms will you see with Huntington’s disease?
- chorea
- hypotonia (rigidity may occur with progression, or in young-onset HD and more akinesia in young-onset)
- eventually WILL develop dementia
- wide-based, staggering gait
Damage to cerebral cortex causes problems on the [contralateral/ipsilateral] side. Damage to cerebellum causes problems on the [contralateral/ipsilateral] side.
- contralateral
- ipsilateral
What does injury to the Cerebrospinocerebellum cause?
- Disturbances in skilled coordinated movements
2. speech
What does injury to the spinocerebellum cause?
Truncal ataxia
What does injury to the vestibulocerebellum cause?
Abnormalities in posture and eye movement
Incoordination or clumsiness of movement not due to strength problems
ataxia
Difficulty in bringing a limb smoothly and accurately to a specific target
dysmetria
Slurred speech due to lack of coordination of muscles
dysarthria
Inability to perform rapidly alternating movements
Dysdiadochokinesia
When a complex movement deteriorates into a series of successive simple movements rather than one, smooth coordinated movement
Decomposition of movement
What symptoms would you see in a cerebellar injury (general injury)?
- dysdiadochokinesia
- decomposition of movment
- action tremors
- dysarthria
- dysmetria
- ataxia
- abnormalities in posture
- abnormal eye movements
What are causes of cerebellar damage?
- Tumors - Lung (50%), breast, kidney, melanoma
- Multiple sclerosis
- Cerebellar hemorrhage
- Stroke
- Chronic alcoholism (Primarily in legs, Due to vitamin deficiency)
What would you expect muscle tone to be like following a stroke?
- initially, hypotonia (may persist if stroke is restricted to primary motor cortex)
- hypertonia replaces hypotonia eventually (spasticity)
- due to damage to premotor, supplementary motor or parietal cortices in dominant hemisphere
- Unable to conceptualize and organize or plan complex movement sequences
- Particularly evident when imitating movements or when performing sequential movements
apraxia
- able to do the movement, but can’t do it voluntarily
What symptoms are seen specifically with R sided lesions?
Motor impersistence – inability to maintain steady grip or posture
- visual perceptual problems
What symptoms are seen specifically with L sided lesions?
- Difficulty performing fast-paced repetitive movements
- Difficulty in sequencing movements
- speech and language problems
what are the negative prognostic variables with stroke?
- Advanced patient age
- Profound motor or sensory loss
- Visuospatial perceptual deficits
- Incontinence
- Magnitude of initial lesion – major factor
What is the most common stroke?
middle cerebral artery
What are the descending tracts of the SC?
lateral and ventral
What are the ascending tracts of the SC?
dorsal, lateral, and ventral columns
What sensory info is in the dorsal columns?
discriminative touch
proprioception
What sensory info is in the lateral columns?
pain and temp
What sensory info is in the anterior columns?
pain and temp
what regions of the cortex do the corticospinal tract UMN originate?
- primary motor
- supplementary cortex
- premotor area
- primary somatosensory cortex
- travel in fiber bundle in forebrain, posterior limb of internal capsule to the pyramids in the medulla (brainstem), where some fibers cross in the caudal medula
- lateral corticospinal cross
- ventral corticospinal do not cross
AKA: anterolateral system
Modalities - Pain, Temperature (hot and cold), Crude touch (light touch, tickle, itch, pressure sensations from bladder and bowel, sexual sensations)
spinothalamic tracts
Spinal tract: from mechanoreceptors; Modalities - discriminative touch, conscious proprioception
DCML
what are S & S of SC lesions?
- Pain
- Paresthesias and numbness
- Muscle weakness
- Abnormal somatic reflexes and muscle tone
where is the most common site of injury to UMN?
Lateral comuns
where is the most common site of injury to UMN?
ventral horn or axons as they leave the spinal cordd
What are the characteristics of an UMN injury?
- hyperreflexia
- spasticity
- abnormal reflex responses
What are the characteristics of an LMN injury?
- atrophy
- hypotonia
- hyporeflexia or areflexia
- fasciculations
