Neurological Signs

Question 1

Dysdiadochokinesis

Answer 1

Lack of coordination when executing rapid alternating movements

Sign of cerebellar impairment

Question 2

Nystagmus

Answer 2

Fast uncontrollable eye movements.

May be horizontal, vertical, or rotational. May affect one or both eyes.

Question 3

Ataxic dysarthria

Answer 3

Difficulty in articulating speech (NOT related to problems with the content of speech, i.e. aphasia)

Scanning speech is an example, where a patient splits up words into syllables, often placing the emphasis in the wrong places.

Question 4

Romberg Sign

Answer 4

When a patient who was able to maintain an erect, balanced stance while eyes were open loses that ability (I.e. starts to sway) upon closing eyes.

Denotes sensory ataxia, where a patient relies heavily on visual input to know the position of their limbs in space.

Question 5

Vertigo

Answer 5

Sign of vestibular dysfunction (loss of balance info from the inner ear)

Question 6

Pseudo ataxia of distal limbs

Answer 6

Sign of corticospinal tract disease

Question 7

Intention tremor

Answer 7

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Question 8

Cerebellar mutism syndrome (CMS)

Answer 8

Unique postoperative syndrome typically arising 1 to 2 days after resection of a midline posterior fossa tumor

Consists of diminished speech progressing to mutism, emotional lability, hypotonia, and ataxia.

Question 9

Ataxia

Answer 9

Hallmark of cerebellar disease

Question 10

Bradykinesia

Answer 10

slow initiation of voluntary movement, poverty of spontaneous movement

Common sign of Parkinson due to loss of the direct pathway.

Question 11

Chorea

Answer 11

Brief, jerk-like movements.

Defined as irregular, random, abrupt/rapid, and flowing.

Typical of HD (i.e. huntington’s chorea).

Can be a side effect of levodopa.

Question 12

Athetosis

Answer 12

Slow, writhing movements of flexion, extension, pronation, supination of fingers and hands

Question 13

Balism

Answer 13

Form of chorea in which large-amplitude jerking or flinging movement, usually of proximal extremities, predominates.

Called hemiballism if it affects only one side of the body.

Question 14

Dystonia

Answer 14

Sustained muscle contraction causing twisting postures, generally repetitive.
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Question 15

Tremor

Answer 15

Rythmic and sinusoidal/oscillatory movements caused by alternate contraction of opposing muscle groups.

Types:

• rest (PD/parkinsonism)
• postural (essential tremor, enhanced physiologic)
• Kinetic (ET, cerebellar)
• All
• Task-specific (writing tremor, dyskinesia)

Question 16

Tics

Answer 16

Intermittent, repeated, and stereotyped movements or sounds under SOME voluntary control

Characterized by internal phenomenology: patient feels the urge to make it, and suppressing the urge leads to “overflow”, need to release the tic.

FOREWARNED AND SUPPRESSIBLE

May be motor or vocal. If both motor and vocal tics present for at least a year, that is the clinical definition of Tourette’s syndrome.

Ex. excessive blinking, throat clearing

Question 17

Myoclonus

Answer 17

Shock-like or lightning-like SINGLE contraction or jerk. Couldn’t fake it that fast, other degenerative (CJD).

Question 18

How do you differentiate PD from ET?

Answer 18

In PD, tremors are usually asymmetric rest tremors with accompanying bradykinesia, cogwheel rigidity, micrographia, and shuffling gait.

Family history is more common in patients with ET. These patients exibit symmetric postural/action tremors with no bradykinesia nor rigidity and “shaky-graphia.”

Question 19

Micrographia

Answer 19

Small, or progressively smaller, handwritting that is difficult to read.

Caused by reduced amplitude of movements (such as those of writting), especially typical of Parkinson’s

Question 20

Apraxia

Answer 20

Acquired deficit in learned or skilled movements in the presence of intact strength and sensation.

Most cases result from left hemisphere lesions

Question 21

“limb-as-tool” error

Answer 21

Alzheimers and other neurodegenerative disease patients will present with apraxia where they try to pantomime using a hammer by using their hand as a hammer.

Question 22

Neglect

Answer 22

Hemispatial neglect is a deficit in attention to and awareness of one side of space, an object, or one’s own body.

It is defined by the inability of a person to process and perceive stimuli on one side of the body or environment that is not due to a lack of sensation

Can be of hemi-space (usually due to inferior parietal lobe lesion), or hemi-object (superior temporal gyrus) modality.

Most common after injury to left parietal lobe.

Question 23

Agnosia

Answer 23

Not to know

Question 24

Prosopagnosia

Answer 24

Inability to recognize faces

Question 25

Agraphia

Answer 25

Inability to write resulting from cortical lesions

Question 26

Acalculia

Answer 26

Inability to perform simple mathematical/arithmetic tasks

Question 27

Optic ataxia

Answer 27

inability to reach for visual targers

Question 28

Ocular apraxia

Answer 28

Inability to direct gaze

Question 29

Simultagnosia

Answer 29

Inability to appreciate an entire scene, thus being limited to focus only on indivisual objects

Question 30

Aphasia

Answer 30

Disorder of language

Question 31

Amusia

Answer 31

Deficiencies in different areas relating to music

Question 32

Central agraphia

Answer 32

Inability to spell words (either sight words or novel words)

Question 33

Peripheral agraphia

Answer 33

Loss in the automaticity of forming letters.

These patients may need up to 1 minute to write each letter.

Question 34

Central alexia

Answer 34

Loss in the ability to either read sight words (these patients read things “phonetically”, sounding out the phoneme of each letter and disregarding the word’s true pronunciation. This problem would not be that evident with Italian or Spanish) OR reading new words (because they can’t read through the word letter by letter; these patients can only read words that are stored in their “sight word” vocabulary)

Question 35

Peripheral alexia

Answer 35

Difficulty with the rapid “translation” of a letter’s geometrical features into its concept.

These patients read in a painstakingly slow, letter-by-letter fashion.

Question 36

Apraxia

Answer 36

Loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability.

Disorder of motor planning usually caused by lesion in the cerebrum, and NOT caused by incoordination, sensory loss, and/or inability to comprehend directions.

Question 37

Fasciculations

Answer 37

Random twitches of denervated motor units visible under the skin.

Question 38

Fibrillations

Answer 38

Invisible 1- to 5-ms potentials, detected by EMG (electromyography).

Question 39

Clonus

Answer 39

Rapid successive reflex contractions and relaxation of agonists and antagonists observed mainly at the knee and ankle joints during reflex testing.

Question 40

Babinski sign

Answer 40

Extensor plantar response (rather than a flexor response) to plantar cutaneous stimulus.

Altered cutaneous reflex typical of an UMN lesion.

NOTE: This is normal in infants until the UMN tracts have become fully myelinated.