Paresis (1,2,3) Flashcards
Voluntary motor control consisted of (2)
UMN and LMN
Involuntary motor control consisted of (2)
Extrapyramidal system and cerebellum
UMN 2 structures.
Corticospinal tract = pyramidal tract
Corticonuclear tract = corticobulbar tract
Start-end of corticospinal tract.
Motor cortex (precentral gyrus) –> anterior horn of spinal cord
Start-end of corticonuclear tract.
Motor cortex –> motor cranial nerve nuclei
Where happens decussation of the pyramids?
Lower end of medulla. Cross 50-80proc of pyramidal fibers
UMN eiga.
Motor cortex (precentral gyrus) –> internal capsule –> pyramidal decussation –> lateral corticospinal tract –> anterior horn. Then goes to skeletal muscle.
Corticonuclear tract eiga.
Motor cortex –> internal capsule –> terminated in brain stem in cranial motor nuclei
LMN 3 structures
Anterior horn cells
Anterior roots
Peripheral nerve and motor end palate
LMN skeletal muscle eiga.
Motoneurons of anterior horns of spinal cord –> anterior spinal root –> spinal nerve –> peripheral nerve –> NMJ in sceletal muscle
LMN cranial eiga.
Motor nuclei of cranial nerves in the brainstem –> cranial motor nerves –> NMJ in cranial muscle
Central palsy. What part of face affected, where nerve damage?
Called supranuclear lesion.
Lower quadrant of face in the opposite side of lesion in the brain.
Peripheral palsy. What part of face affected, where nerve damage?
It’s facial nerve lesion.
Affected half of face on the same side as lesion in peripheral nerve.
Why differs central and peripheral face palsy presentation?
Nerve, that inervates lower face starts in opposite side in the brain.
Nerve, that innervates upper part (forehead) starts in one side, but divides into both nuclei in brain stem. Thus lower part is always affected. But if damage is in the brain, eg left, due to crossing of fibers of forehead innervation, this part gets innervation from right side of brains which is not affected.
C1-C4 innervation?
Neck muscles
C4 innervation?
Diaphragm
C5-Th1 innervation?
Hand muscles
Th2-T11 innervation?
Thoracic and abdominal muscles
Th12-S2 innervation?
Leg muscles
S3 - Co innervation?
Pelvic sphincter
Neck muscles
C1-C4
Diaphragm
C4
Hand muscles
C5-Th1
Thoracic and abdominal muscles
Th2-Th11
Leg muscles
Th12-S2
Pelvic sphincter
S3-Co
What is paralysis?
Complete muscle weakness (UMN or LMN damage)
What is paresis?
Partial muscle weekness (UMN or LMN damage)
Central paresis vs Peripheral paresis. What part damaged, what type of paresis?
Central - UMN, spastic paresis
Peripheral - LMN, flaccid paresis.
If there is damage in brain of UMN, where will be paresis?
Opposite side of the body.
If there is damage in spinal cord of UMN, where will be paresis?
Same side of the body.
If there is damage of LMN, where will be paresis?
Always at the same side of the body
Power in spastic paresis is …?
Decreased
Power in flaccid paresis is …?
Decreased
Inspection of muscles in spastic paresis is …….
Normal. ie diffuse atrophy
Inspection of muscles in flaccid paresis is …….
Atrophy fasciculations
Tone in spastic paresis is ….
Increased
Tone is flaccid paresis is ….
decreased or normal
Tendon reflexes in spastic paresis are …….
Increased
Tendon reflexes in flaccid paresis are …….
Decreased or absent
Do pathological reflexes present in spastic paresis?
Yes
Do pathological reflexes present in flaccid paresis?
No
Do sinkinetic movements present in spastic paresis?
Yes
Do sinkinetic movements present in flaccid paresis?
No
Causes of UMN damage in brain? 5
Stroke, encephalitis, trauma, tumor, abscess
Causes of UMN damage in spinal cord? 4
Trauma, myelitis, tumor, spinal stroke
Causes of LMN damage in anterior horn? 3
Amyotrophic lateral sclerosis, spinal stroke, intramedullary tumor
Causes of LMN damage in nerve root, spinal nerves? 3
Due to degenerative spine, disc herniation, tumor.
Causes of LMN damage in peripheral nerves? 3 and 3
Compression or entrapment (such as carpal tunnel syndrome), neuropathies, traumas
Polyneuropathies, multifocal mononeuropathies, Guillain-Barré syndrome
Due to degenerative spine, disc herniation, tumor. Where cause damage?
Nerve roots, spinal nerves
Amyotrophic lateral sclerosis, spinal stroke, intramedullary tumor. Where cause damage?
LMN anterior horns
Compression or entrapment (such as carpal tunnel syndrome), neuropathies, traumas
Polyneuropathies, multifocal mononeuropathies, Guillain-Barré syndrome. Where cause damage?
Causes of LMN damage in peripheral nerves? 3 and 3
Types of paresis/paralysis 6
Monoparesis, Hemiparesis, Alternating paresis, Tetraparesis, Paraparesis, Segmental paresis
What is monoparesis?
Paresis in one extremity.
Paresis in one extremity?
Monoparesis
Where is the damage in monoparesis?
Frontal lobe damage
What is hemiparesis?
Unilateral paresis, weaknes of one entire side of the body.
What is hemiplegia?
Complete paralysis of half of the body.
Where is the lesion in hemiparesis?
Corticospinal tract in brain or brainstem.
What are the causes of hemiparesis?
Stroke, intracerebral hemorrhage, encephalitis, abscess, tumor, trauma
What is alternating paresis?
Combination of central and peripheral paresis.
Central - paresis on the opposite side of body
Peripheral - paresis of facial muscles or tongue on the side of the lesion
Where is the lesion in alternating paresis?
Brain stem
What is tetraparesis? How it’s divided?
Affected both arms and legs. Central and peripheral.
Central tetraparesis causes in the brain? 6
Stroke, intracerebral hemorrhage, encephalitis, abscess, tumor, trauma
Central tetraparesis causes in spinal cord? 5
Trauma, tumor, myelitis, myelopathy, spinal stroke
Where is damage in case of central tetraparesis?
Bilateral damage, damage in the brainstem, or upper cervical spinal cord
What is the cause of peripheral tetraparesis?
Polyradiculoneuritis
What is paraparesis?
Paresis of both arms or legs.
What are the causes of upper paresis?
Segmental damage in lower parts of cervical spinal cord
Segmental damage in lower parts of cervical spinal cord. Dignosis?
Upper paraparesis
Polyradiculoneuritis causes …..
Peripheral tetraparesis
Where can be damage in case of lower paraparesis? 2
Central and peripheral
What are causes of central lower paraparesis?
Frontal bilateral damage, cervical or thoracic spinal cord
What are causes of peripheral lower paraparesis?
Segmental spinal cord damage at Th12-S2 level, cauda equina damage, polyradiculoneuritis
What is segmental paresis?
peripheral paresis at corresponding segmental level
Where is the lesion in peripheral segmental paresis?
Anterior horn motor cells.
Anterior horn motor cells damage. particular segment. What paresis?
Segmental paresis
What are the causes of segmental paresis?3
Amyotrophic lateral sclerosis, syringomyelia, intramedullary tumor