Patterns of Neurological Dysfunction

Question 1

Where do extrapyramidal signs come from?

Answer 1

basal ganglia

Question 2

Where do pyramidal signs come from?

Answer 2

Corticospinal /

pyramidal tract

Question 3

What are the two types of extrapyramidal sings?

Answer 3

hyperkinetic hypokinetic

Question 4

Signs of hyperkinetic (extrapyramidal) movement disorders?

Answer 4

Dystonia,
Tics,
Myoclonus
Chorea
(Tremor)

Question 5

What is the term for spasmodic jerky contraction of groups of muscles?

Answer 5

myoclonus

Question 6

Signs of hypokinetic movement disorders?

Answer 6

rigidity, bradykinesia

Parkinsonism

Question 7

Name a hypokinetic movement disorder.

Answer 7

Parkinson’s disease

Question 8

What is ataxia and what part of the brain does it come from?

Answer 8

loss of full control of bodily movements

cerebellum

Question 9

What is a pyramidal lesion the same as?

Answer 9

upper motor neuron lesion

Question 10

In which, upper or motor neuron lesions, are there decreased or absent reflexes?

Answer 10

lower

Question 11

Symptoms of muscle disease?

Answer 11

wasting (usually proximal), decreased tone, decreased or absent tendon reflexes

Question 12

Symptoms of neuromuscular junction disease?

Answer 12

fatiguable weakness, normal or decreased tone, normal tendon reflexes. No sensory symptoms

Question 13

Symptoms of functional weakness?

Answer 13

no wasting, normal tone, normal reflexes, erratic power, non-anatomical loss

Question 14

What occurs with acute stroke syndromes, space occupying lesions, and spinal cord problems ?

Answer 14

UPPER motor neuron lesions

Question 15

What type of lesion is suggested by a contralateral pyramidal weakness in face, arm, leg?

Answer 15

hemispheric upper motor neuron

Question 16

What occurs with Parasagittal frontal lobe lesion?

Answer 16

paraparesis

Question 17

In a spinal cord upper motor neuron lesion, where does weakness occur?

Answer 17

pyramidal weakness below the level of the lesion
cervical: arms and legs
Thoracolumbar: legs

Question 18

What disease pattern occurs with motor neuron disease, spinal muscular atrophy, (lead poisoning, poliomyelitis,…)?

Answer 18

LOWER - anterior horn cells

Question 19

How does peripheral nerve involvement with lower motor neurons present?

Answer 19

Symmetrical (often length dependent) polyneuropathy with weakness and sensory symptoms: frequent complication of diabetes. Other aetiologies include a variety of toxic (alcohol) or metabolic insults as well as heritable disorders (often young onset and skeletal deformities)
Mononeuropathy as a result of nerve compression (carpal or tarsal tunnel syndrome, ulnar neuropathy, radial neuropathy) or mononeuritis multiplex (asymmetric polyneuropathy), which occurs in the context of diabetes or vasculitis

Question 20

What type of sensory loss does stocking (and later glove) imply?

Answer 20

dependent neuropathy

Question 21

What does sensory level loss imply?

Answer 21

spinal cord lesion

Question 22

Haemianaestheisa suggests what?

Answer 22

contralateral cerebral lesion, or with no other signs a non-organic disorder

Question 23

Disscociated sensory loss with lost spinothalamic (temperature / pain) but preserved dorsal column (vibration, light touch, proprioception) suggests what?

Answer 23

hemicord damage (anterior spinal artery syndrome, Brown-Sequard syndrome, syringomyelia)

Question 24

What is Dysdiadochokinesis?

Answer 24

clumsy, fast, alternating movements

Question 25

Intention tremor / ataxia is assessed by what in the arms?

Answer 25

finger nose test

Question 26

Intention tremor / ataxia is assessed by what in the legs?

Answer 26

knee heel testing

Question 27

Which part of the brain enables self-criticism and trying again?

Answer 27

frontal lobe

Question 28

Why may anosmia occur with frontal lobe dysfunction?

Answer 28

olfactory pathway is beneath frontal lobe

Question 29

What type of memory dysfunction is particularly common in temporal lobe dysfunction?

Answer 29

episodic memory loss

Question 30

What is the treatment protocol for Parkinson’s?

Answer 30

Symptomatic treatment with Levodopa replacement or dopamine agonist
Multidisciplinary team management including Speech and language, OT, PT, exercise
For selected patients deep brain stimulation (subthalamic nucleus, globus pallidus int)