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Final Frontier Neuro Content > UMN & LMN Lesion and Cerebellum & Basal Ganglia Disorders > Flashcards

UMN & LMN Lesion and Cerebellum & Basal Ganglia Disorders Flashcards

1
Q

Where can a lesion occur for it to be considered UMN lesion? (4)

A
  1. CNS cortex
  2. Brain stem
  3. Corticospinal tracts
  4. Spinal cord
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2
Q

Where can a lesion occur for it to be considered LMN lesion? (3)

A
  1. Cranial nerve nuclei
  2. Spinal cord: anterior horn cells or spinal roots
  3. Peripheral nerve
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3
Q

IMPORTANT
If an UMN lesion occurs, what are the common diagnoses? (3)

A
  1. Stroke
  2. TBI
  3. SCI
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4
Q

IMPORTANT
If a LMN lesion occurs, what are the common diagnoses? (4)

A
  1. Polio, GBS
  2. Peripheral nerve injury
  3. Peripheral neuropathy
  4. Radiculopathy
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5
Q

Describe the tone differences between an UMN & LMN lesion (2 characteristics each)

A

UMN
-Increased; hypertonia
-Velocity dependent

LMN
-Decreased or absent; hypotonia; flaccidity
-Not velocity dependent

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6
Q

What is the main thing to remember about the tone between UMN and LMN lesion?

A

UMN lesion is velocity dependent and LMN is not which is important when testing reflexes or assessing for tone

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7
Q

Describe the reflexes differences between an UMN(3) & LMN (2) lesion

A

UMN
-Increased; hyperreflexia; clonus
-Exaggerated cutaneous & autonomic reflexes
-+Babinski

LMN
-Decreased or absent; hyporeflexia
-Cutaneous reflexes decreased or absent

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8
Q

What do we know about involuntary movements with an UMN and LMN lesion?

A

UMN
-Muscle spasms; flexor or extensor

LMN
-with denervation causes fasciculations

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9
Q

How does an UMN lesion (3) and LMN (2) lesion impact strength?

A

UMN
-weakenss or paralysis; ipsilateral (stroke) or bilateral (SCIS)
-Corticospinal: contralateral if above decussation in medulla; ipsilateral if below
-Distribution: never focal

LMN
-Ipsilateral weakness or paralysis
-Limited distribution; segmental or focal pattern; root-innervated pattern

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10
Q

How does an UMN (1) lesion and LMN (1) lesion impact muscle bulk?

A

UMN
-disuse atrophy; variable widespread distribution especially of antigravity muscles

LMN
-Neurogenic atrophy; rapid, focal distribution, severe wasting

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11
Q

How does an UMN (2) lesion & LMN (1) lesion impact voluntary movements?

A

UMN
-Impaired or absent
-Dyssnergic patterns; obligatory mass synergies

LMN
-Weak or absent if nerve interrupted

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12
Q

What are a few things that are considered IADLs? (4)

A

-money management
-functional communication & socialization
-functional & community mobility
-health maintenance

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13
Q

In technical terms, how do we define mobility?

A

both the BOS & COM are moving

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14
Q

If a lesion occurs to the cerebral cortex or corticospinal tracts, what would that be called?

A

stroke

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15
Q

How is sensation impacted during a stroke (2)?

Tone (3)?

Reflexes (1)?

A

Sensation
-Impaired or absent; depends on lesion location
-Contralateral sensory loss

Tone
-Hypertonia/spasticity & velocity dependent
-Clasp-knife
-Initial flaccidity; cerebral shock

Reflexes
-Hyperreflexia

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16
Q

How is strength impacted during a stroke (2)?

Muscle bulk (1)?

Involuntary movements (1)?

A

Strength
-Contralateral weakness or paralysis; hemiplegia or hemiparesis
-Disuses weakness in chronic stage

Muscle bulk
-Normal during acute stage; disuse atrophy in chronic stage

Involuntary movements
-Spasms

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17
Q

How are voluntary movements impacted during a stroke (1)?

Postural control (2)?

Gait (1)?

A

Voluntary movements
-Dyssynergic: abnormal timing, co-activation, fatigability

Postural control
-Impaired or absent, depends on lesion location
-Impaired balance

Gait
-Impaired; gait deficits due to abnormal weakness, synergies, spasticity, timing deficits

18
Q

When a lesion occurs at the basal ganglia, what pathology do we typically suspect?

A

Parkinson’s Disease

19
Q

When someone has Parkinson’s Disease, how is the sensation affected (1)?

Tone (2)?

Reflexes (1)?

A

Sensation
-Unaffected

Tone
-Lead pipe rigidity; increased uniform resistance
-Cogwheel rigidity; increased, ratchet-like resistance

Reflexes
-Normal or may be decreased

20
Q

When someone has Parkinson’s Disease, how is their strength affected (1)?

Muscle bulk (1)?

Involuntary movements (1)?

A

Strength
-Disuse weakness in chronic stage

Muscle bulk
-Normal or disuses atrophy

Involuntary movements
-Resting tremors

21
Q

When someone has Parkinson’s Disease, how does it affect their voluntary movements (2)?

Postural control (2)?

Gait (1)?

A

Voluntary Movements
-Bradykinesia: slowness of movement
-Akinesia: absence of movement

Postural Control
-Impaired: stooped (flexed)
-Impaired balance

Gait
-Impaired: shuffling, festinating gait

22
Q

When someone has a lesion to their cerebellum, what two diagnoses would we suspect?

A

Tumor or stroke

23
Q

If we suspect a tumor or stroke in the cerebellum, how would we suspect sensation to be affected (1)?

Tone (1)?

Reflexes (1)?

A

Sensation
-Not affected

Tone
-Normal or may be decreased

Reflexes
-Normal or may be decreased

24
Q

If we suspect a tumor or stroke in the cerebellum, how would we suspect strength to be affected (1)?

Muscle bulk (1)?

Involuntary movements (1)?

A

Strength
-Normal or weak: asthenia

Muscle bulk
-Normal

Involuntary movements
-None

25
Q

If we suspect a tumor or stroke in the cerebellum, how would we suspect voluntary movements to be affected (1)?

Postural control (2)?

Gait (1)?

A

Voluntary movements
-Ataxia: intention tremor, dysdiadochokinesia, dysmetria, dyssynergia, nystagmus

Postrual Control
-Impiared: truncal ataixa
-Impaired balance

Gait
-Impaired: ataxic gait deficits, wide-based, unsteady

26
Q

If we suspect a lesion in the spinal cord, what diagnoses should we consider (4)?

A

Trauma
Tumor
Vascular insult
Complete or incomplete SCI

27
Q

If we suspect a lesion to the spinal cord, how would we suspect sensation is affected (1)?

Tone (2)?

Reflexes (1)?

A

Sensation
-Impaired or absent below the level of lesion

Tone
-Hypertonia/spasticity below the level of lesion
-Initial flaccidity: spinal shock

Reflexes
-Hyperreflexia

28
Q

If we suspect a lesion to the spinal cord, how would we suspect strength is affected (1)?

Muscle bulk (1)?

Involuntary movements (1)?

A

Strength
-Impaired or absent below the level of lesion: paraplegia or tetraplegia

Muscle bulk
-Disuse atrophy

Involuntary movements
-Spasms

29
Q

If we suspect a lesion to the spinal cord, how would we suspect voluntary movements to be affected(1)?

Postural control(2)?

Gait (1)?

A

Voluntary movements
-Above level of lesion intact (normal) but below level of lesion: impaired or absent

Postural Control
-Impaired below level of lesion
-Impaired balance

Gait
-Impaired or absent: depends on level of lesion

30
Q

What role does the basal ganglia play in movement and postural control? (4)

A

-initiation and regulation of gross intentional movements, planning, and execution of complex motor responses

-facilitation of desired motor responses while selectively inhibiting others

-accomplish automatic movements & postural adjustments

-maintaining normal background muscle tone

31
Q

What is the importance of the Dorsal (Posterior) Column-Medial Lemniscal Pathway?

A

responsible for the afferent transmission of discriminative sensations & coordinated movement

32
Q

What role does this pathway play in sensory modalities?

A

this system mediates the sensory modalities

33
Q

What sensations are the DCML pathway responsible for? (4)

A

-discriminative touch & kinesthesia
-stereognosis & graphesthaia
-tactile pressure & proprioception
-barognosis & vibration

34
Q

Describe the pathway of the DCML sending ascending neurons to the brain

A

after entering the dorsal column, the fibers ascend to the medulla & synapse w/dorsal column nuclei; then they cross over to the opposite side and pass up to the thalamus then terminate in the posterolateral thalamus

35
Q

What key things is the cerebellum primarily responsible for? (4)

A

-equilibrium
-posture
-muscle tone
-initiation & force of movement

36
Q

What are the 3 regions of the cerebellum and if they are affected due to stroke/tumor, what manifestations are present??

A

Midline (vermis)
-truncal ataxia
-orthostatic tremor
-gait imbalance

Hemispheres (neocerebellum)
-limb ataxia (dysdiadochockinesia, dysmetria)
-dysarthria & hypotnia

Posterior (flocculonodular)
-posture & gait
-eye movement disorders

37
Q

Match the following definitions with its appropriate motor impairment due to cerebellar pathology

-Generalized muscle weakness associated with cerebellar lesions

-Disorder of the motor component of speech articulation

-Movement performed in a sequence rather than as one single/smooth activity

-Inability to judge the distance or range of a movement

-Impaired ability to perform rapid alternating movements

A. Dysmetria
B. Dysarthria
C. Asthenia
D. Dyssnergia
E. Dysdiadochokinesia

A

C. Asthenia
B. Dysarthria
D. Dyssnergia
A. Dysmetria
E. Dysdiadochokinesia

38
Q

Match the following definitions with its appropriate motor impairment due to cerebellar pathology

-Loss of ability to associate muscles together for complex movements

-Decrease in muscle tone

-Rhythmic, quick, oscillatory, back-and-forth movement of the eyes

-Loss of the check reflex

-Involuntary oscillatory movement resulting from alternate contractions of opposing muscle groups

-Ambulatory patterns that demonstrate a broad BOS.

A. Gait ataxia
B. Hypotonia
C. Tremor
D. Rebound phenomenon
E. Nystagums
F. Asynergia

A

F. Asynergia
B. Hypotonia
E. Nystagmus
D. Rebound phenomenon
C. Tremor
A. Gait ataxia

39
Q

What are the 3 common motor deficits associated with basal ganglia pathology?

A
  1. poverty and slowness of movement
  2. involuntary extraneous movement
  3. alterations in posture & muscle tone
40
Q

Match the following definitions with its appropriate motor impairment due to basal ganglia pathology

-Involuntary, rhythmic, oscillaotyr movement observed at rest

-Abnormally increased muscle activity or movement

-Sustained involuntary contractions of agonist & antagonist muscles

-Movement disorder with features of both chorea & athetosis

-Iniability to initiate movement and is seen in the late stages of PD

A. Akinesia

B. Choreoathetosis

C. Dystonia

D. Hyperkinesia

E. Tremor

A

E. Tremor
B. Hyperkinesia
C. Dystonia
B. Choreoathetosis
A. Akinesia

41
Q

Match the following definitions with its appropriate motor impairment due to basal ganglia pathology

-Slow, involuntary, writhing, twisting, “wormlike” movements

-Decreased amplitude & velocity of voluntary movements

-Involuntary, rapid, irregular, and jerky movements involving multiple joints

-Large amplitude sudden, violent, flailing motions of the arm & leg of one side of the body

-Increase in muscle tone causing greater resistance to passive movement

A. Rigidity
B. Athetosis
C. Bradykinesia
D. Hemiballismus
E. Chorea

A

B. Athetosis
C. Bradykinesia
E. Chorea
D. Hemiballismus
A. Rigidity

Final Frontier Neuro Content (4 decks)

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