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Neurology > Upper and lower motor neurons > Flashcards

Upper and lower motor neurons Flashcards

1
Q

Anterior horn ->nerve-> muscle

A

LMN

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2
Q

Brain-> Spine

A

UMN

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3
Q

Spastic

A

UMN

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4
Q

Hypertonic

A

UMN

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5
Q

Disuse Atrophy

A

UMN

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6
Q

+ Banbinski

A

UMN

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7
Q

Flaccid

A

LMN

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8
Q

Hypertonic

A

LMN

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9
Q

Hyporeflexic

A

LMN

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10
Q

Denervation Atrophy

A

LMN

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11
Q

-Babinski

A

LMN

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12
Q

Muscle is in spasm

A

Spastic

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13
Q

Muscles is limp/relax

A

Flaccid

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14
Q

We our not able to use the muscle due to injury

A

Disuse Atrophy

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15
Q

Lose innervation on the muscle

A

Denervation Atrophy

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16
Q

use reflex hammer stroke bottom of the foot, the toes curls down

A
  • Banbinski
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17
Q

use reflex hammer stroke bottom of the foot, the toes curls up

A

+ Banbinski

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18
Q

clasp knife phenomenon

A

tighter in the middle range if motion then as we go towards end of range, that releases.

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19
Q

no rigidity of tremor

A

Spastisity

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20
Q

restruction of wrist movent ROM. tension in extending finger

A

UMN

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21
Q

Velocity dependent

A

UMN

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22
Q

Most affected in anti-gravity muscles

A

Biceps, Quads (hip flex), Hip

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23
Q

involuntary muscle contractions. 5-7hz contraction.

dorsiflex and plantarflex nakikita

A

Clonus

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24
Q

brisk reflexes

A

Hyperreflexia of deep tendon reflex

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25
Q

tapping the supratellar tendon will elicit knee jerk reflex

A

Hyperreflexia of deep tendon reflex

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26
Q

Superficial abdominal reflex and cremasterix reflex are decreased.

A

Hyporreflexia of superficial reflex

UMN

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27
Q

involuntary movements in a limb that have asscoiation to voluntary movements

A

Synkinesia

UMN

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28
Q

CN 7&12, WIP

A

Psuedo bulbar palsy

UMN

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29
Q

lumiliit muscles due to lack of nutrients

A

Muscle Atrophy

LMN

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30
Q

Weekness

A

LMN

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31
Q

Fasciculation

A

LMN

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32
Q

Damaged alpha motor neurons can produce spontaneous action potentials. These spikes cause the muscle fibers that are part of that neuron’s motor unit to fire, resulting in a visible twitch (called a ___) of the affected muscle.

A

Fasciculation

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33
Q

Fibrillation

A

LMN

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34
Q

Maliit na twicth

A

Fibrillation

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35
Q

Because alpha motor neurons are the only way to stimulate extrafusal muscle fibers, the loss of these neurons causes a decrease in muscle tone.

May strenght but less tone

A

Hypotonia

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36
Q

Hyporeflexia

A

LMN

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37
Q

D

The myotatic (stretch) reflex is weak or absent with lower motor neuron disorders, because the alpha motor neurons that cause muscle contraction are damaged.

A

Hyporeflexia

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38
Q

Weakness agad makikita

A

LMN

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39
Q

Late mainly because of disuse wasting

A

UMN

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40
Q

Early and present wasting

A

LMN

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41
Q

is the sudden occurrence of permanent damage to an area of the brain caused by a blocked blood vessel or bleeding within the brain. Other causes of focal brain damage, such as traumatic injury to the brain, demyelinating lesions, brain tumors, brain abscesses, and others, can produce stroke like symptoms but are not included in this definition.

A

Cerebrovascular Accident

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42
Q

Most common weakness of stroke

A

Focal weakness

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43
Q

Close head injury but Skull is not actually penetrated

A

Traumatic Brain Injury

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44
Q

Components of GCS

A

Eyes
Verbal
Motor

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45
Q

Abnormal flex/ abnormal slow flec. What is it and grade

A

Dicorticate, 3

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46
Q

complex, multifactorial disease that requires the expertise of neurologists, physiatrists, occupational therapists, and physical therapists, as well as countless other participants in the patient’s care.

A

Multiple Sclerosis

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47
Q

is considered to be an autoimmune diseases. Like all autoimmune disorders, it is more common in women, occurring about twice as often in women as in men. ➡

A

Multiple Sclerosis

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48
Q

also appears to involve genetic factors with HLA-DR2 in DR-positive families having a greater chance of developing the disease.

A

Multiple Sclerosis

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49
Q

The hallmark of MS pathology

Cardinal Symptoms:

A

Scanning Speech. Intention Tremor, Nystagmus also known as Charcot’s Triad.

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50
Q

The hallmark of MS pathology

Cardinal Symptoms:

A

Scanning Speech. Intention Tremor, Nystagmus also known as Charcot’s Triad.

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51
Q

Refers slowness of movement

A

Bradykinesia

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52
Q

Sx: Bradykinesia

A

Parkinson’s disease

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53
Q

Cardinal features of PD

A

Rigidity
o Bradykinesia
o Tremor
o Postural instability

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54
Q

Shaking palsy

A

Parkinson’s disease

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55
Q

Resistance of mm to passive elongation or stretch

A

Muscle tone

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56
Q

Tone is influenced

A

physical inertia

intrinsic mechanical-elastic stiffness of muscle and connective fissues.

spinal reflex muscle contraction (tonic strotch reflexos),

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57
Q

Hypertonic state characterized by constat resistance thoughout ROM that is independent of the Velocity movment

A

Rigidity

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58
Q

Mukhang sinapian

A

Opisthotonus

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59
Q

UMNL is the first order neurons regulated by the

neurotransmitter___

A

glutamate

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60
Q

what is spaticity

A

Slow passive movement will not elicit the increased
resistance

A velocity dependent increase in mm resistance to
a passive stretch

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61
Q

brisk stretches of mm will cause an abrupt inc in tone followed by a dec in mm resistance c continued stretch

A

Clasp knife rigidity

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62
Q

Affects the antigravity mm of arms and legs (flexors

of the arm and extensors of leg)

A

UMNL

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63
Q

in umnl Patients often exhibit flexor and extensor ____

A

spasms

  • Ex. Stroke pts: UE is in flexion while LE is
    in extension
64
Q

What is clonus?

A

A sequence of rhythmic, involuntary mm cxn that occur at a frequency of ___

5-7 Hz

65
Q

Occurs as a response to abruptly applied stretch

stimuli

A

clonus

66
Q

where does clonus Most easily elicited at?

A

the ankle c brisk dorsiflexion and

plantar flexion movements

67
Q

Patient can be seen to have abnormally brisk
reflexes which are d/t decreased modulation by
descending inhibitory pathways

A

Hyperreflexia of the DTR

68
Q

: the tensing of abs

by stroking the overlying skin

A

Superficial abdominal reflex

69
Q

the elevation of scrotum in

response to stroking medial thigh

A

Cremasteric reflex

70
Q

what is synkinesia

A

Involuntary movements in limb that have
associations c the voluntary movements in other
limbs

71
Q

flexion of arm may result in flexion of leg is an example of

A

synkinesia

72
Q

____ can occur when yawning or sneezing

A

synkinesia

73
Q

Volitional movements of one arm or leg may result

in mirror movements of opposite limb

A

synkinesia

74
Q

Most CN have bilateral innervation from the brain,

with the exception of CN 7 & 12

A

Pseudo-Bulbar Palsy

75
Q

Sx of pseudo-bulbar palsy

A

Slurred speech, dysphagia, dysarthria, brisk jaw

jerk, spastic tongue, and speudobulbar affect

76
Q

Damaged alpha motor neuron → produces

spontaneous action potentials

A

Fasciculation, lmnl

77
Q

These spikes cause the muscle fibers that are part
of the neuron’s motor unit to fire, resulting in visible
twitch of the affected mm.

A

fasciculation

78
Q

Because ____ are the only way to
stimulate extrafusal muscle fibers, the loss of these
neurons causes a decrease in mm tone

A

alpha motor neurons

79
Q

Hyporeflexia
- Myotatic (stretch reflex) is weak or absent c LMN
d/o because the ____that cause
mm contraction are damaged

A

alpha motor neurons

80
Q

Where is the lesion for UMNL?

A

Above the anterior
horn in the SC or
above the nuclei of
the CN

81
Q

Where is the lesion for LMNL?

A

Anterior horn cell,
motor nn fiber or
neuromuscular
junction

82
Q

Where is the mm weakness in UMNL?

A

LE: All muscle groups (more
marked in the flexors)

UE:  distally > proximally (Both flex & ext)
(bec. UE ay usually naka-flex,
so yung extensors di
nag-cocontract, pero
counterproductive rin
kasi lagi namang
nag-cocontract yung
flexors)
83
Q

Where is the mm weakness in LMNL?

A

distally>proximally. (Both

flexors and extensors affected)

84
Q

Fasciculation in UMNL

A

absent

85
Q

Fasciculation in LMNL

A

May be present in anterior horn cell

86
Q

2 Major categories of stroke:

A

Ischemic

Hemorrhagic

87
Q

Caused by a vascular occlusion

A

Ischemic

88
Q

Caused by bleeding within the Parenchyma

of the brain

A

Hemorrhagic

89
Q

Artery

pt deficit: CL weakness and sensory
loss primarily in the LE,
incontinence, aphasia,
memory and behavioral
deficits
A

Anterior cerebral Artery

90
Q

Artery

pt deficit: CL sensory loss and
weakness in face and UE
Less involvement in LE,
homonymous hemianopia

A

Middle cerebral Artery

91
Q

Artery
pt deficit: Ataxia, equilibrium,
disturbances, headaches,
dizziness

A

Vertebrobasilar Artery

> balance

92
Q 
Artery
pt deficit: CL sensory loss, thalamic
pain syndrome,
homonymous
hemianopsia, visual
agnosia, and cortical
blindness
A

Posterior cerebral Artery
> for Vision
> Related sila ng vertebrobasilar
(without vision, nawawala visuospatial awareness)

93
Q

TRAUMATIC BRAIN INJURY (TBI) Are classified as ___, wherein the skull is ____.

A

Closed Head Injuries, not actually penetrated

94
Q

nature of the injury sustained in vehicular accidents and falls (e.g., blunt impact, acceleration-deceleration) often results in multifocal lesions and diffuse brain damage with a variety of physical, cognitive, and neurobehavioral impairments that are unique to each person and pose formidable obstacles to community integration

A

TBI

95
Q

● Clinical assessment of coma was made more precise

and objective _____

A

Glasgow Coma Scale (GCS)

96
Q

GCS for Eye opening

Spontaneous
Opens eyes on own

A

4

97
Q

GCS for Best motor response
Pain
Pulls examiner’s hands away when pinched

A

5

98
Q

GCS for Eye opening
Speech
Opens eyes when asked in a loud voice

A

3

99
Q

GCS for Eye opening

Pain
Opens eyes when pinched

A

2

100
Q

GCS for Eye opening

Pain
Does not open eyes

A

1

101
Q

GCS for Best motor response
Pain
Pulls a part of the body away when pinched

A

4

102
Q

GCS for Best motor response
Pain
Flexes body inappropriately when pinched (decorticate posturing)

A

3

103
Q

GCS for Best motor response
Pain
Body becomes rigid in an extended position when pinched (decerebrate posturing)

A

2

104
Q

GCS for Best motor response
Pain
Has no motor response to pinch

A

1

105
Q

GCS for Verbal response (talking)

Speech Carries on conversation correctly and tells examiner where he or she is, month and year

A

5

106
Q

GCS for Verbal response (talking)

Speech Seems confused or disoriented

A

4

107
Q

GCS for Verbal response (talking)

Speech Talks so examiner can understand victim but makes no sense

A

3

108
Q

GCS for Verbal response (talking)

Speech Makes sounds that examiner cannot understand

A

2

109
Q

GCS for Verbal response (talking)

Speech Makes no noise

A

1

110
Q

Best and lowest score for GCS

A

BEST score to achieve: 15

○ Lowest is 3

111
Q

VERBAL
○ What is your name? Where are you? What
month is it?
■ If they answer all >

A

“ORIENTATED”

112
Q

○ What is your name? Where are you? What
month is it?
■ If pt speaks in incomplete sentences

A

> “CONFUSED”

113
Q

○ What is your name? Where are you? What
month is it?
■ If talking gibberish/ swearing at
you >

A

“WORDS”

114
Q

○ What is your name? Where are you? What
month is it?
■ moaning/groaning and can’t
make out what they are saying >

A

“SOUNDS”

115
Q

○ What is your name? Where are you? What
month is it?
■ If there’s no response

A

> “NONE”

116
Q

○ What is your name? Where are you? What
month is it?
■ If there is a tube on pt’s mouth >

A

“NOT TESTABLE (NT)”

117
Q

○ Grasping and releasing fingers or opening

the mouth and sticking out the tongue >

A

“OBEYS COMMANDS”

118
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ If trapezius gives no response >

A

go to Supraorbital notch and test

that area

119
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ If they move their arm/hand up
above clavicle towards stimulus >

A

“LOCALISING” to pain

120
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ If arm bends and moves rapidly
away from body and stimulus >

A

“NORMAL FLEXION”

121
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ Elbow bends slowly and arm
comes across body >

A

“ABNORMAL FLEXION

“(Decorticate )

122
Q

*Counterpart of Decorticate is

A

“ABNORMAL EXTENSION”

Decerebrate

123
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ No response

A

> “NONE”

124
Q

○ Trapezius pinch (central stimulus), and
assess what their response is
■ If paralyzed

A

> “indicate NT” (not

testable)

125
Q

Pathophysiology of TBI
● Primary TBI

■ Ex. nauntog sa dashboard, yung rebound
effect non
○ Damage that occurs directly and immediately as a
result of trauma to the brain. Cortical contusion
and DAI are the 2 subtypes of primary injury.

A

○ Cerebral contusion is the other main type of
primary injury. These cortical bruises commonly
occur at the crests of the gyri and extend to
variable depths, depending on severity.
○ Contusions often occur on the undersurface of
the frontal lobes, as well as the frontal and
temporal tips, regardless of the site of impact, due
to the internal architecture of the skull.
○ Coup-contrecoup injuries are more likely seen
when the moving head hits a stationary object,
such as with a fall. In this situation, one may see a
contusion at the site of impact as well as another,
often larger, contusion on the opposite cortex

126
Q 
distinguishing feature of TBI.
Acceleration-deceleration and rotational
forces that commonly result from motor
vehicle accidents produce diffuse axonal
disruption.
A

Diffuse Axonal Injury (DAI)

127
Q

primarily responsible for the initial loss of consciousness

A

Diffuse Axonal Injury (DAI)

128
Q 
○ Any damage to brain tissue that takes place after
the initial (primary) injury
A

Secondary TBI

■ Nanggaling sa primary TBI/ remnant ng
primary TB

129
Q

____ are examples of intracellular processes that lead to secondary injury, but can be driven by factors taking place at the tissue or systemic level.

A

Apoptosis and excitotoxicity

○ Systemic factors such as anemia, hypotension,
pulmonary injury, and cardiac or respiratory arrest
also may contribute to secondary injury by
diminishing the delivery of oxygen to the injured
brain

130
Q

Cerebral Hypoperfusion is assessed by

evaluating the _____

A

Cerebral Perfusion Pressure (CPP),
-the difference between mean arterial pressure (MAP) and intracranial pressure (ICP)

○ Factors that increase ICP or decrease MAP can
decrease CPP, leading to increased ischemic
injury.

■ ICP: di nag fflow maayos yung dugo, and
nag p-pile up lang siya sa isang area

131
Q

Cerebral Perfusion Pressure

(CPP), which is defined as the

A

difference between
mean arterial pressure (MAP) and intracranial
pressure (ICP)

132
Q

Glasgow Outcome Scale-Extended

1

A

Dead

133
Q

Glasgow Outcome Scale-Extended

Dead

A

1

134
Q

Glasgow Outcome Scale-Extended

2

A

Vegetative state (VS)
No cerebral cortical function that can be judged by
behavior (not able to follow simple commands or
communicate)

135
Q

Glasgow Outcome Scale-Extended

3

A

Lower severe disability (lower SD)

136
Q

Glasgow Outcome Scale-Extended

4

A

Upper severe disability (upper SD)

Need supervision/assistance in ADL, but can be alone for >8h/d

137
Q

Glasgow Outcome Scale-Extended

5

A

Lower moderate disability (lower MD)
Independent in adl and can shop and travel indep on
public transportation, but has not returned to previous
position or lifestyle

138
Q

Glasgow Outcome Scale-Extended

6

A

Upper moderate disability (upper MD)
Able to resume previous position or lifestyle with
alternative/modified duties or part-time d/t injury

139
Q

Glasgow Outcome Scale-Extended

7

A

Lower good recovery (lower GR)
Able to resume previous position or lifestyle (may be
modified), but reporting some problems

140
Q

Glasgow Outcome Scale-Extended

8

A

Upper good recovery (upper GR)
Complete return to previous lifestyle with no reported
problems

141
Q

Glasgow Outcome Scale-Extended
Vegetative state (VS)
No cerebral cortical function that can be judged by
behavior (not able to follow simple commands or
communicate)

A

2

142
Q

Lower severe disability (lower SD)

A

3

143
Q

Upper severe disability (upper SD)

Need supervision/assistance in ADL, but can be alone for >8h/d

A

4

144
Q

Lower moderate disability (lower MD)
Independent in adl and can shop and travel indep on
public transportation, but has not returned to previous
position or lifestyle

A

5

145
Q

Upper moderate disability (upper MD)
Able to resume previous position or lifestyle with
alternative/modified duties or part-time d/t injury

A

6

146
Q

Lower good recovery (lower GR)
Able to resume previous position or lifestyle (may be
modified), but reporting some problems

A

7

147
Q

Upper good recovery (upper GR)
Complete return to previous lifestyle with no reported
problems

A

8

148
Q

A complex, multifactorial dse that requires the expertise
of neurologists, physiatrists, OTs, and PTs, as well as
other participants in patient care

A

MULTIPLE SCLEROSIS

149
Q

MS is a Autoimmune disease that is occurs twice as often in ___than ___
● Also appears to involve genetic factors c HLA-DR2 in
DR-positive families- having a greater chance of
developing the dse

A

women > men

150
Q

Hallmark of MS Pathology:

A

Presence of:

  1. multifocal plaques (lesions) of demyelination in the cerebral hemispheres,
  2. optic nn
  3. brain stem, and
  4. spinal cord
151
Q

Cardinal Symptoms (Charcot’s Triad):

A

SIN
○ Scanning speech
○ Intention tremor
○ Nystagmus

152
Q

○ Characterized by discrete attacks of neurological
deficits (relapse) with either full or partial recovery
(remission) in subsequent weeks to months
■ To be considered a relapse, symptoms
must occur for more than 24 hours
■ Attacks for <24 hrs: pseudo- ng MS
○ The periods between relapses are characterized
by lack of disease progression
○ The stable patient may have local inflammatory
activity that is clinically silent
○ Affects approximately 85% of patients with MS at
diagnosis

A

● Relapsing-Remitting MS (RRMS)

153
Q

○ Characterized by an initial relapsing-remitting
course, followed by a change in clinical course
with progression to steady and irreversible
decline with or without continued acute
attacks
○ May be the result of progressive axonal loss
rather than new lesions
○ Before newer treatments, the majority of patients
with RRMS progressed to SPMS

A

● Secondary-Progressive MS (SPMS)

154
Q

○ Characterized by disease progression and steady
functional decline from onset; patients may
experience modest fluctuations in neurological
disability but discrete attacks do not occur
○ PPMS is associated with later onset (mean age
40 years) and more equal gender distribution
○ Affects approximately 10% of patients with MS

A

● Primary-Progressive MS (PPMS)

155
Q

○ Characterized by a steady deterioration in
disease from onset (similar to PPMS) but with
occasional acute attacks.
○ Intervals between attacks are characterized by
continuing disease progression
○ Affects approximately 5% of patients with MS
○ Poor prognosis

A

● Progressing-Relapsing MS (PRMS)

Neurology (4 decks)

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