W4L1 - Brain Body Connection Failure

Question 1

Apraxia: Symptoms and Types

Answer 1

Apraxia

Symptoms:

• “Without Action” but not paralysed
• Inability to imitate or perform actions to vocal instructions

Types:

• Limbs
  
  • Kicking, etc.
• Oral (Speech/Muscle)
  
  • Facial muscles and vocalization
• Constructional agraphia (rare)
  
  • Imitating a picture/ Legos
• Apraxic agraphia (rare)
  
  • Can spell word (understand) but cannot write

Question 2

Apraxia: Causes and Treatment

Answer 2

Causes

• Parietal Lobe
  
  • Limb: Left frontal and parietal
  • Constructional: Right parietal

Treatment

• Physical/occupational/speech therapy

Question 3

Ataxia: Symptoms

Answer 3

Symptoms

• “Without coordination”
• Poor coordination, speech change, unsteady walking, difficulty swallowing

Question 4

Ataxia: Causes

Answer 4

Causes

• Cerebellar damage
  
  • Alcohol abuse
  • Stroke
  • Tumour
  • Multiple Sclerosis
  • Hereditary forms
  • Virus

Question 5

Ataxia: Treatment/Management

Answer 5

Ataxia: Treatment

• Treat underlying cause (e.g. alcohol consumption)
• Virus may reverse spontaneously

Ataxia: Management

• Physical/Speech/Occupational therapy
• Devices to aid mobility when untreatable

Question 6

PD: Symptoms

Answer 6

PD: Symptoms

• Muscle tremor, slow movement, rigidity
  
  • “Freezing gait”
• Cognitive difficultiies (memory loss, depression)
• Loss of oflaction (smell)

Question 7

PD: Causes

Answer 7

PD: Cause

• Neuronal death in substantia nigra which have dopamine releasing axons to basal ganglia
• Genetics and environmental contributions

Question 8

PD: What are the 2 pathways of dysfunction? What does it mean for the pathways when there is no DA

Answer 8

1.) Direct

• Overall excitatory

2.) Indirect

• Overall inhibitory

No DA > Both pathways are inhibitied > Everything is dampaned (Inhibitory)

Question 9

What is freezing gait. Which disease is it related to and how does one avoid it?

Answer 9

Freezing gait in PD:

Involuntary inability to move at unpredictable times (e.g. suddenly stop walking)

Avoiding

• Marching: Stepping rhythamically
• Stepping over an imaginary line

One can cycle but cannot walk

Question 10

PD: Treatment

Answer 10

PD: Treatment

• Behavioural (Exercise)
• Dopamine Agonists and Mao-B inhibitors (inhibit dopaine breakdown)
• Deep Brain Stimulation (Advanced disease)

Question 11

Polio: Prevalance and Symptoms

Answer 11

Polio: Viral disease.

Asymptomatic in 90-95% (Common Cold); Symptomatic in 5-10%

Symptoms

• Symptomatic: Flu-like, full recovery
• Non-Paralytic (1%): Headache, pain, full recovery
• Paralytic (0.5%): Muscle paralysis, weakness, not all recover
• Post-polio syndrome (25-50% of all): Weakeness years after

Question 12

Polio: Causes. What is paralyptic polio

Answer 12

Polio

• Viral infection spread through faeces-mouth.
• Paralytic Polio
  
  • Virus attacks the spinal alpha motor neurons.

Question 13

Polio: Treatment

Answer 13

Treatment:

• None
  
  • Focus on prevention via vaccination (Booster vaccination recommended if travelling to active areas (Afghanistan, Pakistan, Nigeria))

Question 14

Myasthenia Gravis: Symptoms and Causes

Answer 14

Symptoms

• Muscle weakness and fatigue, usually starting with head muscles (often eyelids).

Cause

• Bodies own immune system creates antibodies that bind to Acetylcholine receptor.

Question 15

Myasthenia Gravis: Treatment

Answer 15

Treatment

• Immunosuppressant’s that slow antibody production.
• Acetycholinesterase inhibitors to increase the time that Ach is present in the neuromuscular junction.

Question 16

Anarchic hand (Alien hand syndrome). Definition and Cause

Answer 16

Definition

Rare disorder of involuntary, yet purposeful, hand movements.

Causes

• Anterior cerebral artery strokes, midline tumors, and neurodegenerative illnesses.

Question 17

What are the variants of Anarchic hand and what are the brain parts implicated?

Answer 17

Frontal variant:

• Groping movements. SMC, prefrontal cortex, corpus callosum involvement.

Posterior variant:

• Levitating hand, withdrawal. PPC, thalamic, occipital lobe damage.

Question 18

Tourette Syndrome: Symptoms and What are the simple and complex variants

Answer 18

Tics:

• Rapid, repetitive, “involuntary” muscle movements and vocalisations.
  
  • Commonly associated with OCD and ADHD

Simple

• Motor: eye blink, head jerk, nose twitch, shrugging.
• Vocal: grunts, sniffs, throat clearing, barking noise

Complex

• Motor: jumping, twirling, pulling at clothes
• Vocal: words or phrases, coprolalia, echoalia, palilalia

Question 19

Tourette Syndrome: Causes

Answer 19

Cause:

Unclear pathophysiology but

• Abnormal activity in the cortico-basal ganglia loops.
• Genetic involvement assumed

Question 20

Tourette Syndrome: Treatment

Answer 20

Treatment

• Mild: Nothing
• Comorbid conditions (ADHD, OCD, anxiety)
• Problematic: haloperidol, pimozide, deep brain stimulation.

Question 21

What are psychogenic movement disorders

Answer 21

Abnormal movements not attributable to an organic neurologic disorder.

• Considered to be psychologically mediated (conversion disorder)
• Many patients lack clear psychological distress and don’t believe there is a psychological cause of abnormality.
  
  • CBT can be useful.