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S4- Neuro 1 > Week 6- Cerebellar Dysfunction > Flashcards

Week 6- Cerebellar Dysfunction Flashcards

1
Q

PART 1: CEREBELLAR ANATOMY REVIEW

A

PART 1: CEREBELLAR ANATOMY REVIEW

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2
Q

What are the many roles of the cerebellum?

A
  • Coordination (limb, trunk, oculomotor)
  • Balance
  • Muscle Tone
  • VOR Suppression
  • Motor Control
  • Motor Learning
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3
Q

How is the cerebellum thought to be involved with motor control?

A

Facilitating movements by detecting errors in real-time and correcting them.

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4
Q

How is the cerebellum thought to be involved with motor learning?

A

Reduce errors in movement that will occur in the future by pulling from what it has learned from our movement patterns and what it has learned in the past.

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5
Q

Cerebellum sits on our hindbrain, under our cerebrum, and is nestled behind the ___________.

A

brainstem

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6
Q

The cerebellum connects to the brainstem through the cerebellar ____________.

A

peduncles (3)

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7
Q

The cerebellum makes up about 10% of total volume of our brain but contains __-__% of our brains neurons.

A

-50-80%

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8
Q

What 3 arteries supply the cerebellum?

A
  • SCA
  • AICA
  • PICA
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9
Q

The cerebellum has 2 hemispheres jointed by a midline called the ________.

A

vermis

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10
Q

The first way we describe cerebellar anatomy is by the lobes. What are the 3 lobes called?

A
  • Anterior
  • Posterior
  • Flocculonodular
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11
Q

Anterior and posterior lobes are separated by the __________ fissure.

A

primary fissure

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12
Q

What is the other way we describe cerebellar anatomy? There are also 3.

A
  • Cerebrocerebellum
  • Spinocerebellum
  • Vestibulocerebellum
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13
Q
  • Cerebrocerebellum = ____________
  • Spinocerebellum = ____________
  • Vestibulocerebellum = ____________
A
  • lateral
  • medial (contains vermis and perimedian zone)
  • flocculonodular lobe (one in the same)
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14
Q
  • The cerebrocerebellum talks to the ________ _______ and is involved with ________ extremities.
  • The spinocerebellum talks to the _______ _____ and is involved in trunk, EOMs, and _________ muscles.
  • The vestibulocerebellum talks to the _______ _________ and ________ and is involved in VOR and _________/________.
A
  • cerebral cortex, distal
  • spinal cord, proximal
  • vestibular apparatus and system, equilibrium/balance
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15
Q

Does the cerebellum have its own homunculus?

A

Yes

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16
Q

What are the major nuclei located in the medulla and pons for afferent and efferent cerebellar tracts.

A
  • Vestibular Nuclei
  • Deep Pontine Nuclei
  • Red Nuclei
  • Superior and Inferior Olivary Nuclei
  • Reticular Formation
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17
Q

PART 2: CEREBELLA IMPAIRMENTS 1

A

PART 2: CEREBELLA IMPAIRMENTS 1

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18
Q
  • The functional role of the cerebellum in movement and motor control is not the generation of movement but the _______ and _____ ________ of movement.
  • Therefore cerebellar damage does not cause a loss in movement but rather leads to ___________ movement.
A
  • shaping and fine tuning

- uncoordinated (increased variability, poor accuracy, decreased speed)

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19
Q

________ is the primary sign often associated with the cerebellum.

A

Ataxia (uncoordinated or disordered movement)

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20
Q

What are the 3 types of ataxia commonly seen?

A
  • Truncal
  • Appendicular (Limb)
  • Gait
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21
Q

Truncal ataxia:

  • Associated with _____cerebellar damage.
  • Oscillations occur in sitting and standing (more pronounced in ________)
  • Falling/LOB often occurs ________ side of lesion
A
  • Spinocerebellar
  • sitting
  • towards
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22
Q

Appendicular (Limb) Ataxia:

  • Associated with _____cerebellar damage.
  • Tends to be more noticeable in _____/_______.
  • Associated with _________.
A
  • Cerebrocellebar
  • arms/hands
  • tremors
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23
Q

Gait Ataxia:

  • Associated with a ________ of cerebellar impairments.
  • “Drunken Gait” presents as a lack of ______/______/______ of steps typical of healthy adults. They have a ________ BOS with their arms in low/medium/high ______ positions.
  • Leads to significant _______ difficulties.
  • Falls are common (most common _______ and/or ________ side of lesion).
A
  • variety
  • timing/length/direction, widened, guard
  • balance
  • backwards and/or towards side of lesion
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24
Q
  • _________ is the inability to properly scale movement distance.
  • What is the mechanism?
A
  • Dysmetria
  • Inability to account for interaction torques → impaired ability to predict and account for dynamics of limbs as they interact
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25
Q

Dysmetria:

  • Is it seen in proximal or distal joints?
  • Does it involve single or multi-joint movements?
  • What is the difference between hypometria and hypermetria?
A
  • both
  • both
  • Hypometria is undershooting (also slow movements), hypermetria is overshooting (also fast movements).
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26
Q
  • What are some UE techniques to examine for dysmetria?

- What are some LE techniques to examine for dysmetria?

A
  • UE = finger to nose, finger to finger

- LE = heel-to-shin, ankle circles/alphabet

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27
Q
  • _________ is an impairment of multi-joint movements leading to decompensation of movement. This results in a loss of proper sequencing and MOVEMENTS BECOME FRAGMENTED.
  • It is closely associated with ________ and commonly compensated with massed pattern of movements.
A
  • Dyssynergia

- Dysmetria

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28
Q

_________ is a complete loss of ability to associate movements for complex movements.

A

Asynergia

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29
Q

What different tests are done to identify dyssynergia vs dysmetria?

A

Nothing, the same tests are performed for both.

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30
Q
  • ________________ is a deficit in coordination between agonist-antagonist muscle pairs elicited during voluntary rapid alternating movements.
  • Specifically it appears to be caused by poor regulation of cessation of __________ when we want to initiate _________.
  • Manifests as rigid movements, compensatory __________ of limbs.
  • Can it impact speech and swallowing?
A
  • Dysdiadochokinesia
  • agonists, antagonists
  • bradykinesia
  • Yes (dysarthria, dysphagia)
31
Q

What are some tests to do for dysdiadochokinesia?

A
  • supination/pronation

- toe tapping

32
Q

PART 3: CEREBELLAR IMPAIRMENTS 2

A

PART 3: CEREBELLAR IMPAIRMENTS 2

33
Q

Our cerebellum descending drive is the polar opposite of the cortex in that it helps keep tone _____. Therefore, if we lose the cerebellum’s descending drive, what happens?

A

Up, we will see hypotonia.

34
Q

The majority of the descending drive that comes from the cerebellum stems from the ______cerebellum in the ________ lobe.

A

spinocerebellum in the anterior lobe

35
Q

Hypotonia:

  • In particular, decreased _________ tone necessary for holding body upright against gravity. (can see effects in limbs, EOMs, speech muscles)
  • Typically more problematic in more ________ cerebellar lesions or in the acute stages of cerebellar injury only.
  • Usually ______ resolve with time, fortunately for most does not cause big functional impacts.
A
  • extensor
  • severe
  • will
36
Q

Cerebellar hypotonia generally causes dysfunction with what?

A

posture and balance

37
Q

Tremor:

  • Due to insufficient ability to anticipate the effects of movement and excessive reliance on ________ feedback loops.
  • Typically an ________ tremor.
A
  • sensory

- action (not seen at rest)

38
Q

How do we tell dysmetria from cerebellar tremor?

A

Dysmetria is much more random while cerebellar tremors are small oscillatory and are predictable.

39
Q

Imbalance due to cerebellar lesions can present in what ways?

A
  • Postural instability (static and dynamic)
  • Midline disorientation
  • Variability seen with visual stabilization’s influence on balance with cerebellar damage
40
Q

Imbalance (Postural Instability):

  • ________ postural sway
  • impaired postural responses to _________ (inc/dec)
  • _________, which is abnormal oscillations of head/neck.
  • ___________
A
  • increased
  • perturbations
  • titubation
  • disequilibrium
41
Q

With midline disorientation due to cerebellar lesions, they will have lateral pulsion ________ side of lesion.

A

towards

42
Q

-What oculomotor deficits can be seen with cerebellar lesions?

A
  • Impaired smooth pursuit
  • Impaired saccades
  • Nystagmus may be present (most common: gaze evoked)
  • Loss of VOR suppression
43
Q
  • Which oculomotor deficits are associated with the spinocerebellar region?
  • Which oculomotor deficits are associated with the vestibulocerebellar region?
A
  • Impaired smooth pursuit
  • Impaired saccades

-Nystagmus (gaze evoked)

44
Q
  • _________ is a vestibular impairment.

- What is gaze-evoked nystagmus?

A
  • Nystagmus

- holding specific directions causes nystagmus

45
Q
  • What speech deficit can be seen with cerebellar impairments?
  • What is it?
A 
Ataxic dysarthria (have to focus hard to get from word to word)
-Impaired articulation, impaired prosody, slowed speech, volume variability, staccato voice.
46
Q

How do cerebellum impairments impact motor control?

A
  • Loss of real-time integration of feedback from peripheral systems. (anticipated movement vs. actual movement)
  • Delayed or absent adjustments to inaccurate motor programs.
47
Q

What types of learning is the cerebellum associated with?

A
  • Associative

- Procedural

48
Q

The cerebellum is essential for learning to adjust motor behavior through __________ _________.

A

repeated practice (don’t have to hold rails on subway when used to it vs. new rider who constantly loses balance)

49
Q

How do cerebellum impairments impact motor control?

A
  • Impaired ability to store adapted movement patterns after repeated exposure.
  • Impaired automatic processes involved with rapidly adjusting movements for new, predictable demands. (becomes inefficient and difficult, high cog load)
50
Q

PART 4: CEREBELLAR PATHOLOGY, OUTCOMES

A

PART 4: CEREBELLAR PATHOLOGY, OUTCOMES

51
Q

Possible Causes of Cerebellar Dysfunction:

A

1

52
Q

Variability in Rate and Progression:

  • CVA, brain lesions = _____/______ onset
  • Infarction, immune-mediated disorders = ______ progression (hours to days)
  • Paraneoplastic disorders, encephalopathy, vitamin deficiency states, general medical conditions = ________ progression (weeks to months)
  • Genetic ataxias, toxins (alcohol) = ________ (months to years
A
  • acute/abrupt
  • rapid progression
  • slower progression
  • chronic
53
Q

What is the first line of diagnosis for cerebellar dysfunction?

A

Brain and brainstem MRI

54
Q

Chronic alcohol use leads to a deficiency in ________ (vitamin B1).

A

thiamine

55
Q

_________-________ Syndrome is a syndrome commonly found with chronic alcohol abuse that also involves a lot of cerebellar dysfunction.

A

Wernicke-Korsakoff Syndrome

56
Q

How does Korsakoff Syndrome present?

A
  • Severe impairments in immediate recall
  • Anterograde or retrograde amnesia
  • Disorientation
  • Emotional changes
  • Confabulation
57
Q

What is confabulation?

A

Type of memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information.

58
Q

How does Wernicke’s Encephalitis present?

A
  • Confusion
  • Ataxia
  • Opthalmoplegia
  • Aniscoria
  • Nystagmus
59
Q
  • What is opthalmoplegia?

- What is aniscoria?

A
  • Paralysis or weakness of the eye muscles.

- Asymmetrical pupil size.

60
Q

Alcoholic ataxia presents like cerebellar ataxia, what is the difference?

A

Tends to be a lot more pronounced.

61
Q

What are the S/Sx of alcoholic ataxia?

A
  • Wide-footed, unsteady gait
  • Dysarthria
  • Clumsiness of their hands
  • Diplopia, saccades
  • PERIPHERAL NEUROPATHY
62
Q
  • _______ _________ is a congenital condition in which structural abnormalities lead to herniation of cerebellum through foramen magnum, compressing involved structures.
  • How many types are there?
A
  • Chiari Malformation

- 3

63
Q

Chiari Malformation:

  • Type 1 = symptoms appear in ___________/__________.
  • Type 2 = symptoms appear in __________, more severe than Type I
  • Type 3 = rare, most severe, seen in __________.
A
  • adolescence or adulthood
  • childhood
  • babies
64
Q

What are the symptoms of chiari malformation?

A
  • CAN BE ASYMPTOMATIC!
  • Neck pain
  • Occipital HA
  • Hearing/balance problems
  • Dizziness
  • Vomiting
  • Tinnitus
  • Incoordination
65
Q
  • Treatment for asymptomatic chiara = __________

- Treatment for symptomatic chiara = __________

A
  • monitor

- surgery

66
Q

Do people with chiari malformation tend to do well after surgery?

A

Yes, unless they went a little too long with the compression.

67
Q

What are 2 types of hereditary ataxia?

A
  • Friedreich’s Ataxia

- Spinocerebellar Ataxia

68
Q

Friedreich’s Ataxia:

  • Degeneration of _______ and ________ nerves, cerebellum.
  • When do symptoms onset?
  • Signs and symptoms are __________ in nature.
  • Cerebellar symptoms: Imbalance, incoordination, dysarthria, dysphagia, weakness
  • Non-Cerebellar symptoms: scoliosis, visual or hearing loss, hypertrophic cardiomyophaty
  • Prognosis: mortality between 40s-60s.
A
  • spinal and peripheral
  • childhood, late mid-twenties
  • progressive
  • 40s-60s
69
Q

Spinocerebellar Ataxia:

  • Degeneration of ________ and ________ nerves, cerebellum.
  • Over 50 types of genetically identified SCA’s (most common: Type 1)
  • Onset anywhere between childhood in adulthood
  • Signs and symptoms are ____________ in nature, highly variable.
  • Cerebellar symptoms + spasticity, muscle atrophy, peripheral neuropathy and memory loss
  • Prognosis: unknown/variable
A
  • spinal and peripheral

- progressive

70
Q

Which hereditary ataxia has non-cerebellar symptoms?

A

Friedreich’s Ataxia

71
Q
  • What is the SARA?
  • It is an 8-item performance scale graded from 0-40 with ____ being the most severe ataxia.
  • What 8 items are evaluated?
  • Does not take _________ function into consideration?
A

Scale for Assessment and Rating of Ataxia

  • 40
  • Evaluates gait, standing, sitting, speech, finger-to-finger, nose-to-finger, RAMs, heel-to-shin
  • oculomotor
72
Q
  • How do cerebellar symptoms respond to pharmaceutical management?
  • What may be used?
A

Not well, limited options with variable success.

-vitamin E, Coenzyme Q10

73
Q

Physical Therapy Management:

  • Extent of recovery variable – but patients with cerebellar dysfunction tend to respond to PT __________!
  • May depend on location of damage within cerebellum (Deep nuclear involvement _______ prognosis for recovery compared to cerebellar cortex).
  • If nearby _________ involved in injury, patients will likely have more significant and lingering deficits.
  • Cerebellar CVAs tend to have _________ prognosis.
A
  • positively
  • poorer
  • brainstem
  • excellent

S4- Neuro 1 (12 decks)

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