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Med Neuro Block 3 > Cerebellar Disorders > Flashcards

Cerebellar Disorders Flashcards

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1
Q

Functions of the cerebellum:

A

To make movements of the extremities, trunk and eyes as smooth as possible by continually making small corrections.

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2
Q

How does the cerebellum achieve movements

A

Achieved through coordinated contraction/relaxation of agonist & antagonist muscles

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3
Q

Inputs to cerebellum come from which areas

A

sensory (proprioception) pathways from spinal cord, cortex, brainstem

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4
Q

How does motor information from cord get to cerebellum

A

–> ventral spino cerebellar tract —>superio rcerebellar peduncle–> cerebellum

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5
Q

Visual,sensory,motor information from cortex get to cerebellum how?

A

pontine nuclei–>middle cerebellar peduncle –>cerebellum

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6
Q

How does Proprioceptive information from limbs get to crebellum

A

–>fasiculus gracilis/cuneatus–> spinocerebellar tract and cuneo cerebellar tract –> interior cerebellar peduncle –>cerebellum

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7
Q

How does there cerebellum cause movement (the path)?

A

VL thalamus–> primary motor&supplementary motor cortex–> ventral&lateral corticospinal tract–> movement

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8
Q

Tract cerebellum takes to get head/eye control and posture

A

Cerebellum–> vestibular nuclei–> head/eye control&posture

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9
Q

how does cerebellum cause unconsious motor control?

A

Cerebellum –> medullary&pontine reticular formation–> medullary&pontine reticulospinal tract –>unconscious motor control

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10
Q

Deficits are_______ to the lesion due to ‘doublecrossing’ or because fibers remain ipsilateral

A

ipsilateral

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11
Q

Deficits are ipsilateral to the lesion due to _________or because fibers remain ipsilateral

A

‘doublecrossing’

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12
Q

Acute lesions to cerebellum are accompanied by

A

nausea/vomiting due to vertigo and ataxic on finger to nose or heel to shin

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13
Q

Cerebellar lesion symptoms resulting in nausea/vomiting can mimic what?

A

vestibular dysfunction… similar but

these pts are not necessarily ataxic on finger to nose or heel to shin

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14
Q

Ataxia =

A

uncoordinated muscle movement; errors in speed, range, force, timing

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15
Q

uncoordinated muscle movement; errors in speed, range, force, timing

A

Ataxia

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16
Q

Truncal ataxia =

A

wide-based, unsteady gait or difficulty sitting up; “drunklike”; localizes to lesion of
vermis

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17
Q

wide-based, unsteady gait or difficulty sitting up; “drunklike”; localizes to lesion of ______

A

vermis, this is truncal ataxia

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18
Q

Romberg test=

A

ask patient to stand in place, feet together and close eyes, if she or hee needs to step to stabilize, then deficit could be due cerebellar, proprioceptive, or vestibular
dysfunction; not specific to cerebellar disorders

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19
Q

Romber test is specific to cerebellar disorders

A

false

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20
Q

difficulty coordinating an extremity; manifests as dysmetria & dysrhythmia;
lesion of ipsilateral lateral hemispheres

A

Appendicular Ataxia

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21
Q

Appendicular Ataxia

A

difficulty coordinating an extremity; manifests as dysmetria & dysrhythmia;
lesion of ipsilateral lateral hemispheres

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22
Q

What are 6 signs of Appendicular Ataxia

A 
Dysmetria
Dysrhythmia
Finger-nose-finger test
heel-to-shin test
Finger tapping
Dysdiadochokinesia
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23
Q

overshoot/undershoot of a body part (limb) during movement toward a target

A

Dysmetria =

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24
Q

Dysmetria =

A

overshoot/undershoot of a body part (limb) during movement toward a target
–seen in appendicular ataxia

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25
Dysrhythmia =
abnormal rhythm and timing of movement | --for appendicular ataxia
26
abnormal rhythm and timing of movement
Dysrhythmia
27
Finger-nose-finger test—
alternating between touching nose and examiner’s finger; abnormal if patient’s finger shakes as it approaches target (either nose or finger) --for appendicular ataxia
28
Finger tapping—
watch amplitude, rhythm, speed; cerebellar disorders cause abnormal rhythm, slowed speed, and varying amplitude
29
During finger tapping... cerebellar disorders cause ______rhythm,______ speed, and______ amplitude
abnormal slowed varying
30
Dysdiadochokinesia =
abnormal speed/rhythm when tapping hand with | palm/dorsum alternatively
31
abnormal speed/rhythm when tapping hand with | palm/dorsum alternatively
Dysdiadochokinesia
32
involuntary, rhythmic oscillation of a body part
tremor
33
Postural tremor =
tremor that occurs when a limb is held in a particular position (eg. open hands held extended); lesion of ipsilateral lateral hemisphere
34
tremor that occurs when a limb is held in a particular position (eg. open hands held extended); lesion of ipsilateral lateral hemisphere
Postural tremor
35
Action/intention tremor =
tremor that occurs when limb is in motion; lesion of ipsilateral lateral hemisphere
36
tremor that occurs when limb is in motion; lesion of ipsilateral lateral hemisphere
Action/intention tremor
37
Action/intention tremor occurs when limb is in motion; lesion is on _______ side
ispliateral hemisphre
38
Titubation =
tremor of trunk or head; lesion of vermis
39
Lesion in the vermis results in
titubation
40
Ocular dysmetria =
overshoot or undershoot of the eyes as patient focuses on a target; lesion of flocculonodular lobe (part of lateral hemispheres)
41
overshoot or undershoot of the eyes as patient focuses on a target; lesion of flocculonodular lobe (part of lateral hemispheres)
Ocular Dysmetria
42
Lesion of flocculonodular lobe results in
Ocular dysmetria--overshoot or undershoot of patient focusing on target
43
Flocculonodular lobe is in which part of hemisphere
lateral
44
Saccades =
quick, voluntary movement of eyes onto target; mediated by cortex—frontal & parietal eye fields
45
quick, voluntary movement of eyes onto target; mediated by cortex—frontal & parietal eye fields
Saccades
46
Slow eye movements =
involuntary movement of eyes mediated by cerebellum, vestibular nuclei & pathways, and extraocular motor nuclei
47
involuntary movement of eyes mediated by cerebellum, vestibular nuclei & pathways, and extraocular motor nuclei
Slow eye movements
48
Nystagmus =
rhythmic oscillations of the eyes; mediated by cortex; is an attempt by the cortex to correct abnormal signal to brain b/c of deficit of slow eye movements
49
mediated by cortex; is an attempt by the cortex to correct abnormal signal to brain b/c of deficit of slow eye movements
Nystagmus
50
Named after fast-beating phase of eye movements; eg. “right beating nystagmus”—fast phase of eye movements are to the______ & slow phase of eye movements to ____
right | left
51
Nystagmus is due to
Due to a deficit of the slow eye movement system
52
If nystagmus is acute in onset, can be accompanied by
vertigo, nausea, vomiting
53
Lesion of ________ can cause vertical, horizontal, or rotatory nystagmus
vermis/flocculonodular lobe
54
Pure vertical nystagmus
ALWAYS caused by CNS lesion (ie brainstem or cerebellar injury) direction-changing nystagmus in central
55
A horxontal or rotary nystagmus could be causes by:
a central or peripheral nervous system lesion
56
R beating horizontal nystagmus on R gaze, upgaze, downgaze -->
L VOR or L vestibular nuclear lesion (lesion could be central or peripheral with horizontal nystagmus)
57
R beating horizontal nystagmus on R gaze, L beating horizontal nystagmus on left gaze, verticle nystagmus on upgaze-->
likely to be cerebellum or one of it's pathways
58
Slow saccades =
slowness in eye movements when trying to quickly look at target
59
Scanning (or ataxic) speech =
slow, effortful speech with difficulty articulating; lesion of lateral hemispheres
60
slow, effortful speech with difficulty articulating; lesion of lateral hemispheres
Scanning (or ataxic) speech
61
Hypotonia of ipsilateral limb results in
b/c cerebellum influences corticospinal tracts; pt falls to weak side (ipsilateral to lesion)
62
Lateral hemispheres of cerebellar are in charge of
motor planning for extremities
63
Motor pathway lateral hemisferes influence
LCST
64
If Lateral hemispheres are lesioned we see
Appendicular ataxia
65
Intermediate hemisphere is in charge of
distal limb coordination
66
Motor pathway intermediate hemisphere influences
LCST, rubrospinal tract
67
Lesion in intermediate hemisphere results in
Appendicular ataxia
68
Region of the cerebellum responsible for proximal limb
Vermis
69
trunk coordination and balace and vestibuloocular reflexes
Floculonodular lobe
70
Vermis influences which motor pathway
VCST, reticulospinal tract, vestibulospinal tract
71
Flocculonodular lobe influences which motor pathway
Medial longitudinal fasciculus
72
If the vermis is lesioned we see
truncal ataxia
73
If the flocculonodular lobe is lesioned we see
Nystagmus/slow saccades
74
Differential diagnosis for cerebellar dysfunction: vestibular dysnfunction
Vestibular dysfunction (also causes vertigo, difficulty walking, N/V, nystagmus); but usually no dysmetria or ataxia on finger to nose or heel to shin
75
Differential diagnosis for cerebellar dysfunction: corticospinal tract dysfunction
Corticospinal tract dysfunction—also causes hypotonia & weakness can be mistaken for ataxia
76
Differential diagnosis for cerebellar dysfunction: impaired proprioception
Impaired proprioception—these pts have a sensory ataxia (proprioceptive loss in feet makes walking difficult)
77
Clinical deduction for cerebellar disorders:
• Determine if process is acute (ie. occurred over minutes to hours) or chronic (slowly over many days to weeks) • Localize lesion
78
``` Cerebellar stroke (ischemic or hemorrhagic) Alcohol intoxication Drug overdose (eg. phenytoin) Multiple sclerosis ....examples of ```
Acute
79
Essential tremor Spinocerebellar ataxia Tumor (eg. astrocytoma) Chronic alcoholism
Chronic
80
Pathogenesis of cerebellar stroke
the main arteries supplying blood (SCA, PICA, AICA) become diseased due to atherosclerosis; more commonly, the penetrating arteries from these arteries undergo arteriolosclerosis (thickening of vessels) from chronic HTN & other vascular risk factors (diabetes, smoking, high cholesterol)--> blood flow compromised --> ischemic stroke; or severe spike in blood pressure causes brittle vessel to rupturehemorrhagic stroke
81
Symptoms and onset of cerebellar stoke can be:
acute or sudden; may be felt right away and improve over weeks
82
Symtpoms of cerebellar stroke
inability to walk, frequent falls, nausea, vomit, vertigo
83
Signs of cerebellar stroke
dysmetria of ipsilateral arm/leg on finger-to-nose and heel-to-shin, mild ipsilateral dysdiadochokinesia,mild dysarthria, horizontal and verticle nystagmus
84
dysmetria of ipsilateral arm/leg on finger-to-nose and heel-to-shin, mild ipsilateral dysdiadochokinesia,mild dysarthria, horizontal and verticle nystagmus
signs of cerebellar stroke
85
Localization of cerebellar stroke
ips cerebellar hemisphere (lateral and flocculonodular lobes) and vermis
86
What risks do we look for cerebellar stoke?
HTN, smoking, diabetes, high cholesterol
87
One of the most common causes of ataxia
Alchohol intoxication
88
What are the acute symptoms of alcohol ataxia
inability to walk with frequent falls, no ‘checking’ of loss of balance, slurred speech; caused by cerebellar neuronal dysfunction
89
Chronic symptoms of alcohol intoxication
: ataxia with walking/maintaining balance, difficulty with finger dexterity; caused by Purkinje cell destruction & subsequent atrophy of vermis
90
Signs of alcohol ataxia
difficulty walking/tandem gait, dysarthria, dysmetria of limbs, nystagmus
91
what is the localization of alcohol intoxication
cerebellar vermis
92
The most common movement disorder
essential tumor
93
Essential tumor characteristics - characteristic of tremor - genetic pattern - ect
Usually symmetric, bilateral, postural or action tremor that is persistent & visible; no other cause found; autosomal dominant in 50% of patients; involves arms/hands, voice, head; chronic neurodegenerative disorder; gradual loss of Purkinje cells
94
Signs of essential tumor
dysmetria, ataxic gait, head titubation
95
Localization of essential tumor
cerebellar hemispheres & vermis
96
Spinocerebellar ataxia is a group of ________ disorders caused by ___________ and _________
Group of autosomal dominant ataxic disorders caused by degeneration of afferent & efferent cerebellar pathways & destruction of Purkinje cells
97
Spinocerebellar ataxia is caused by a gene mutation which is:
each caused by a gene mutation resulting in a CAG triplet repeat expansion at different genetic loci
98
What symptoms do we see with spinocerebellar ataxia | -3 qualities
Slowly progressive ataxia of limbs/trunk, scanning speech, slowed saccades
99
Most cause profound cerebellar atrophy
Spinocerebellar ataxia
100
Higher morbidity & mortality than essential tremor
spinocerebellar ataxia
101
Localization of essential tumor
entire cerebellum
102
Most common childhood primary brain tumor
Astrocytoma
103
Astrocytoma is a low grade tumor comprised of ________
A low grade tumor composed of astrocytes (a type of glial cell & hemce a glioma)
104
Localization: tumor usually grows in
cerebellar hemisphere
105
Slowly progressive ipsilateral limb/truncal ataxia, scanning speech, nystagmus due to tumor compressing on adjacent cerebellar parenchyma
Astrocytoma
106
Astrocytoma is slowly progressive _______ limb/truk ataxia
ipsilateral
107
nystagmus due to astrocytoma tumor | compressing on
adjacent cerebellar parenchyma
108
An astrocytoma show signs of increased intracranial pressure which cause:
—morning headaches, blurred vision, | may culminate in nausea/vomiting, difficulty concentrating in school
109
An autoimmune/inflammatory disorder affecting CNS white matter
Mutliple sclerosis
110
MS is more common in ____________ and each lesion is reffered to as _________
Predilection for young (25-40’s), white females • Each lesion is referred to as a ‘plaque’
111
``` In MS affects on: optic nerves Cerebral white matter regions Cerebellar white matter Medial longitudinal fasciculus spinal cord ```
Optic nerves--sudden vision loss cerebral white matter--all descending/ascending cortex cerebrellar white matter--especially middle cerebellar peduncle Medial long fasciculus--white matter that mediates eye movements and if lesioned causes internucuer opthalmoplegia
112
How does MS affect the spinal cord
resluts in complete or incomplete spinal cord lesion in transverse section affecting ascending/descending tracts--called transverse myelitis

Med Neuro Block 3 (9 decks)

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