Gait, Cerebellar Function, and Movement Disorders Flashcards Preview

Neurology Clerkship > Gait, Cerebellar Function, and Movement Disorders > Flashcards

Flashcards in Gait, Cerebellar Function, and Movement Disorders Deck (44)
Loading flashcards...
1
Q

List the essentials for normal walking.

A
  1. Strength in the lower limbs and trunk (UMNs, LMNs, NMJs, muscles)
  2. Coordination and postural control (cerebellar and extrapyramidal systems)
  3. Intact sensation (especially proprioception)
  4. Memory/concept of walking (gait apraxia)
2
Q

What does the Romberg sign indicate?

A

Impaired proprioception (posterior or dorsal column pathways or their afferent sensory nerves)

3
Q

Causes of broad-based gait ataxia?

A

Lesions of the posterior columns or proprioceptive sensory nerves (worse with eyes closed) or cerebellar dysfunction (always present)

4
Q

Appearance and cause of hemiplegic gait?

A

Affected lower limb is stiffly extended and swung or circumducted when walking while the ipsilateral upper limb is flexed at the elbow and wrist with decreased arm swing; stroke

5
Q

Appearance and cause of tabetic gait?

A

Foot slapping characteristics (compensating for impaired sensation in the feet by forcibly planting the feet down to feel the floor); tabes dorsalis from neurosyphilis

6
Q

Appearance and cause of steppage gait?

A

Foot drop or weak dorsiflexion of the foot; to prevent tripping over the toes when walking, the hip is flexed or pulled up even higher to elevate the drooping foot, which is then lowered to the floor toe first

Unilateral foot drop - lesion of peroneal nerve or L5 nerve root

Bilateral foot drop - severe polyneuropathy, motor neuron disease, bilateral L5 root lesions

7
Q

Appearance and cause of duck waddle/waddling gait?

A

Patient leans or bends the trunk to the left as the right foot is raised and vice versa, alternately tilting the pelvis and hips side to side like a walking duck

Weakness of the hip girdle muscles, usually seen in muscle disease (myopathy)

8
Q

Appearance and cause of scissors gait?

A

Advancing leg or foot tends to cross over the opposite lower limb

UMN (CST) lesion -> spasticity in the lower limbs, including the adductor muscles of the thighs

9
Q

Appearance of parkinsonian gait?

A

Slow and shuffling with decreased armswing and bent over posture; may exhibit festination

10
Q

Tests of cerebellar function?

A

Finger-nose-finger
Heel-shin-knee
Rapid alternating movements

11
Q

What is dysmetria?

A

Overshooting or undershooting of the target by the hand or foot in cerebellar testing

12
Q

What is dysdiadochokinesia?

A

Uncoordinated, non-rhythmic sloppy hand movements in rapid alternating movement testing

13
Q

What is a rebound phenomenon?

A

Cerebellar deficits in upper limbs create an imbalance between agonist and antagonist muscles - patient contracts biceps muscle against the examiner’s efforts. If the examiner suddenly lets go, normally the patient’s triceps reflexively contract to stop the unopposed elbow flexion. If there is cerebellar disease, the persisting elbow flexion may cause the patient to stroke his or her chest or face.

14
Q

What is cerebellar dysarthria?

A

Slurred speech associated with involvement of the left cerebellar hemisphere; speech is less distinct, “thick,” erratic, jerky, or explosive; syllables are broken down or hyphenated with non-rhythmic or unequal emphasis or force

15
Q

What type of eye movements can occur in cerebellar disease?

A

Multidirectional nystagmus (may also occur with lesions of othe vestibular system and brain stem)

16
Q

Presentation of cerebellar hemisphere lesion?

A

Affects ipsilateral limbs causing kinetic tremor, limb dysmetria, dysdiadochokinesia, and rebound phenomenon

17
Q

Causes of unilateral cerebellar hemispheral lesions?

A

Ischemic infarction, hemorrhage, tumor, MS

18
Q

Causes of bilateral cerebellar hemisphere lesions?

A

Degenerative or toxic diseases

19
Q

Presentation of a cerebellar lesion in the vermis?

A

Truncal unsteadiness while standing or walking, with impaired balance and gait ataxia

20
Q

Causes of cerebellar vermis lesions?

A

HHemorrhage, tumor, MS, degenerative or toxic disorders (alcohol in particular)

21
Q

What is the most common spinocerebellar degeneration or ataxia?

A

Friedreich’s ataxia

22
Q

Presentation of Friedreich’s ataxia?

A

AR disorder
Begins in school-age children and gradually worsens
Spinocerebellar tract lesions (patchy loss of cerebellar Purkinje cells) -> limb dysmetria, gait ataxia, and dysarthria
CST lesions -> weakness and Babinski signs
Dorsal root ganglia/dorsal or posterio columns -> loss of vibration, position sense, and absent reflexes in the lower limbs
Other features: scoliosis, pes cavus, cardiac hypertrophy, potentially fatal cardiac arrhythmias

23
Q

Diagnose Friedrich’s ataxia?

A

Blood test revealing multiple trinucleotide repeats from a defect in chromosome 9

24
Q

What are hyperkinesias?

A

Spontaneous, involuntary movements with characteristic clinical features

25
Q

What is a tremor?

A

Spontaneous, rhythmic, oscillatory movement of hands, limbs, head, or voice

26
Q

A resting tremor is typical of ___.

A

Parkinson’s disease

27
Q

What is a postural tremor?

A

More obvious tremor when the limbs are maintained in various positions, such as holding an object or extending an arm or leg

28
Q

What is a kinetic tremor?

A

Primarily occurs in a limb moving towards a target or performing a task

29
Q

Postural and kinetic tremor without other neurological signs or symptoms is often due to ___.

A

Familial essential tremor

30
Q

Kinetic tremor may be caused by ___.

A

Cerebellar disease

31
Q

What is athetosis?

A

Slow, writhing, fairly continuous movements of the distal limbs

32
Q

What is chorea?

A

Purposeless, random, non-rhythmic movements of the limbs, face, neck, and trunk

33
Q

Cause of choreoathetosis?

A

Lesions in the caudate nucleus or its connecting pathways (eg, Huntington’s disease)

34
Q

What is hemiballismus?

A

Rapid, violent, flinging movements of the proximal limbs on one side

35
Q

Cause of hemiballismus?

A

Lesion in the contralateral subthalamic nucleus (usually an ischemic infarction)

36
Q

What is dystonia?

A

Continual, sustained, often painful contraction of muscles leading to spasms, turning, and twisting of the limbs, neck, head, or trunk into unnatural positions or fairly fixed postures

37
Q

What are tics?

A

Stereotyped, often repetitive, focal muscle contractions that appear semipurposeful, such as an eyeblink, facial twitch, or sniff

38
Q

What are two movement disorders which accompany encephalopathy?

A

Myoclonus and asterixis

39
Q

What is myoclonus and what causes it?

A

Rapid, shocklike, lightning movements or jerks of the limbs and trunk, which is usually bilateral but asynchronous and irregular

May be seen in Cretzfeldt-Jakob

40
Q

What is asterixis?

A

Semirhythmic loss of postural control of hands and feet, so that the extended hands or feet appear to have a “flapping tremor”

If unilateral - structural brain disease such as ischemic infarction

41
Q

Rx resting tremor of Parkinson’s disease?

A

Anticholinergics (if isolated or predominant)
Levodopa and dopamine agonists if other parkinsonian symptoms

Severe cases - deep brain stimulation to the sub-thalamus

42
Q

Rx essential tremor?

A

Beta-adrenergic blocker drugs; barbiturates

Severe cases - deep brain stimulation to the thalamus

43
Q

Rx choreoathetosis, hemiballismus, tics

A

Dopamine antagonists

44
Q

Rx dystonia?

A

Anticholinergics, benzos, botulinum toxin injections