Lecture 14 - CNS Motor D/o Flashcards Preview

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Flashcards in Lecture 14 - CNS Motor D/o Deck (21):
1

desccribe the pyramidal tract:
UMN --> LMN

UMN -- the Pyramidal Tract
Primary Motor Cortex -- Pre-central Gyrus
Corona Raidata ---> Internal capsule
Cross of at the Decussations of the Pyramids (medulla)
Continues through the Lateral corticospinal tract
Synapse with LMN in ventral horn

2

UMN vs LMN disorders:

UMN -- Increased tone, hyperreflexia, babinksi and clonus

LMN -- charactersitics feature: Fasciulations; hyporeflexia and tone; no clonus

3

Lesions along the Pyramidal Tract:
- what is the manifestations
- other associated findings

Paresis vs paralysis

Clasp Knife Spasticity; Myoclonus

4

What level is the divider between quadraparesis and paraparesis ?

what is the divider between contra lateral and ipsilateral hemiparesis

What term is used to describe pareparetic gait?

Above c5 - quadra
below cevical enlargement -- para

Contra -- above the decussation of the pyramids


Paraparetic gait = Scissoring (bilateral cirumduction)

5

Therapies for spastic paresis

what systems to these therapies target?

Baclofen and benzos -- enhance GABA mediated inhibition

Tizanidine -- Alpha 2 agonist

Botulinum Toxin

6

What is the Akinetic disorder of the BG?

Describe the pathway leading to this physiology?

PD

Loss of Dopaminergic Neurons of the SN
Increased Glutamine relesae from Subthalamic nucleus
Increased inhibitory release from Internal GP
Dereased Glutamine relesae from Motor Thalamus
Net decreased excitation of the Motor cortex
Bradykinesia

7

Common features of parkinson's disease

Bradykinesia, resting tremor, rigidity
begins unuilateral
NO VOICE TREMOR
small, but non tremulous handwriting

walking-->running pace
Freezing (hesitations)
En block turning
Shuffling giat

8

what else can cause parkinsonian symptoms

Drugs -- Dopamine antagonists (metoclopramide)
Strokes

Progressive supranuclear palsa
Coricobasilar degeneration
Multiple system atrophy

9

Treatments of PD

LevoDopa + Carbidopa (DA decarboxylase inhibitor)

Dopamine aognists -

Amantadine --

COMT Inhibitors -- block breakdown of dopamine
MAO-b Intibioor -- block reuptake of dopamine
DBS

10

Complications of treatment
Main side effect of DOPA

what is used to acute rescue therapy?

main side effect -- nausea

compications -- decreased responsiveness to levodopa

Paradoxical hypersensitivity -- leading to too much movement (think MJF)

11

What are the three hyperkinetic D/o of the BG?

Essential Tremor
Chorea
Dystonia

12

Essential Tremor
- what is it
how does it differ from PD?

Rhythmic osscilations of a body part

Occurs with maintenance of posture and movement (handwriting is tremulous)

Involves upper limbs, head and voice
Bilateral

Usually a FMHx

Improves with alcohol

13

Treatment of Essential tremor?

Propranolol

Primidone (barbiduate)

Botuliumum Toxin

DBS

14

Chorea

what is it?
what can cuase it?

Slow non ryhthmical movements
random, not sterotyped
DIstal worse than proxima
appears fidgety, twitchy

Causes: HD, Drugs Lupus

15

forms of chorea: atheosis and ballismus
what are they?

atheosis -- chorea + flowing

Ballismus -- extreme form of chorea; wild flinging

16

HD --
describe the genetics
where is the damage occur?

AD
Chromosome 4
CAG repeats
Anticipation
Neuron loss and gliosis of the striatum

17

Clincal features of HD

common cause of death for HD patients?

Chorea, dementia
Psychosis -- depression, SI
Dysphagia (die from aspiration pneumo)

18

Dystonia -- what is it?

what is focal dystonia?

Syndrome of sustained muscle contractions causing stereotyped twisting or turning movement or abnormal postures

FD: sustained sterotyped spasms of a localized area
Blephaarospams -- eye closure
Oromandiruabar - -mouth opening
Larnygeal -- Diane Rehm (over abduction)
task specific -- writer's cramp, muscians cramp

19

Treatment of dystonia

Botulinum Toxin

20

Symptoms of Cerebellar dysfunction

Incoordination
Dysmetria (FNF)
Dysdiadokinesia
Ataxis
Dysathria
Nystag

21

3 different cerebellar disease described in this lecture

Freidrich's ataxia -- degenerative; wide irregulary irregular gait; Dysmetria

Hereditary Cerebellar ataxia -- irreguarly sepacch, gait, dysmetria, disdiadokinesia

Sporadic Ocular Overshoot Dysmetria -- degenerative; patients overshoots saccades