Flashcards in Lecture 14 - CNS Motor D/o Deck (21):
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
UMN vs LMN disorders:
UMN -- Increased tone, hyperreflexia, babinksi and clonus
LMN -- charactersitics feature: Fasciulations; hyporeflexia and tone; no clonus
Lesions along the Pyramidal Tract:
- what is the manifestations
- other associated findings
Paresis vs paralysis
Clasp Knife Spasticity; Myoclonus
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)
Therapies for spastic paresis
what systems to these therapies target?
Baclofen and benzos -- enhance GABA mediated inhibition
Tizanidine -- Alpha 2 agonist
What is the Akinetic disorder of the BG?
Describe the pathway leading to this physiology?
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
Common features of parkinson's disease
Bradykinesia, resting tremor, rigidity
NO VOICE TREMOR
small, but non tremulous handwriting
En block turning
what else can cause parkinsonian symptoms
Drugs -- Dopamine antagonists (metoclopramide)
Progressive supranuclear palsa
Multiple system atrophy
Treatments of PD
LevoDopa + Carbidopa (DA decarboxylase inhibitor)
Dopamine aognists -
COMT Inhibitors -- block breakdown of dopamine
MAO-b Intibioor -- block reuptake of dopamine
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)
What are the three hyperkinetic D/o of the BG?
- 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
Usually a FMHx
Improves with alcohol
Treatment of Essential tremor?
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
forms of chorea: atheosis and ballismus
what are they?
atheosis -- chorea + flowing
Ballismus -- extreme form of chorea; wild flinging
describe the genetics
where is the damage occur?
Neuron loss and gliosis of the striatum
Clincal features of HD
common cause of death for HD patients?
Psychosis -- depression, SI
Dysphagia (die from aspiration pneumo)
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
Treatment of dystonia
Symptoms of Cerebellar dysfunction