Motor System Flashcards
(51 cards)
Sensory disturbances of the hand
- The carpal tunnel syndrome causes painful aches and needles which wake the patient at night and are relieved by movement or a change in position.
- Cervical spondylosis causes a feeling of ordinary pain or just numbness in the appropriate root distribution. The patient usually points to the back of the hand but may have little or no pain in the neck.
- Ulnar nerve lesion also causes numbness or loss of feeling.
Twelve cranial nerves
Olfactory Optic Occulomotor Trochlear Trigerminal Abducens Facial Vastibulococchlear Glossopharyngeal Accessory Hypoglossia
Lower motor dermatomes
Hip flexion: Iliopsoas L1,L2
Plantar flexion: Gastronemicus, S1
Hip extension: Glutei L4,L5
Dorsiflexion: anterior tibialis muscle L4,L5
Hip adductors: adductors in the muscle, L2-L4
Knee flexion: hamstrings L3,L4
Knee extension: quadricepsL5,S1
Inversion: anterior and posterior tibialis muscle, L4
Eversion: Peronei muscle, S1
Extension of the great toe: extensor hallucis longus, L5
Hyposmia or Amos Mia ( loss of sense of smell )
- upper respiratory infection
- sinus disease
- damage to olfactory filaments after head injury or trauma
- smoking
- old age
- tumors of ethmoid bone
- Parkinson’s dx
- Alzheimer’s dx
- Harrington’s dx
- kartegener’s syndrome
- local compression of olfactory nerves
Hyposmia or Amos Mia ( loss of sense of smell )
- upper respiratory infection
- sinus disease
- damage to olfactory filaments after head injury or trauma
- smoking
- old age
- tumors of ethmoid bone
- Parkinson’s dx
- Alzheimer’s dx
- Harrington’s dx
- kartegener’s syndrome
- local compression of olfactory nerves
DDx of anosmia
- upper respiratory infections
- covid 19
- tumor on the ethmoid bone
- head trauma
- smoking
- old age
- Parkinson’s disease
- Huntington’s disease
- kartenger’s disease
DDx of unilateral anosmia
- subfrontal meningioma
- mucous blocked nostril
DDx of ptosis
- cranial nerve 3 palsy
- senile ptosis
- myotonic dystrophy
- myasthenia gravis
- eye lid tumor
- paralysis of the lavatory muscle causing complete ptosis
DDx of dilated pupil
- cranial nerve 3 palsy
- pharmacological treatment with a dilating agent
- post surgical
- Aldies tonic pupil
DDx of constricted pupil
- Horner syndrome
- late stage of Aldies tonic pupil
- pharmacological treatment with constricting agent eg pilocarpine
- mydriasid
DDx of nystagmus
/ disease of the 8th cranial nerve and it’s connection to the brain
- cerebellar disease
- multiple sclerosis
- meningitis
- vascular disease
- heredity ataxia
- basilar artery ischemia
In motor exam upper
W
I-introduce and inform patient about the whole procedure and ask for name and age
P- permission and pain
E- expose patient the arms and legs
R- lying supine with arms by his side and pillow under his head
Ask if he is left handed or right handed
Abnormal posture( lateral or medial rotation or clawing of hand)
Tone upper
Hypotonic: lower motor neuron lesion and cerebellar lesion
Hypertonic:
Spastic rigidity- upper or pyrimidial motor lesion. Clasp knife movement
Lead pipe rigidity: extrapyrimidial lesion . Parkinsonism disease
Cog wheel: tremors+ lead pipe rigidity
Seen in Parkinsonism
Protonator drift
Extend hand with palmar surface up and ask to close the eyes
- unilateral protonator drift implies pyrimidial distribution of weakness old stroke
- bilateral pronates drift implies weakness of both hands
Pyrimidial lesion
Pyramidal signs indicate that the pyramidal tract is affected in some region. Pyramidal tract dysfunction can lead to clinical presentations like spasticity, weakness, slowing of rapid alternating movements, hyperreflexia, and Babinski sign.
Pyrimidial lesion
- Pyramidal signs indicate that the pyramidal tract is affected in some region. Pyramidal tract dysfunction can lead to clinical presentations like spasticity, weakness, slowing of rapid alternating movements, hyperreflexia, and Babinski sign.
Compartmental Power
- shoulder : abduction(deltoid C4) and adductor C5
- elbow : flexion(biceps C6) and extension (triceps C7)
- wrist extension by radial nerve
Grading of reflexes
Hyperactive, normal , sluggish/ diminished and absent
Reflex interpretation
Interpretation on CNS
- wrong technique
- isolated loss of a reflex that can point to a radiculopathy affecting that segment eig loss of biceps jerk if there s a C5-C6 disc prolapse
- isolated loss of a reflex that can point to a radiculopathy affecting that segment eig loss of ankle jerk if there is an S1 disc prolapse
Unsustained clonus less than five beat
Physiological
Sustained clonus greater than five beats
Pathological
Lesion to the pyrimidial tract
Plantar reflex
Normal: flexor plantar reflex that is flexion of the big toe and adduction of the other toes
Abnormal: extensor plantar reflex that is extension of the big toe with abduction (fanning) of the other toes. This is the positive Babinski sign and signifies UMN lesion
Abdominal refle T8-T10
- moving the sharp object lateral to medial
- you will see contractions of the abdominal muscles and deviation of the umbilicus to the stimulus
This is normal
When reflex when not seen is due to UMN lesion above the segmental level
Reflex can be lost due to obesity, pregnancy, multiparous woman, age, abdominal surgery, when process is done repeatedly several times the reflex disappears
Abdominal reflex helps to
- helpful as a localizing sign in patient’s with thoracic cord lesion
- Above umbilicus lesions T8-T10
- below umbilicus T10-12
