Sx include: ataxic limb movements, Intention tremor, irregular oscillatory voluntary movements. Dysdiadokinesia, Dysmetria, Dyssynergia. ie. MS
Cerebellar Disease of the Pontocerebellum/Neocerebellum
Sx include: Hypotonia, truncal ataxia: disequilibrium, static postural tremor, inc. sway, wide BOS, high guard arm position. Posture worse with eyes closed, narrow BOS (Rhomberg, Sharpened Romberg). Ataxic gait; unsteady, inc falls, uneven dec. step length, inc. step width. ie. alcoholic cerebellar disease, Fredrich's ataxia.
Cerebellar Disease of the Spinocerebellum/ Paleocerebellum
Sx include: ipsilateral sx:
Contralat sx: ocular dysmetria, poor eye pursuit, dysf. VOR, impaired eye-hand coordination, Gait /trunk ataxia
Little chance in tone/dyssynergia of extremity mvmts. (vertigo, nystagmus, unsteady gait.)
Cerebellar Disease of the Vestibulocerebellum/Archicerebellum
3 Types of Traumatic Nerve Injuries
Neurapraxia, Axonotmesis, Neurotmesis
Neurapraxia Class I
transient loss of function (conduction block ischemia) may be rapidly reversed or persist a few wks. ie. compression
Axonotmesis Class II
loss of function Wallerian degeneration distal to lesion; no disruption of endoneurium. (regen. distal to site is possible) ie. crush injury
Neurotmesis Class III
cutting of nerve severance of all structures, complete loss of function. Reinnervation typically fails with out surgical intervention.
inflammation of muscle, disease of muscle. sx: Proximal muscle weakness ie. MD
nerve rts, DDD, herniated disc, diabetes, spur, infection-trauma.
single n. due to physical injury, prolonged pressure
Sensory neuropathy(peripheral neuropathy)
Peripheral Neuropathy (Sensory)
most common is DM neuropathy
symmetrical, Bilat, (related to glucose control), tingling in ft, dec sensation, affects LEGS > ARMS, and DISTAL> PROXIMAL.
Charcots jt neuropathy
affects jt, ft mostly, also compression of cranial autonomic neuropathies, Sx: DISTAL weakness of extremities
generalized weakness, F to G muscle grades.
Medial Medullary Syndrome
Sx include: ipsilat paralysis of tongue,
contralat-paralysis of arm, leg, with impaired sensation.
Medial Inferior Pontine Syndrome (branch of basiliar artery)
ipsilat-cerebellar (nystagmus, ataxia, paralysis of conjugate gaze to SIDE OF LESION, diplopia.
Central-hemiparesis, impaired sensation
Lateral inferior pontine Syndrome: AICA
ipsilat sx: cerebellar facial paralysis, conjugate gaze to SIDE OF LESION.
deafness, tinnitus, impaired facial sensation
Contralat sx: pain & temp 1/2 body
Lateral Medullary Syndrome (Wallenburgs)
ipsilat sx: ataxia, vertigo, nystagmus.
Horners Syn: miosis, ptosis, dec sweating.
Dysphagia, impaired speech, dec gag reflex
Sensory loss; ipsilat arm, trunk, leg
Contralat: loss pain& temp 1/2 body
occlusion of vessels of MCA or circle of Willis (branches) or vertebral art. and branches.
Vertebral Basiliar Artery Syndrome
Locked in syndrome
Bilat corticospinal tracts; vertigo, ataxia, dysarthria (corticobulbar tracts) hemiplegia, tetraplegia, LOC, CN 6 VI (Abducens)
Posterior Cerebral Artery
Supplies; midbrain, temp lobe, post 1/3 cortex.
Thalamic syndrome; pain and loss of sensation in face, arms, or legs.
Involuntary mvmts- athetosis, chorea, hemiballismus
Webers syndrome-oculomotor n. palsy, contralat hemiparesis
Central sensory loss
Central homonymous hemianopsia
Visual sx-miosis, ptosis, dec. papillary light reflex.
Anterior Cerebral Artery (ACA)
supplies 2/3 of medial cerebral cortex
Contralat sensory, hemiparesis LE>UE
Middle Cerebral Artery (MCA)
supplies lateral cerebral cortex, basal ganglia, large portions of internal capsule.
Contralat- sensory loss, hemiparesis UE> LE
Motor speech- Broca's
Loss of conjugate gaze on OPPOSITE side
Sensory ataxia (parietal lobe)
Most common type of CVA
CVA of Middle Cerebral Artery (MCA)
Raising involved UE above 100 deg with elbow extension will produce extension and abduction of fingers.
involved LE will ABD/ADD with applied resistance to uninvolved LE in the same direction.
flex pattern of involved UE, facilitates flexion of involved LE.
prolonged severe spasm of m. causing hd, neck, heels to arch backwards. Arms/hands held rigidly flexed, Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning.
pt cannot perform task on command but can do task when left on own.
pt cannot perform task at ALL, either on command or on own.
inability to recognize familiar obj w/one sensory modality while retaining ability to recognize the same obj. w/ other sensory modalities.
inability to perform voluntary learned mvmts w/loss of some conceptual/motor system.