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Neuro - MOTOR
Terms in this set (59)
UMNL vs LMNL
Stance & gait depend on intact p/ws:
common gait abnormalities
Unsteadiness on standing with the eyes open is common in_______
Instability that only occurs, or is markedly worse, on eye closure (Romberg's sign) indicates______
1- proprioceptive sensory loss (sensory ataxia)
2- or bilateral vestibular failure.
1- caused by?
2- what is it like?
1- (unilateral UMNL)
2-characterised by extension at the hip, knee and ankle and circumduction at the hip, such that the foot on the affected side is plantar flexed and describes a semicircle as the patient walks. The upper limb may be flexed
What causes a scissor-like gait?
Bilateral UMN damage due to spasticity.
Postural instability on the pull test, especially backwards, occurs in?
Bizarre gaits, such as when patients drag a leg behind them?
but some dzs, including Huntington's, produce unusual and chaotic gaits.
1- LMNL cause mm wasting
2- UMNL may cause disuse atrophy
3- a MNL in childhood may impair growth (smaller limb or hemiatrophy) or cause deformities eg pes cavus
muscle disorders cause proximal wasting except for _____
Myotonic dystrophy (distal; often temporalis)
Pseudohypertrophy occurs in
Replacement of lost muscle with fibrofatty tissue --> weak
Fasciculations occur in
- Seen not felt
- may need to wait a few minutes before observing any
- Physiological is common, esp in calfs
Affects orbicularis Oculi and first dorsal interosseous
A hypnic jerk is a form of
myoclonic jerk (physiological)
Myoclonic jerks may occur pathologically in
Diffuse brain damage
Some neurodegenerative disorders eg prion dz
a fine (low-amplitude),
fast (high- frequency, 3-30 Hz) postural tremor.
Causes of physiological tremor
- with excess alcohol or caffeine intake,
- common AE of beta-agonist bronchodilators.
The most common pathological cause of tremor
-- typically symmetrical in the UL
-- may involve the head and voice.
-- noted on posture & w/ movement (kinetic).
-- may be improved by alcohol
-- often demonstrates an AD pattern of inheritance.
slow (3-7 Hz), coarse, 'pill-rolling' tremor,
-- worse at rest
-- reduced w/ voluntary movement.
-- more common in UL,
-- usually asymmetrical and does not affect the head, although it may involve the jaw/chin and sometimes the legs.
Isolated head tremor
-- usually dystonic
-- may be assoc w/abnormal neck postures such as torticollis, antecollis or retrocollis.
--absent at rest
-- maximal on movement and on approaching the target (hunting tremor)
Intention tremor is usually due to____and is assessed with_____
cerebellar damage; finger-to-nose test
Neuropathic tremors involve
Hereditary or acquired demyelinating neuropathies
Eg Charcot Marie Tooth dz
Drugs that commonly cause tremors involve
- sodium valproate
Know definition of
Early cerebral or spinal shock
Spasticity vs rigidity
Spasticity is velocity-dependent resistance to passive movement:
--detected w/ quick movements
--feature of UMNL
--usually accomp by weakness, hyper-reflexia, an extensor plantar response & sometimes clonus.
--In mild forms it is detected as a 'catch' at the beginning or end of passive movement.
--in severe cases it limits range of movement && may be assoc w/ contractures.
UL -> more obvious on attempted extension;
legs -> more evident on flexion.
Rigidity is a sustained resistance throughout the range of movement
-- most easily detected when limb is moved slowly.
--In Parkinsonism -> described as 'lead pipe' rigidity.
--In the presence of a Parkinsonian tremor there may be a regular interruption to the movement, giving it a jerky feel ('cog wheeling').
Clonus is evoked by _______ of a muscle & tendon
Clonus types & causes
Unsustained (<6 beats) -> physiological
Sustained -> UMNL (accomp by spasticity)
Clonus is best elicited in_____
(Knee is r a r e )
Grading muscle power
Extensors of UL are weaker than flexors, opposite in LL
Pyramidal weakness after a stroke
Approximate muscle weakness
Distant muscle weakness
Weakness of a large group of muscles for example a limb or more than one limb
Foot drop may be caused by
L5 radiculopathy our common peroneal n palsy
Wildly fluctuating or sudden give-way weakness suggests
Improvement of apparently weak hip extension when it is tested at the same time as contralateral hip flexion (hip flexion is assoc w/ c/l reflex hip extension)
--> often present in functional leg weakness
Sciatica (Prolapsed IVD)
Pain going down one leg
Absent ankle jerks (S1)
Sensory loss on the sole of the foot (S1)
Inverted biceps reflex
Absent or reduced biceps reflex but finger flexion occurs
Cause of inverted biceps reflex
Combined SC & n root pathology
-> most commonly: cervical spondylotic Myeloradiculopathy (C5/6 level)
Hoffman's reflex occurs in
-may in normal ppl
-if asymmtric -> abnormal (cerebellar dz)
Superficial abd reflex is lost in
UMNL or LMNL
After abd surgery
The cremasteric reflex is absent in _______
Primitive reflexes involve
Presence of all primitive reflexes together suggests
Frontal lobe lesion
U/L grasp + palmomental reflex occurs with
Contralateral frontal lobe patho.
Glabellar sign is an unreliable sign of
☝️ to 👃 test may reveal
Dysmetria or past-pointing
impairment of rapid alternating movements
--evident as slowness, disorganisation and irregularity of movement.
--Dysarthria and nystagmus also occur with cerebellar disease.
Much less reliable signs of cerebellar disease include
-- the rebound phenomenon (when the displaced outstretched arm may fly up past the original position),
-- pendular reflexes
Constructional apraxia (difficulty drawing a figure) is a feature of _______.
Dressing apraxia, often assoc w/ spatial disorientation & neglect, is usually due to _______
parietal lesions of the non-dominant hemisphere.
have difficulty walking but are able to perform cycling movements on the bed surprisingly well.
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