Lecture 14 - CNS Motor D/o

Question 1

desccribe the pyramidal tract:

UMN –> LMN

Answer 1

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

Question 2

UMN vs LMN disorders:

Answer 2

UMN – Increased tone, hyperreflexia, babinksi and clonus

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

Question 3

Lesions along the Pyramidal Tract:

• what is the manifestations
• other associated findings

Answer 3

Paresis vs paralysis

Clasp Knife Spasticity; Myoclonus

Question 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?

Answer 4

Above c5 - quadra
below cevical enlargement – para

Contra – above the decussation of the pyramids

Paraparetic gait = Scissoring (bilateral cirumduction)

Question 5

Therapies for spastic paresis

what systems to these therapies target?

Answer 5

Baclofen and benzos – enhance GABA mediated inhibition

Tizanidine – Alpha 2 agonist

Botulinum Toxin

Question 6

What is the Akinetic disorder of the BG?

Describe the pathway leading to this physiology?

Answer 6

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

Question 7

Common features of parkinson’s disease

Answer 7

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

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

Question 8

what else can cause parkinsonian symptoms

Answer 8

Drugs – Dopamine antagonists (metoclopramide)
Strokes

Progressive supranuclear palsa
Coricobasilar degeneration
Multiple system atrophy

Question 9

Treatments of PD

Answer 9

LevoDopa + Carbidopa (DA decarboxylase inhibitor)

Dopamine aognists -

Amantadine –

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

Question 10

Complications of treatment
Main side effect of DOPA

what is used to acute rescue therapy?

Answer 10

main side effect – nausea

compications – decreased responsiveness to levodopa

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

Question 11

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

Answer 11

Essential Tremor
Chorea
Dystonia

Question 12

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

Answer 12

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

Question 13

Treatment of Essential tremor?

Answer 13

Propranolol

Primidone (barbiduate)

Botuliumum Toxin

DBS

Question 14

Chorea

what is it?
what can cuase it?

Answer 14

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

Causes: HD, Drugs Lupus

Question 15

forms of chorea: atheosis and ballismus

what are they?

Answer 15

atheosis – chorea + flowing

Ballismus – extreme form of chorea; wild flinging

Question 16

HD –
describe the genetics
where is the damage occur?

Answer 16

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

Question 17

Clincal features of HD

common cause of death for HD patients?

Answer 17

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

Question 18

Dystonia – what is it?

what is focal dystonia?

Answer 18

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

Question 19

Treatment of dystonia

Answer 19

Botulinum Toxin

Question 20

Symptoms of Cerebellar dysfunction

Answer 20

Incoordination
Dysmetria (FNF)
Dysdiadokinesia 
Ataxis
Dysathria
Nystag

Question 21

3 different cerebellar disease described in this lecture

Answer 21

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