PHTY3070 Revision

another name for vestibulocerebellum

archicerebellum, floccular node

another name for spinocerebellum

paleocerebellum, vermis

another name for neocerebellum

cerebrocerebellum, pontocerebellum

symptoms of vestibulocerebellar lesions

truncal ataxia, postural sway, nausea, impaired VOR, cerebellar nystagmus

symptoms of spinocerebellar lesions

hypotonia esp in prox mm, hypermetria, inability to decelerate, rebound phenomena, lack of motor plasticity, limb ataxia, wide BOS, fall randomly, intention tremor

symptoms of neocerebellar lesions

movt decomposition, asthenia, dysmetria, dysdiadokinesia, dysarthria, mm dysygnergy, ocular dysmetria

symptoms of sensory ataxia

no proprioception or vibratory sense, worse w/ EC, slapping foot gait

symptoms of vestibular ataxia

vertigo, nausea, no balance, nystagmus

symptoms of frontal ataxia

dementia, cognitive deficits

types of acquired ataxias

symmetrical & asymmetrical ataxias

causes of symmetrical ataxias

intoxifications, infections, Lyme disease, hypothyroidism, genetic disorders, high altitude cerebral oedema, hydrocephalus

causes of asymmetrical ataxias

stroke, TBI, infections, demyelination, tumours, trauma, AIDs, cervical spondylosis

types of inherited ataxias

fredereichs & spinocerebellar ataxias

most common hereditary ataxia

frederichs

pathogenesis of fredereichs

mutation in frataxin gene

dx of fredereichs

EMG, CSF, nerve conduction velocity, MRI, DNA, <25yrs

symptoms of fredereichs

progressive weakness, fatigue, dysarthria, dysphagia, dec sensation, hyporeflexia, spasticity, pes cavus, scoliosis

sequence of loss of sensation in fredereichs

1. vibration 2. proprioception 3. light touch 4. pain 5. temp

inheritance of spinocerebellar ataxia

autosomal dominant

dx of spinocerebellar ataxia

MRI, DNA, >18yrs

symptoms of spinocerebellar ataxia

ataxia, dementia, slow eye movts, visual loss, genetic anticipation

which inherited ataxia is more fatal?

spinocerebellar ataxia

inheritance of frederichs ataxia

autosomal recessive

causes of SCI

trauma, disease processes, vascular insult, degeneration, prolapsed IV disc, spina bifida, MS, ALS, transverse myelitis

tetraplegia

no motor &/or sensory function in arms, trunk, legs & pelvic organs due to damaged C/cord

paraplegia

no motor &/or sensory function in T/L/S spine- arm function okay, trunk/legs/pelvic organs possibly involved

neurological level

most caudal segment w/ intact sensation & G3 motor function

sensory level

most caudal segment w/ normal sensory function bilat

motor level

most caudal segment w/ G3 strength, provided the segment above has G5 bilat

skeletal level

level where by X-ray, the greatest vertebral damage is found

complete injury

absence of sensory & motor function below lesion level & in lowest sacral segment

incomplete injury

partial preservation of sensory &/or motor function below neuro level & incl lowest sacral segment

complete transverse syndrome

complete loss of motor power & sensation below injury level

central cord syndrome

loss of power & sensation in ULs w/ minimal loss in LLs

most common group affected by central cord syndrome

elderly

most common mechanism of central cord syndrome

hyperextension injury

anterior artery syndrome

loss of motor power, pain & temp w/ preservation of proprioception, vibration & touch

brown-sequard syndrome

loss voluntary motor control on same side of cord damage + loss of pain & temp on contralat side

onset of CES

20-29yrs, M

symptoms of CES

saddle anaesthesia, inc freq urination, inability to void, no sphincter control, motor & sensory loss in LLs, pain w/ altered posture

ASIA A

complete, no sensory/motor function preserved below neuro level + absent S4/S5

ASIA B

incomplete, sensory but no motor function preserved below neuro level + S4/S5 present

ASIA C

incomplete, motor function preserved below neuro level & more than 1/2 key mm below NL < G3

ASIA D

incomplete, motor function preserved below NL & at least 1/2 key mm below NL >= G3

ASIA E

normal sensory & motor function

ant spinal artery supplies how much of SC?

front 2/3

SCI most commonly caused by

traumatic causes

most common cause of CES

central lumbar disc herniation

3 most common cause of death in SCI

pnemonia/influenza, septicaemia, cancer

spinal shock

temporary loss of cord mediated reflexes/function below lesion level

80% of SCI present with ---

spasticity

why don't you use banding when testing sensation for SCI?

may create false +ves due to vibration

what % of WC users report shoulder pain?

70%

ANS controls

BP, HR, temp, appetite, fluid balance, bladder function, GI motility, carb & fat metabolism, sleep & sexual function

autonomic dysreflexia

exaggerated sympathetic response to noxious stimuli below lesion level, occurs in @ or above T6

causes of autonomic dysreflexia

bladder/renal, bowel, skin, #, infection, pain, sexual stimulation, onset of labour

symptoms of autonomic dysreflexia

severe headache, inc BP, red blotchy rash, anxiety, snuffly sensation, bradycardia

syringomyelia

cyst formation @ injury site

up to 1/3 of bone mass may be lost in first -- months post SCI

16

postural hypotension

blood pools in abdomen & LL

poikilothermia

lose ability to shiver/sweat w/ SCI above T6

when does heterotopic ossification most commonly occur

during first year post injury

causes of pressure injuries

unrelieved pressure, shearing, friction, trauma

dizziness affects --% of people >40yrs

40%

causes of dizziness

drug interactions, orthostatic hypotension, cardiac disorders, agoraphobia, VBI, cerebral pathology, migraine, Cspine pathology

symptoms of vestibular deficits

nausea, vertigo, visual impairment, gait/balance disorders, nystagmus

types of nystagmus

spontaneous, positional or evoked

VOR

acts to keep what we see stable

VSR

acts to stabilise the body

most common vestibular disorder

BPPV

pathogenesis of BPPV

otoconia from the utricle becomes dislodged

dx of BPPV

Hallpike-Dix

symptoms of UVH

nystagmus, oscillopsia, blurred vision, gait/balance impaired, vertigo

symptoms of BVH

oscillopsia, ataxia, postural disturbance, NO VERTIGO

irritative vertigo

over-active vestibular system caused by inflam of vestibular apparatus/nerve

ablative vertigo

under-active vestibular system caused by degeneration

Is MND more common in men or women?

M~3:2

peak onset MND

50-70yrs

what % of MND has familial form

5-10%

symptoms of MND if LMN predominates

mm atrophy in specific mm, hyporeflexia, dec or normal tone, fasciculations

symptoms of MND if UMN predominates

widespread mm wasting, hyperreflexia, hypertonia, primitive reflexes

dx of MND

clinical dx, EMG, excl other disorders

4 types of MND

ALS, PBP, PMA, PLS

early symptoms of MND

cramps, slowed movt, mm stiffness, emotional responses triggered easily, dysarthria, dysphagia

what is NOT affected in MND

sensory or cognitive function

symptoms of advanced MND

depression, weight loss, malnutrition, venous thrombosis, contractures, RF

what type of MND has mixed bulbar & limb signs, + is more common in older F

PBP

most common neurological disease affecting young AUS

MS

MS is more prevalent

further from the equator

peak onset of MS

20-25yrs

Is MS more common in men or women?

F~3:1

sites of MS plaques

close relationship to veins, periventricular regions, cerebellar white matter, optic nerves, BS, SC

which MS clinical course makes up 85% of presentations?

relapsing-remitting

dx of MS

at least 2 episodes of symptoms, diffuse CNS areas involved, neurophysiological, radiological testing, lumbar puncture, blood tests

initial symptoms of MS

motor, sensory, pain, optic, cerebellar ataxia, bladder/bowel dysfunction, Lhermitte's sign

Lhermitte's sign

electric shock sensation w/ passive neck flexion

later symptoms of MS

motor impaired +/- fatigue, sensory deficit, ataxia, sphincter & sexual dysfunction, optic neuritis, diplopia, intention tremor, cognitive impairment

fatigue in MS is worse when?

hot weather, strenuous activity, immersion in hot water

which race is MS most common in?

Caucasians

--% of people aged >65yrs will fall in any given year

30%