Signs and symptoms of CNS and PNS disorders

signs and symptoms

are clinical manifestations of an underlying pathology

Central nervous system (CNS) lesions:

primary impairments affecting motor, sensory/perceptual, and/or cognitive/behavioral systems

Secondary impairments

do not result from CNS lesion directly but as a result of original problem

Negative signs/symptoms

loss or reduction of normal neurologic function.

Positive signs/symptoms

abnormal or excessive phenomena that appear because of nervous-system dysfunction

Level Nervous System - CNS

Brain: Supratentorial, Infratentorial

Spinal cord

Level of the nervous system - PNE

peripheral nerves

Main signs and symptoms at Levels of NS - supratentorial

• Delirium

• Dementia

• Memory loss

• Language disorder

• Agnosia

• Apraxia

• Anosmia

• Gaze disturb

• Hemianopsia

• Hemiplegia

• Hemisensory

Main signs and symptoms at Levels of NS - infratentorial

• LOC

• Vertigo

• Diplopia

• Hearing loss

• Dysarthria

• Dysphagia

• Ataxia

• Nystagmus

• Bilateral motor/sensory

Main signs and symptoms at Levels of NS - spinal

• LBP

• Neck pain

• UMN or LMN weakness

• Change in DTR

• Sensory

• Segmental loss

• Bladder weakness

Main signs and symptoms at Levels of NS - peripheral

• Distal symmetrical sensory and/or motor weakness

• Loss conforming to root or peripheral nv.

• Muscle atrophy

• Fasciculations

• Decreased DTR

Disorder Types

UMN disorders

LMN disorders

Involuntary movement disorders

Cerebellar disorders

Cortical S/S

• Awareness/attention deficits

• Language deficits

• Apraxias

• Perceptual deficits

Delerium:

Altered state of attention-focus, perception, cognition

Cannot localize brain structure (frontal, pre-frontal area)

Dementia:

Non-specific syndrome with progressive decline in cognition

Depression:

Several underlying causes

Coma:

State of unarousable unresponsiveness

Brain stem/non-localizing (space occupying lesion, metabolic, drug-induced)

Amnesia

loss of long term memory

types: anterograde and retrograde

Anterograde

loss of memories for events following the trauma, past memories are intact, medial temporal lobes)

Retrograde

loss of memories for events that occurred prior to the trauma, temporal lobe

Confabulations:

Fabrication of information in response to questioning

Could be secondary to retrograde amnesia

Delusions:

False beliefs

Seen in conjunction with neurologic and mental illness, no specific area (limbic system strong candidate)

Emotional disturbances:

Non-localized structure

Perseveration

continuous repetition of words, thoughts, or acts not related to current context

Aphasia

loss of production and/or comprehension of language

types:

• expressive/broca’s/non-fluent

• receptive

• global

Aphasia - expressive/broca’s/non-fluent

cannot produce, dominant broca’s area

Aphasia - receptive

cannot interpret, dominant wenicke’s area

aphasia - global

cannot produce and comprehend

dysarthria

Difficulty in articulation, Motor speech disorder (content of speech is fine, d/d from aphasia)

Apraxia:

Inability to perform purposeful movement which cannot be accounted for by inadequate strength, loss of coordination, impaired sensation, abnormal tone, attentional difficulties, poor comprehension, etc.

types - ideomotor, or ideational

Ideomotor

movement is not possible on command but may occur automatically (premotor)

Ideational

purposeful movement is not possible, either automatically or on command (parietal lobe)

Unilateral neglect:

• Failure to report or respond to people or objects presented to the side opposite to the brain lesion

• Left-sided neglect is more common

• 2 classification systems:

  • Modality

    • Sensory (inattention)

    • Motor

  • Distribution

    • Personal

    • Spatial

Agnosia:

Inability to recognize familiar objects when using a specific sense, even though discriminative ability with that sense is intact.

Typically sensory association areas are affected

Visual agnosia

inability to recognize familiar objects despite intact vision [visual association area]

Prosopagnosia

inability to identify familiar faces

Color agnosia

inability to recognize colors

Tactile agnosia

inablity to recognize forms by handling them [somatosensory association area]

Auditory agnosia

inability to recognize sounds [auditory association area]

Sensory Signs and Symptoms - Dyasthesias, Parasthesias, Numbness, Tingling:

Sensory receptors, sensory nerve, ascending tracts

Sensory Signs and Symptoms - Exaggeration of sensory stimuli:

Sensory integration, parietal lobe

Dyasthesias

bad, uncomfortable, can also be painful sensations, unpleasant abnormal

Parasthesias

pins and needles

Motor Signs and Symptoms - UMN

• Hyperactive MSR

• Babinski, Clonus, Hoffman sign

• Increased Tone (Spasticity)

• Spastic weakness

Motor Signs and Symptoms - LMN

• Hypoactive MSR

• Decreased Tone (Flaccidity)

• Flaccid Weakness

• Atrophy

• Fasciculations

• Fibrillations

Ataxia:

incoordination of movement; ataxic gait

Dysmetria:

Movements overshoot or undershoot the intended mark

Dysdiadokinesia:

Failure of smooth progression of movements

Scanning speech:

Incoordination of speech producing muscles

Cerebellar Tremor

occurs at the end of a purposeful movement (intention tremor)

Coordination disorders - Signs and Symptoms: Cerebellar

ataxia, dysmetria, dysdiadokinesia, scanning speech, cerebellar tremor

Coordination disorders - Signs and Symptoms: Basal Ganglia

Resting tremor, chorea, athetosis, bradykinesia, dystonia, dyskinesias

Chorea:

Random uncontrolled movement patterns occur continuously, St.Vitus dance

Athetosis:

Slow writhing movements occuring continuously, wormlike movements

Bradykinesia:

Slowness of movement

Dystonia

sustained involuntary muscle contractions that can cause painful/abnormal postures

Dyskinesias

involuntary twitching, jerking, twisting, or restlessness; s/e of medications (anti-parkinsonism, anti-psychotic drugs)

CNS

• More variable

• Difficult to localize

• Cognitive deficits evident

• Smaller lesions cause more diffuse patterns of loss

• Emotional disturbances more common (due to the pathology)

PNS

• Less variable

• Easier to localize

• Cognitive deficits absent

• Extent of injury can be related to lesion size

• Secondary emotional disturbances may be evident