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Flashcards in Patterns of Neurological Presentation Deck (29):

what type of movement disorders are caused by problems of the corticospinal / pyramidal tract?

pyramidal / UMN features
*pyramidal weakness


what type of movement disorders are caused by problems of the basal ganglia?


hyperkinetic MD

hypokinetic (rigidity, bradykinesia)
*parkinsons disease


what type of movement disorders are caused by problems of cerebellum?



weakness may be focal or non-focal, what is the difference between these?

focal - in distribution of peripheral nerve or spinal root, hemi-distribution, pyramidal distribution

non-focal - generalised, predominantly proximal or distal, if truly generalised it includes bulbar motor function otherwise quadri or tetraparesis


in UMN lesion, what pattern of sensory loss is seen compared to LMN?

UMN - central pattern

LMN - none, glove, stocking, peripheral nerve or root distribution


what is the difference between deep tendon reflexes, superficial reflexes and pathological reflexes in UMN lesion vs LMN?

UMN - increased deep tendon, decreased superficial and increased pathological

LMN - normal or decreased deep tendon, normal superficial and pathological


how is the sphincter function affected in UMN lesion vs LMN?

UMN = sometimes impaired

LMN = usually normal (unless for example cauda equina lesion)


how is muscle tone and bulk affected in UMN and LMN lesions?

UMN = increased tone, sometimes muscle hypertrophy

LMN = normal / decreased tone, muscle wasting


what are the main upper motor neurone signs?

increased tone
extensor plantar responses
spastic gait
exaggerated jaw-jerk
slowed movements


what are the main lower motor neurone signs?

muscle wasting
absent or reduced deep tendon reflexes


what is an upper motor neurone pattern of weakness?

increased tone
brisk reflexes
pyramidal / corticospinal pattern of weakness (weak extensors in arm, weak flexors in legs)


what is a lower motor neurone pattern of weakness?

wasting, fasciculation, decreased tone, decreased or absent reflexes, flexor plantars (normal)


what are the signs of muscle disease?

wasting (usually proximal), decreased tone, decreased or absent tendon reflexes


what are the signs of neuromuscular junction disease?

fatiguable weakness, normal or decreased tone, normal tendon reflexes
no sensory symptoms


what are the signs of functional weakness?

no wasting, normal tone, normal reflexes, erratic power, non-anatomical loss


UML pattern of weakness usually occurs with stroke, SOLs and spinal cord problems and can usually be determined by body segments involved and accompanying signs - what signs suggest a hemispheric, parasagittal frontal lobe and spinal cord lesion?

hemispheric = contralateral pyramidal weakness in face, arm and leg

parasagittal frontal lobe lesion = paraparesis

spinal cord = pyramidal weakness below level of lesion (cervical = arms and legs, thoracolumbar = legs)


what conditions can cause lower motor neurone pattern of weakness?

motor neurone disease
spinal muscular atrophy (lead poisoning, poliomyelitis)


how does peripheral nerve involvement normally present?

symmetrical polyneuropathy with weakness and sensory symptoms (diabetes, alcohol, metabolic insults)
mononeuropathy (nerve compression) or mononeuritis multiplex (asymmetric polyneuropathy) which occurs in diabetes or vasculitis


give examples of conditions which are neuromuscular junction disorders?

myasthenia gravis
organophosphate poisoning
lambert-eaton paraneoplastic syndrome


what are the different patterns of sensory loss and what type of disorder do these indicate?

stocking - length dependent neuropathy
sensory level - spinal cord lesion
haemianaesthesia - contralateral cerebral lesion
dissociated sensory loss with lost spinothalamic but preserved dorsal column - hemicord damage


what are the signs of a cerebellar disorder?

gait - broad based and unsteady
intention tremor / ataxia (assessed by finger-nose test and knee-heel test)
dysdiadochokinesis - clumsy fast alternating movements
nystagmus and dysarthria are additional features


what is the role of the frontal lobe?

generates novel strategies and has executive functions
enables self criticism and trying again


what are the many signs which can be associated with frontal lobe dysfunction?

personality dysfunction
grasp reflex
frontal gait dysfunction (magnetic gait)
cortical hand
visual field defects
expressive dysphasia (brocas area)


what are the signs of temporal lobe dysfunction?

memory dysfunction (esp episodic memory)
agnosia (visual and sensory modalities in particular)
language disorders (wernickes)
visual field defects (congruous upper homonymous quadrantanopia)
auditory dysfunction (heschel's gyrus)
limbic dysfunction
temporal lobe epilepsy


what are the signs of parietal lobe dysfunction?

visual field defect (congruous lower homonymous quadrantanopia)
sensory dysfunction (visual and sensory modalities)
gerstmanns syndrome (disease of dominant angular gyrus - dysgraphia, left-right disorientation, finger agnosia, acalculia)


what are the symptoms of a lacunar stroke?

no visual field defect
no new higher cortical or brainstem dysfunction

pure motor hemiparesis or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxia hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)

at least 2 of the 3 areas (face, arm and leg) should be involved


what are the symptoms of posterior circulation stroke?

one of:
- cranial nerve palsy
- unilateral or bilateral motor or sensory deficit
- disorder of conjugate eye movements
- cerebellar dysfunction
- homonymous hemianopia
- cortical blindness


what are the symptoms of total anterior circulation stroke?

hemiplegia and homonymous hemianopia contralateral to lesion
either aphasia or visuospatial disturbances
+/- sensory deficit contralateral to the lesion


what are the symptoms of partial anterior circulation syndrome?

one or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia)

motor or sensory deficit may be less extensive than in lacunar syndromes