Transcript Motor Systems - Metadon.net Homepage

Weakness & Sensory Deficit
Describe unique findings in
• Myopathy, NMJ disorder, neuropathy,
plexopathy, radiculopathy
• Myelopathy, motor neuron disease
• Brain stem and cortical lesions
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Weakness
Pertinent parameters include:
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Motor power pattern
Sensory findings
Deep tendon reflexes and muscle tone
Others
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Symptomatology of Motor Dysfunction
1.Muscle mass and contour
• atrophy, hypertrophy, dystrophy
• myopathy, myotonia
2.Muscle tone
• spasticity
• rigidity
• decorticate, decerebrate posture
• hypotonia
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Symptomatology of Motor Dysfunction
3.Involuntary movement
• tremor, myoclonus, chorea, athetosis,
ballism, dystonia, spasm, tics, clamps
4.Weakness
• paresis, paralysis, -plegia, palsy
• mono-, para-, hemi-, quadri4
Neurologic examination
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Cerebral function
Cranial function
Motor function
Sensory function
Reflexes and muscle tone
Coordination
Gait and posture
Meningeal irritation
Funduscopic examination
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Motor Power
Grading system (British Medical Research Council)
• V normal, full resistance to external force
• IV partial resistance to external force
• III against gravity, not to external force
• II joint movement, not against gravity
• I muscle contraction, no joint movement
• 0 no muscle contraction
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Sensory Functions
1. Dorsal column system
• proprioception, touch
2. Anterolateral system
• pain (pinprick), temperature
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Reflexes
Deep tendon reflexes
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4+
3+
2+
1+
0
pathological
normal, pathological
normal
normal, pathological
pathological
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Etiology (VINDICATEN_HIM)
V vascular
I infectious/inflammatory
N neoplastic
D degenerative
I intoxicative
C congenital/hereditary
A autoimmune
T traumatic
E endocrinopathic
N neoplastic
H hematologic
I idiopathic
M metabolic & miscellaneous
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Where is the lesion?
Peripheral lesions
• Myopathy
• Neuromuscular junction
• Peripheral nerve
× polyneuropathy
× mononeuropathy (single, multiple)
× plexopathy
× radiculopathy
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Central lesions
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Motor neuron
Spinal cord
Brainstem
Cerebral hemisphere
Others
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Lower Motor Neuron Lesions
Muscle (myopathy)
• hypokalemia
• myositis, muscular dystrophy
NMJ
• myasthenia gravis
Peripheral nerves (neuropathy)
• Polyneuropathy
• Mononeuropathy (single, multiple)
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Plexus (plexopathy)
• diabetic plexopathy
Nerve root (radiculopathy)
• Guillain-Barre Syndrome (AIDP), CIDP
• herniated disk
Spinal cord (myelopathy)
• motor neuron disease
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Symptoms/Signs of LMN Lesions
Focal weakness
• monoparesis, selective neuropathy weakness
Flaccid tone
Areflexia, hyporeflexia
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Upper Motor Neuron Lesions
Spinal cord
• cord compression, myelitis
Brain stem, cerebral cortex, cerebellum and
basal ganglia
• cerebrovascular disease, tumor, degenerative
disease
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Symptoms/Signs of UMN Lesions
Diffuse weakness
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paraparesis, hemiparesis, quadriparesis
Spastic tone
Hyperreflexia
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Hypotonia - Hyporeflexia
Reflex arc dysfunction (any components)
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receptor organs
afferent neurons
reflex center
efferent neurons
effector organs
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Spasticity
Hypertonia
• unidirectional
• velocity-dependent
Hyperreflexia
Seen in upper motor neuron lesion other than
basal ganglia pathology
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Rigidity
Hypertonia
• bidirectional
• velocity-independent
• cog-wheeling
Normoreflexia
Seen in basal ganglia pathology
• Parkisonism, Parkinsonism plus
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Coordination
Equilibratory coordination
• Romberg sign
• Tandem walk
Non-equilibratory coordination
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finger to nose, finger to finger, nose-finger-nose
dysdiadokokinesia
rebound
past-pointing
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Gait & Posture
• ataxic gait (proprioceptive, vestibular,
cerebellar): wide base, high swing, sway
• festinating gait (Parkinsonism): short, slow, rigid
and shuffling
• steppage gait (polyneuropathy): excessive hip
flexion
• waddling gait (myopathy): body swaying from
side to side like a duck
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0%
RT. HEEL STRIKE
RIGHT STANCE
LEFT SWING
0%
100%
RT. HEEL STRIKE
50%
LT. HEEL STRIKE
RIGHT SWING
LEFT STANCE
RIGHT STRIDE LENGTH
50%
100%
•Myopathy
•NMJ
•Peripheral nerve
•Plexus
•Root
•Cord
•Brain
Motor
P>D
P/D with F
D>P
P/D
P/D
focal/diffuse
diffuse
Sensory
normal
normal
impaired
impaired
impaired
impaired
impaired
Reflexes
N, De
N, De
De
De
De
De, I
I
P = proximal, D = distal
N = normal, De = decreased, I = increased
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Sensory Deficits
Spinal sensory Pathways
• Dorsal Column system
• Touch, proprioception, two-point
discrimination, vibratory sense
• Anterolateral system
• Pain (sharp and dull aching)
• Temperature sense
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Sensory Deficits
Cranial sensory pathways
• CN I (olfaction)
• CN II (vision)
• CN V (pain and touch)
• CN VII, IX, X (gustatory, etc)
• CN VIII (hearing and vestibular sense)
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Diabetic neuropathy
Clinical features
- Initial tingling paresthesia
- Pain
- Dysesthesia
- Loss of feeling distally
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Diabetic neuropathy
Distal sensory impairment ascends
symmetrically in legs and arms
Physical exam:
• Glove and stocking pattern
• Hyperalgesia
• Numbness or lack of sensation
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• http://www.metadon.net/
• students
• neurologic-examination.pdf
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