Neuro Exam 3
Neuro Exam 3
Cerebellum:
- 50 billion out of 86 billion neurons are in the cerebellum
- Receives sensory input from all modalities
- Medial cerebellum controls ventromedial tracts (posture) while lateral cerebellum
controls lateral tracts (independent skilled limb movements)
- Input to the cerebellum provide info for motor function while its output influences
motor systems
Lobes:
1. Flocculonodular lobe - vestibulocerebellum
Implicated in balance, eye movements
2. Posterior lobe - cerebrocerebellum
Voluntary activity, procedural memory
3. Anterior lobe - spinocerebellum
Gait (démarche), coordination, skilled movements
Longitudinal zones: Extend projections to 3 deep cerebellar nuclei
- Medial zone (vermis): vestibular, visual, auditory, somatosensory inputs. Regulates
posture, gait. Projects to vestibular (brainstem) & spinal cord.
- Intermediate zone: receives motor commands from motor cortices, and
somatosensory (limbs). Regulates limb movements, independent of trunk. Projects to
thalamus and red nucleus (brainstem)
- Lateral zone: receives cortical, pontine inputs, motor commands, somatosensory
info from spinal cord. Regulate independent limb movements to accomplish rapid
skilled movements that require precise timing (ballistic movements). Projects to
dentate nucleus, thalamus and red nucleus (brainstem).
Descending tracts:
Lateral Tracts:
- Input from M1
- Independent movements of distal portion of limbs
1. Pyramidal tract
- In finger, hand, arm regions of M1 (controls those)
- Grasping and manipulation
- Terminate in spinal cord
2. Corticorubral-rubrospinal tract
- Originate in M1 and red nucleus (brainstem)
- Terminate in spinal cord
- Controls hands (not fingers), feet, distal portion of limbs
3. Corticobulbar tract
- Originate in face region of M1
- Terminates in cranial nuclei
- Control face and tongue movement
Ventromedial tracts:
- Inputs from midbrain/brainstem nuclei and from M1
- Mostly control of trunk and proximal portions of limbs
1. Ventral corticospinal tract
- Originate in trunk and proximal region of M1
- Terminate in spinal cord
- Controls trunk, legs, feet
- Walking and posture
2. Vestibulospinal tract
- Originate in brainstem vestibular nuclei
- Terminate in spinal cord
- Controls trunk and legs, posture
3. Tectospinal tract
- Originate in superior colliculi
- Terminate in spinal cord
- Controls neck and trunk
- Coordinate eye/head movements
4. Lateral reticulospinal tract
- Originate in medullary reticular formation
- Terminate in spinal cord
- Controls flexor muscles of legs, walking
5. Medial reticulospinal tract
- Originate in pontine reticular formation
- Terminate in spinal cord
- Controls extensor muscles of legs, walking
DISORDERS
Myasthenia Gravis:
- Neuromuscular junction don’t work, muscles don’t get the message to contract
- Autoimmune disorder: antibodies attack a patient’s ACh receptors
- First muscle of the head: drooping of the eyelids, double vision, slow speech. Later
stages result in paralysis of the muscles that control swallowing and respiration and
is life-threatening
- Treatment: suppressing the immune system, AChE inhibitors
Multiple sclerosis:
- Disease of CNS myelin, gradual destruction of myelin sheaths
- Autoimmune dysfunction
- Accompanying development of hard scar tissue
- Later stages: muscular weakness, tremor, urinary incontinence, numbness, visual
disturbances, ataxia (trouble in balance and walking)
- Onset in early adulthood
- Occasional remissions
Amyotrophic lateral sclerosis - ALS (Lou Gehrig’s disease)
- Rapid, progressive atrophy of CNS and PNS motor neurons (brain and spinal cord)
- Onset between 40-70
- Death usually in 2-5 years
- No dementia
- Eyes and bladder spared
- Advanced ALS: progressive weakness, paralysis, wasting of muscles, loss of
speech/swallowing/breathing
- Causes not clearly established. 10% arise from a single gene defect in superoxide
dismutase gene. Other causes may be toxic mineral exposure, immune responses,
endocrine dysfunction
Cerebellar ataxia:
- Cerebellar disease/damage causing ataxia, astasia (inability to stand upright)
intention tremor
- Loss of coordination of the legs
Apraxia:
- Inability to carry out complex movements even if paralysis or weakness is not evident
and language/motivation are intact
- Can still do things like smile but cannot do it when asked to
- Ideomotor apraxia: incorrect organization or sequencing of movement, left frontal or
parietal lesions
- Constructional apraxia: skilled movements are intact but inability to draw or
assemble, right parietal damage
Parkinson’s disease:
- Destruction of dopaminergic cells of SNpc (which project to caudate nucleus,
regulation of excess movement)
- More than 70% of dopaminergic neurons are destroyed before first symptoms
- Symptoms: tremor, rigidity, slow movement/inability of movement, postural instability
- Later stages: loss of voluntary behavior and death
- Depression and dementia
- Stages:
1. Symptoms on one side, inconvenient but not disabling, tremor of one limb,
changes in posture and facial expression
2. Bilateral symptoms, posture and gait affected
3. Slowing of body movements, impairment of equilibrium, generalized
dysfunction, constant nursing care required
4. Severe symptoms, can still walk a little, not able to live alone, maybe less
tremor than before
5. Cachetctic (loss of body weight and muscle mass), complete invalidism,
cannot stand or walk, constant care needed
- Cause unknown, but associated with toxic insults, disease
- Treatments:
- L-dopa + carbidopa (converted to dopamine)
- Bromocriptine (dopamine receptor agonist)
- Selegiline (MAO-B inhibitor)
- Amantidine (increases dopamine release and blocks reuptake)
- Benztropine (antagonizes muscarinic cholinergic receptors)
- Diphenhydramine (benadryl) (antagonizes muscarinic cholinergic receptors,
may block dopamine reuptake)
- Surgery: fetal nigra cell grafts, pallidotomy, deep brain stimulation
Huntington’s disease:
- Autosomal dominant disorder that onsets in early middle-age (35-50 years)
- Loss of striatal neurons, atrophy of caudate, decrease in GABA and substance P
- Jerky movements and intellectual deterioration, facial grimacing, ataxia
- Later stages, muscular rigidity occurs
- Psychiatric disturbances, apathy & irritability, manic-depressive, schizophrenia
- Walking, swallowing, dementia disables severely in later stages
- No treatment known for this progressive disorder, genetic counseling is important as
½ of offsprings will be affected