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Cerebellar Disorders Function: Integrates (Sensory and Other Information From

Cerebellar Disorders Function: Integrates (Sensory and Other Information From

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Published by mcwnotes

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Published by: mcwnotes on Apr 03, 2009
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11/15/2012

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Cerebellar DisordersFunction
: Integrates (sensory and otherinformation from multiple regions of cortex,brainstem, and spinal cord)Vision, Proprioception, Muscle Strength, Muscle Tone,Vestibular, Pressure
Uses inputs to partitipate in motor planning
Coordinates ongoing movementsLateral Hemisphere: Motor planning Extremities,lateral corticospinal tractIntermediate Hemisphere: Distal LimbCoordination, lateral corticospinal tract,rubrospinal tractVermis /Flocculonodular Lobe : Proximal limb/trunkmovements; Anterior corticospinal tract etc..Balance/VOR reflex, medial longitudinal fasiculusCEREBELLAR DYSFUNCTION: INCOORDINATION1.
Appendicular Ataxia
– difficulty with smoothycoordinated movements: Agonist/AntagonistMuscles aren’t coordinated; jerky movements;
IPSILATERAL TO LESION
2.
Dysdiadochokinesia
-imparied repetitivemovements (supination/pronation)
IPSILATERALTO LESION
3.
Titubation
(truncal ataxia)- difficultymaintaining upright posture: Agonist/antagonistmuscles of Trunk; jerky head/thorax
*LESIONVERMIS/FLOCCULONODULAR LOBE
4.
Impaired Suppression of VOR
- jerky eyemovements/blurred vision fixation on movingobject due to intermittent triggering of VOR*VOR maintains fixation on stationary object whilehead is moving; VOR suppressed by VERMIS whenwatching a MOVING object to fixate and keepfocus even if you are moving. (hittingbaseball)*
MIDLINE CEREBELLAR LESION
5.
Gait Imbalance-
wobbly/erratic gates legataxia/ impaired VOR supression6.
Scanning Dysarthria
- syllables are clippedand can not put words together
Not Aphagia!Can communicate Slow speech7.
Decreased Muscle Tone/ DecreasedReflexesCerebellar Disorders:
 Tumor (Cerebellar), Stroke (PICA, AICA, SCA),Hemorrhage, Infection (abscess), Atropy (EtOH)1.Suddent Onset of Unilateral Ataxia (Ipsilateral to
Basal Ganglia DisordersDirect Pathway
: Stimulates Thalamus
MovementLesion:
Hypokenisis
 
Indirect Pathway
: Inhibits Thalamus
InhibitsMovementLesion:
Hyperkenisis (Globus pallidusExternal/Subthlalamic Nucleus SignReversal)
*Thalamus projects to motor areas in the cortex.1. Unilateral Flapping/Flingining(Hemiballism)(Hyperkinetic, Indirect Pathway,Contral lateral Lesion in Subthalamic Nuclei)2. Irregular Jerking Movements/Marital Problems;decrease tone (Hyperkinetic, Indirect Pathway,Decreased Size of Caudate)Huntingtons Disease3. Assymetrical resting tremor, rigidity,bradykinesia, gait difficulties , decreased facialExpression(Hypokinesia, Direct Pathway)Parkinson’s
Huntington’s Disease
: Atrophy of BasalGanglia; Progressive disease; AutosomalDominant; Involuntary movements: chorea(dancelike movements), athetosis (movementhands/feet); Memory loss +cognitive dysfunction;psychiatric disturbances (Indirectpathway/Hyperkinetic)
Parkinson’s Disease:
Hypokinetic, Lesion inDirect Pathway , Decrease in Dopamine inSubstatia Nigra compacta. Treatment: Dopamine1.Tremor at Rest2.Rigidity3.Bradykinesia
Stereotactic Surgery
: Surgery to correctmovement1)Bradykinesia correction via indirect pathway
( Pallidotomy :
Globus pallidus; Subthalamic N,)2) Severe Tremor/Hyperkinesia correction viadirect pathway
( Thalamotomy 
: Thalamus)
Stereotactic Surgery
: Option forBradykinesia/Rigidity
Deep Brain ElectricStimulation (inhibition Subthalamic Nucleus) Lessinhibition=more movement

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