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Cerebellar Disorders Basal Ganglia Disorders

Function: Integrates (sensory and other Direct Pathway: Stimulates Thalamus


information from multiple regions of cortex, Movement
brainstem, and spinal cord) Lesion: Hypokenisis
Vision, Proprioception, Muscle Strength, Muscle Indirect Pathway: Inhibits ThalamusInhibits
Tone, Movement
Vestibular, Pressure Lesion: Hyperkenisis (Globus pallidus
• Uses inputs to partitipate in motor planning External/Subthlalamic Nucleus Sign
• Coordinates ongoing movements Reversal)
*Thalamus projects to motor areas in the cortex.
Lateral Hemisphere: Motor planning Extremities,
lateral corticospinal tract 1. Unilateral Flapping/Flingining
(Hemiballism)(Hyperkinetic, Indirect Pathway,
Intermediate Hemisphere: Distal Limb Contral lateral Lesion in Subthalamic Nuclei)
Coordination, lateral corticospinal tract, 2. Irregular Jerking Movements/Marital Problems;
rubrospinal tract decrease tone (Hyperkinetic, Indirect Pathway,
Decreased Size of Caudate)Huntingtons Disease
Vermis/Flocculonodular Lobe: Proximal limb/trunk 3. Assymetrical resting tremor, rigidity,
movements; Anterior corticospinal tract etc.. bradykinesia, gait difficulties , decreased facial
Balance/VOR reflex, medial longitudinal fasiculus Expression(Hypokinesia, Direct Pathway)
Parkinson’s
CEREBELLAR DYSFUNCTION: INCOORDINATION
1.Appendicular Ataxia – difficulty with smoothy Huntington’s Disease: Atrophy of Basal
coordinated movements: Agonist/Antagonist Ganglia; Progressive disease; Autosomal
Muscles aren’t coordinated; jerky movements; Dominant; Involuntary movements: chorea(dance
IPSILATERAL TO LESION like movements), athetosis (movement
2. Dysdiadochokinesia-imparied repetitive hands/feet); Memory loss +cognitive dysfunction;
movements (supination/pronation) IPSILATERAL psychiatric disturbances (Indirect
TO LESION pathway/Hyperkinetic)
3. Titubation (truncal ataxia)- difficulty
maintaining upright posture: Agonist/antagonist Parkinson’s Disease: Hypokinetic, Lesion in
muscles of Trunk; jerky head/thorax *LESION Direct Pathway , Decrease in Dopamine in
VERMIS/FLOCCULONODULAR LOBE Substatia Nigra compacta. Treatment: Dopamine
4. Impaired Suppression of VOR- jerky eye 1. Tremor at Rest
movements/blurred vision fixation on moving 2. Rigidity
object due to intermittent triggering of VOR 3. Bradykinesia
*VOR maintains fixation on stationary object while
head is moving; VOR suppressed by VERMIS when Stereotactic Surgery: Surgery to correct
watching a MOVING object to fixate and keep movement
focus even if you are moving. (hitting 1)Bradykinesia correction via indirect pathway
baseball)*MIDLINE CEREBELLAR LESION (Pallidotomy: Globus pallidus; Subthalamic N,)
5. Gait Imbalance- wobbly/erratic gates leg 2) Severe Tremor/Hyperkinesia correction via
ataxia/ impaired VOR supression direct pathway (Thalamotomy: Thalamus)
6. Scanning Dysarthria- syllables are clipped
and can not put words togetherNot Aphagia! Stereotactic Surgery: Option for
Can communicate Slow speech Bradykinesia/RigidityDeep Brain Electric
7. Decreased Muscle Tone/ Decreased Stimulation (inhibition Subthalamic Nucleus) Less
Reflexes inhibition=more movement

Cerebellar Disorders:
Tumor (Cerebellar), Stroke (PICA, AICA, SCA),
Hemorrhage, Infection (abscess), Atropy (EtOH)

1.Suddent Onset of Unilateral Ataxia (Ipsilateral to


lesion)
2. Walking like Drunkard(fall Ipsilateral to lesion)
3. Head turns toward the direction of the lesion =
blurriness of vision

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