Comparison of UMN & LMN syndromes
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Differential diagnosis: Comparison of major types of CNS D/oLOCATION OF LESION
CEREBRAL CORTEX CORTICOSPINAL TRACTS
BASAL GANGLIA: SUBCORTICAL GRAY
Disorder Stroke ParkinsonismSensation Impaired or absent: depends on
location of lesion: contralateral sensory loss
Not affected
Tone Hypertonia/spasticity velocity-dependent clasp knife initial flaccidity: cerebral shock
↑ uniform resistance: leadpipe rigidity
Rachet-like at wrist or forearm: cogwheel; independent of rate
Reflexes ↑ hypereflexia Normal or maybe ↓Strength Contralateral weakness/paralysis:
hemiplegiaSlowness of movement
Bulk Normal: acute; disuse atrophy: chronic
Normal or disuse atrophy
Involuntary movements
Spasms Resting tremor
Voluntary movements
Dyssynergic: abnormal timing, coactivation, activation, fatigability
Bradykinesia/akinesia slowness, lack of spontaneous and automatic movements
Postural control
Impaired or absent, depends on the lesion location
Impaired: stooped
Gait Impaired: gait deficits due to abnormal synergies, spasticity, timing deficits
Impaired: shuffling , festinating gait
Spasticity: hypertonic motor d/o characterized by velocity-dependent resistance to passive stretch. Thus the larger and the quicker the sretch, the stronger the resistance of the spastic muscle.clasp knife response: during rapid movement, initial high resistance (spastic catch) may be followed by a sudden inhibition or letting go of the limb (relaxation) in response to a stretch stimulus, termed clasp-knife response.Dyssynergia: impaired ability to associate muscles together for complex movement; decomposition of movementleadpipe rigidity: a hypertonic state characterized by increased uniform resistance that persists throughout the whole ROM & is independent of the velocity of movement. Associated c lesions of the basal ganglia system (extrapyramidal syndromes). Pts demonstare stiffness, inflexibility & significant functional limitationcogwheel rigidity: a hypertonic state of rigidity c superimposed rachet-like jerkiness; characterized by and alternating giving way & then increased resistance to movements (e.g., wrist and elbow flexion & extension). It may represent the presence of tremor superimposed on rigidity.Resting tremor: involuntary oscillatory movements that occur when a body segment is at rest; typically disappears or decreases c purposeful movement.
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Bradykinesia: extreme slowness and difficulty maintaining movementAkinesia: inability to initiate or execute movement
Differential diagnosis: comparison of UMN & LMN syndromesUMN lesion LMN lesion
Location of lesion, Structures involved
CNSCortex, brainstem, corticospinal tracts, spinal cord
Cranial nerve nuclei/ nervesSC: anterior horn cells, spinal roots, peripheral nerve
d/o Stroke, TBI, SCI Polio, GBS, PNI, peripheral neuropathy, radiculopathy
Tone Increased: hypertonia, clonusVelocity dependent
Decreased or absent: hypotonia, flaccidityNot velocity dependent
Reflexes Increased: hyperreflexia, clonusExaggerated cutaneous and autonomic reflexes + Babinski
Decreased or absent: hyporeflexiaCuaneous reflexes decreased or absent
Involuntary movements
Muscle spasms: flexor or extensor C denervation: fasciculations
Strength Weakness or paralysis: ipsilateral (stroke) or bilateral (SCI)Corticospinal: contralateral if above decussation in medulla; ipsilateral if belowDistribution: never focal
Ltd distribution: segmental or focal pattern, root-innervated pattern
Muscle bulk Variable, disuse atrophy Neurogenic atrophy; rapid, focal, severe wasting
Voluntary movements
Impaired or absent: dyssynergic patterns, obligatory synergies
Weak or absent if nerve interrupted
Flaccidity/hypotonia: terms used to define decreased or absent muscular tone. Resistance to passive movement is diminished, stretch reflexes are dampened or absent, and limbs are easily moved (floppy) Babinski: dorsiflexion of the great toe c fanning of the other toes on stimulation of the lateral sole of the foot