WEAKNESS PATTERNS First determine if the lesion is affects upper or lower motor neurones:

Upper Motor Neurone Lower Motor Neurone Tone ↑ ‘Spastic’ ↓ ‘Flaccid’ Weakness ‘Pyramidal’ pattern i.e. weakness of Focal pattern i.e. only muscles upper limb extensors, lower limb innervated by damaged neurones are flexors affected Coordination Reduced Increased Reduced/ Absent Babinski Positive Negative Others Pronator drift Muscle wasting Clasp knife response (to removal of Fasciculations force) Fibrillations Causes / Myasthenia gravis Motor Neurone Disease Motor Neurone Disease Cerebral Palsy

CAP 37 HAP 33 Kevin Gervin 7/2/17 What do we mean by extrapyramidal?

Extrapyramidal symptoms  Symptoms affecting tracts other than corticospinal and corticobulbar  Extrapyramidal tracts don’t travel through the medullary pyramids  The system regulates posture and muscle tone so pathology usually leads to movement disorders  Most common cause is typical antipsychotics affecting Dopamine (D2) receptors e.g. haloperidol  Treatment is anticholinergics e.g. procyclidine

Extrapyramidal conditions:  Acute dystonic reactions → muscle spasms e.g. neck, jaw, back.  - feeling of internal restlessness  Drug induced - , rigidity etc.  Tardive - involuntary muscle movements of lower face and extremities, often permanent

What’s the difference between a Bulbar and Pseudobulbar palsy?

Bulbar Pseudobulbar Pathophysiology LMN lesion CN V, VII, IX- XII Disease of corticobulbar tracts UMN lesion CN IX- XII Symptoms Difficulty chewing Difficulty chewing / choking/ nasal regurgitation Dysphagia/ choking Dysarthria Dysphonia Dysphonia Signs Rasping speech (unilateral) Slow, indistinct speech Nasal speech (bilateral) Stiff, spastic tongue Atrophic tongue/ fasciculations Emotions labile Drooling Brisk jaw (Gag can be ↑↓↔) Absent jaw & gag reflex UMN lesion of limbs Normal emotions LMN lesions of limbs Causes Botulism Bilateral CVA of internal capsule Medullary infarction Parkinson’s MND/ ALS MND/ ALS Lyme disease High tumours Guillain- Barre Demyelinating conditions e.g. MS Poliomyelitis Progressive supranuclear palsy Acute intermittent porphyria Myasthenia Gravis

CAP 37 HAP 33 Kevin Gervin 7/2/17