Neurological Disorders and Pain Mechanisms
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Questions and Answers

What is Thalamic Pain Syndrome and what primary symptoms does it present with?

Thalamic Pain Syndrome, or central post-stroke pain, is characterized by contralateral sensory loss, hemi-ataxia, and severe spontaneous burning pain.

Identify and describe the two main types of ataxia.

Sensory ataxia is due to loss of position sensation, while cerebellar ataxia results from lesions in the neocerebellum.

What are the characteristics of peripheral neuropathy and how does it differ between mononeuropathy and polyneuropathy?

Peripheral neuropathy leads to sensory loss in affected areas; mononeuropathy affects one nerve, whereas polyneuropathy involves multiple nerves, often causing 'glove and stocking' sensory disturbances.

Explain the pathophysiology of Herpes Zoster and its symptoms.

<p>Herpes Zoster occurs when the herpes virus attacks a dorsal root ganglion, causing severe pain and a painful skin rash in the associated dermatomal segment.</p> Signup and view all the answers

What defines neuropathic pain and what are some common examples?

<p>Neuropathic pain is a chronic pain arising from damage to nerve fibers, often described as burning or electric; examples include trigeminal neuralgia and diabetic neuropathy.</p> Signup and view all the answers

What role do sensory cortical lesions play in somatic sensations?

<p>Sensory cortical lesions do not completely abolish somatic sensations, indicating some degree of sensory function remains.</p> Signup and view all the answers

How does the distribution of symptoms differ in diabetic neuropathy compared to other neuropathies?

<p>Diabetic neuropathy typically presents with 'glove and stocking' sensory disturbances, affecting distal areas of the limbs.</p> Signup and view all the answers

What are the key features that distinguish neuropathic pain from other pain types?

<p>Neuropathic pain is characterized by specific sensations such as burning or tingling, and it often occurs in paroxysms along with hyperalgesia and/or paresthesia.</p> Signup and view all the answers

What are the consequences of a spinal cord hemi section at the level of the lesion?

<p>At the level of the lesion, there is flaccid paralysis and loss of all reflexes on the same side, along with loss of all sensations at the corresponding dermatome.</p> Signup and view all the answers

What sensory and motor consequences occur below the level of a spinal cord hemi section on the same side?

<p>Below the lesion, there is loss of fine touch, pressure, and vibration sensation due to dorsal column damage, along with spastic paralysis and hyper-reflexia from corticospinal tract damage.</p> Signup and view all the answers

What are the sensory deficits observed on the opposite side of a spinal cord hemi section?

<p>On the opposite side, there is a loss of pain and temperature sensations due to the lesion in the crossed spinothalamic tract.</p> Signup and view all the answers

What role does the lateral zones of the cerebellum play in voluntary movement?

<p>The lateral zones of the cerebellum plan and time movements by receiving impulses from cortical association areas, coordinating the progression from one movement to the next.</p> Signup and view all the answers

Describe ataxia and its relation to cerebellar lesions.

<p>Ataxia is characterized by incoordination of movements, resulting from errors in the rate, range, force, and direction of movement due to cerebellar lesions.</p> Signup and view all the answers

What happens to reflex arcs in the case of areflexia?

<p>Areflexia involves the interruption of the reflex arc, which can be caused by peripheral neuritis or tabes dorsalis.</p> Signup and view all the answers

How does a lesion in the cerebellar cortex differ from one in the cerebellar nuclei concerning movement abnormalities?

<p>Lesions in the cerebellar cortex lead to temporary movement abnormalities that may compensate over time, while lesions in the cerebellar nuclei produce permanent and generalized defects.</p> Signup and view all the answers

How do the corticospinal tract and spinothalamic tract contribute to motor function and sensation after a spinal cord injury?

<p>The corticospinal tract is responsible for voluntary motor control, and its damage leads to spastic paralysis, while the spinothalamic tract affects pain and temperature sensations, causing loss on the opposite side of a spinal cord injury.</p> Signup and view all the answers

What role does the intermediate zone of the cerebellum play in voluntary movements?

<p>It compares intended movements with actual movements and initiates corrective signals to the motor cortex.</p> Signup and view all the answers

Define hyporeflexia and provide two conditions that can cause it.

<p>Hyporeflexia is a decreased reflex response due to interruption of facilitatory impulses; it can be caused by neocerebellar syndrome and myxoedema.</p> Signup and view all the answers

Describe the 'rebound phenomenon' associated with cerebellar lesions.

<p>The rebound phenomenon refers to the inability to stop movement promptly when resistance is removed, causing the limb to fly backward.</p> Signup and view all the answers

What is intention tremor, and how does it differ from resting tremors?

<p>Intention tremor is characterized by oscillations that occur during voluntary movements, while resting tremors occur when limbs are at rest.</p> Signup and view all the answers

What is the significance of the cortico-ponto-cerebellar tract in motor control?

<p>It transmits information about commands from the motor cortex to the cerebellum, facilitating adjustments to muscle activity.</p> Signup and view all the answers

How do hypereflexia and hyporeflexia differ in terms of neurological function?

<p>Hypereflexia involves exaggerated reflex responses due to upper motor neuron lesions, while hyporeflexia entails diminished responses from interrupted facilitatory impulses.</p> Signup and view all the answers

Explain what dysmetria is and how it can be assessed.

<p>Dysmetria is the inability to properly gauge distances in movement, often assessed using the finger-nose test which reveals overshooting.</p> Signup and view all the answers

What are the common signs of disturbance in posture and gait associated with cerebellar lesions?

<p>Common signs include a wide-based, unsteady gait and tilting of the head toward the side of the lesion.</p> Signup and view all the answers

What is adiadochokinesia and how does it manifest in patients?

<p>Adiadochokinesia is the inability to perform rapidly alternating opposite movements, such as repeated pronation and supination of the hands.</p> Signup and view all the answers

Describe the 'decomposition of movements' seen in patients with cerebellar disease.

<p>Decomposition of movements refers to the difficulty in performing actions that involve simultaneous motion at more than one joint.</p> Signup and view all the answers

What types of sensory losses are observed with a lesion in the somatic sensory association cortex?

<p>The types of sensory losses include loss of fine touch, stereognosis, proprioceptive sensations, and some pain localization but with mild effects on pain sensation.</p> Signup and view all the answers

What are the characteristics of nystagmus, particularly horizontal nystagmus?

<p>Nystagmus is characterized by tremors of the eyeball when attempting to fix gaze laterally, often due to lack of damping function.</p> Signup and view all the answers

What is syringomyelia and how does it affect sensory modalities?

<p>Syringomyelia is a condition characterized by the widening of the central canal in the spinal cord, affecting pain, temperature, and crude touch sensations due to damage to crossing fibers.</p> Signup and view all the answers

Explain the term hypotonus in the context of cerebellar lesions.

<p>Hypotonus refers to decreased muscle tone on the side of the lesion, resulting in diminished stretch reflexes.</p> Signup and view all the answers

What role does the cerebellum play in the planning and timing of movements?

<p>The cerebellum functions as a servo-comparator that assists in planning and timing voluntary movements.</p> Signup and view all the answers

Describe the impact of tabes dorsalis on sensory function and coordination.

<p>Tabes dorsalis leads to degeneration of sensory nerves causing loss of vibration and proprioceptive senses, resulting in incoordination and ataxia.</p> Signup and view all the answers

What is primary hyperalgesia and what causes it?

<p>Primary hyperalgesia is an exaggerated pain response in injured or inflamed skin, caused by the sensitization of peripheral nociceptors by inflammatory mediators.</p> Signup and view all the answers

How does the cerebellum contribute to the maintenance of equilibrium?

<p>The cerebellum maintains equilibrium via input from the vestibular apparatus, modulating tone in axial and girdle muscles.</p> Signup and view all the answers

How does secondary hyperalgesia differ from primary hyperalgesia?

<p>Secondary hyperalgesia occurs in uninjured skin and is due to sensitization of central pain neurons, which leads to prolonged and severe pain when the pain threshold is reached.</p> Signup and view all the answers

What is the basis of muscle tone and its role in the human body?

<p>Muscle tone is based on static stretch reflex and is essential for maintaining body posture against gravity.</p> Signup and view all the answers

Why does muscle tone not lead to fatigue?

<p>Muscle tone does not cause fatigue due to the subtetanic contraction of different muscle fibers alternating in use.</p> Signup and view all the answers

Explain the term 'dissociated sensory loss' in the context of syringomyelia.

<p>'Dissociated sensory loss' refers to the preservation of dorsal column sensations, such as fine touch, while there is loss of pain and temperature sensations.</p> Signup and view all the answers

What are the clinical signs associated with sensory ataxia in patients with tabes dorsalis?

<p>Patients with sensory ataxia typically exhibit a high steppage gait and a positive Romberg's sign, indicating loss of proprioceptive input.</p> Signup and view all the answers

What does the term 'amorphosynthesis' refer to and what causes it?

<p>Amorphosynthesis, or neglect syndrome, refers to the failure to perceive or respond to stimuli on the contralateral side of the body due to lesions in sensory areas of the cortex.</p> Signup and view all the answers

What are the main manifestations of cerebellar lesions?

<p>The main manifestations include ataxia, disturbance of posture and gait, dysmetria, intention tremor, adiadochokinesia, slurred speech, and nystagmus.</p> Signup and view all the answers

How does the neocerebellum influence the stretch reflex?

<p>The neocerebellum facilitates the stretch reflex by prolonging its effect, aiding in posture maintenance.</p> Signup and view all the answers

What role do muscle spindles play during voluntary movements?

<p>Muscle spindles assist in smooth muscle contractions through feedback adjustments and prevent oscillatory movements.</p> Signup and view all the answers

Describe the braking effect of the cerebellum in motor control.

<p>The cerebellum inhibits the motor cortex to precisely time muscle movements, allowing for corrections to stop at the intended point.</p> Signup and view all the answers

What impacts result from damaging the deep cerebellar nuclei?

<p>Damage leads to symptoms like ataxia and disturbances in posture and gait, affecting coordination on the same side as the lesion.</p> Signup and view all the answers

Explain the significance of the stretch reflex in maintaining muscle tone.

<p>The stretch reflex helps to maintain muscle length and control voluntary movements, essential for muscle tone.</p> Signup and view all the answers

What is adiadochokinesia and how does it manifest?

<p>Adiadochokinesia is an inability to perform rapid alternating movements, often observed in patients with cerebellar lesions.</p> Signup and view all the answers

Why is the cerebellum described as having a 'braking effect' on movements?

<p>It provides inhibitory impulses to control and fine-tune muscle actions after they begin, ensuring smooth and accurate movements.</p> Signup and view all the answers

Flashcards

Thalamic Pain Syndrome

A rare condition that arises after a stroke affecting the ventro-postero-lateral thalamus, causing severe burning pain on one side of the body.

Ataxia

A loss of coordination in voluntary movements without weakness, caused by damage to the cerebellum, sensory pathways, or vestibular system.

Sensory Ataxia

A type of ataxia caused by damage to the posterior columns of the spinal cord, leading to impaired sense of position.

Cerebellar Ataxia

A type of ataxia caused by damage to the cerebellum, the part of the brain responsible for coordinating movements.

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Vestibular Ataxia

A type of ataxia caused by damage to the vestibular system, responsible for balance and spatial awareness.

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Neuropathic Pain

A type of pain caused by damage to or dysfunction of the nervous system, often described as burning, stabbing, or shooting.

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Herpes Zoster

A viral infection affecting a dorsal root ganglion, causing severe pain in the corresponding dermatome.

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Mononeuropathy

Damage to a single peripheral nerve, leading to sensory loss in the area it supplies.

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Sensory Loss at the Level of Lesion in Brown-Sequard Syndrome

Loss of all sensation at the level of the spinal cord injury, including touch, pressure, temperature, and pain.

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Motor Loss at the Level of Lesion in Brown-Sequard Syndrome

Weakness or paralysis on the same side of the body as the spinal cord injury.

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Sensory Loss Below the Level of Lesion (Same Side) in Brown-Sequard Syndrome

Loss of fine touch, pressure, vibration, and proprioception on the same side of the body below the level of the spinal cord injury.

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Motor Loss Below the Level of Lesion (Same Side) in Brown-Sequard Syndrome

Increased muscle tone and reflexes on the same side of the body below the level of the spinal cord injury.

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Sensory Loss Below the Level of Lesion (Opposite Side) in Brown-Sequard Syndrome

Loss of pain and temperature sensation on the opposite side of the body below the level of the spinal cord injury.

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Cerebellum Role in Voluntary Movements

The cerebellum receives signals from the cortex, plans movements, and sends signals back to the cortex to initiate movements through the corticospinal tract.

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Ataxia in Cerebellar Lesions

Incoordination of movements due to errors in rate, range, force, and direction of movement.

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Areflexia

Absence of reflexes, often seen in peripheral nerve damage or diseases affecting the sensory pathways.

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Syringomyelia

A condition where a fluid-filled cavity (syrinx) forms in the spinal cord's central canal, affecting pain and temperature perception. It usually affects the cervical region, resulting in a 'jacket' loss of pain and temperature sensation, while touch remains intact.

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Tabes Dorsalis

A neurological disorder caused by syphilis that damages sensory nerves in the spinal cord's dorsal root and column, leading to pain, loss of vibration sense, and proprioceptive sensation.

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Hyperalgesia

An exaggerated response to pain, categorized as primary and secondary. Primary occurs in injured areas due to sensitized nociceptors, while secondary occurs in unaffected areas due to central nervous system sensitization.

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Astereognosis

The inability to recognize objects by touch, despite intact sensory function, often associated with damage to the sensory association cortex.

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Amorphosynthesis (Neglect syndrome)

A neurological disorder where a patient neglects the contralateral side of their body, often caused by damage to the somatic sensory association cortex.

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Sensory Loss

A loss of fine touch, stereognosis, proprioception, weight discrimination, and temperature localization, often caused by lesions on the opposite side of the body.

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Stereognosis

The ability to perceive the size, shape, texture, and weight of an object through touch.

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Proprioception

The sense of body position and movement, allowing us to know where our limbs are without looking.

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Steppage Gait

A high-stepping gait, often seen in patients with sensory ataxia, where they lift their legs high to avoid tripping.

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Hypereflexia

A condition characterized by increased reflex responses, often caused by damage to the upper motor neuron or due to factors like anxiety or hyperthyroidism.

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Hyporeflexia

A condition characterized by decreased or absent reflex responses, often caused by damage to sensory pathways or conditions like myxoedema.

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Servo-comparator function of the cerebellum

The proposed mechanism that explains how the cerebellum compares intended movements with actual movements during voluntary actions. It involves a feedback loop between the cerebral cortex and the cerebellum, allowing for corrections to be made.

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Intermediate zone of cerebellar hemisphere

The part of the cerebellum responsible for receiving information from the cerebral cortex about intended movements.

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Intention tremor

A type of tremor that appears during voluntary movements, and is absent at rest.

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Rebound phenomenon

A condition characterized by impairment of voluntary movements caused by difficulty in 'stopping' a movement once it has started.

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Scanning speech

A type of speech characterized by a slow, hesitant, and broken rhythm.

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What is ataxia?

The ability to coordinate voluntary movements, allowing for smooth and accurate actions.

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What is an intention tremor?

A jerky or tremoring movement that occurs when a person tries to perform a precise action like reaching out to touch something.

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How is the cerebellum related to ataxia?

The cerebellum is a part of the brain that helps with coordination and balance. Damage to the cerebellum causes ataxia.

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What is the stretch reflex?

A reflex that helps maintain muscle length and tone. It involves the stretch receptors in muscles.

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How does the stretch reflex contribute to voluntary movements?

The stretch reflex helps maintain the muscle length and prevents jerky movements during voluntary actions.

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What is the α-γ-linkage?

The α-γ-linkage allows the muscle spindle to remain sensitive during muscle contraction, ensuring proper coordination.

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How does the cerebellum act as a brake during voluntary movements?

The cerebellum's inhibitory role is crucial to precisely stopping movements at the intended point.

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What causes cerebellar lesions?

Damage to the deep cerebellar nuclei and cerebellar cortex can cause ataxia and other movement disorders.

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Adiadochokinesia

Inability to perform rapidly alternating opposite movements, such as repeated pronation and supination of the hands.

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Decomposition of Movements

Difficulty performing actions involving simultaneous motion at multiple joints, often tested by the heel-knee test.

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Nystagmus

Tremor of the eyeball that occurs when fixing gaze on an object to the side of the head.

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Cerebellar Hypotonia

Marked decrease in muscle tension on the side of a cerebellar lesion.

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Muscle Tone

The continuous, alternating, subtetanic contraction of muscle fibers responsible for muscle tone.

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Base of Muscle Tone

Reflects the continuous stretching of the muscle spindle during rest due to factors like gravity, muscle length, and y-efferent discharge.

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Flocculonodular Lobe

The part of the cerebellum responsible for maintaining equilibrium.

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Cerebellum Function in Equilibrium

A feedback circuit between the flocculonodular lobe and the vestibular apparatus helps maintain balance by adjusting muscle tone.

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Study Notes

Thalamic Pain Syndrome (Dejerine Roussy Syndrome)

  • Also known as central post-stroke pain (CPSP)
  • A rare condition
  • Develops after infarction of the ventro-postero-lateral thalamus
  • Symptoms:
    • Contralateral sensory loss
    • Hemi-ataxia
    • Thalamic pain (spontaneous bursts of intolerable burning pain) - accompanied by secondary hyperalgesia and allodynia

Ataxia

  • Definition: Incoordination of voluntary movements without paralysis
  • Types:
    • Sensory ataxia: Due to loss of position sense (e.g., tabes dorsalis, pernicious anemia)
    • Cerebellar ataxia: Due to lesions in the neocerebellum
    • Vestibular ataxia: Due to lesions in the vestibular division of the 8th nerve

Peripheral Neuropathy

  • Mononeuropathy: Injury to one peripheral nerve causes loss of sensation in the area supplied by that nerve
  • Polyneuropathy (peripheral neuritis):
    • Diffuse lesion of all peripheral nerves (e.g., Vitamin B12 deficiency, diabetic neuritis)
    • Affects distal sensory nerve endings, causing "glove and stocking" sensory disturbance (numbness, tingling, burning, and ultimately complete sensory loss)
    • Nerve injury can lead to chronic neuropathic pain

Herpes Zoster

  • Viral infection caused by the herpes virus
  • Attacks the dorsal root ganglion (DRG) in individuals with a history of varicella (chickenpox) infection
  • Virus reproduces, irritating pain afferents and causing severe pain in the affected dermatomal segment
  • Virus spreads along neuronal cytoplasmic flow to peripheral axons, causing painful skin rash and vesicles.

Neuropathic Pain

  • Chronic pain due to damage or pathological changes in peripheral or central nervous system nerve fibers.
  • Characteristics: Often described as burning, electric, tingling, or shooting pain in bouts or paroxysms, usually accompanied by hyperalgesia and/or paraesthesia.
  • Examples: Trigeminal neuralgia, herpes zoster, diabetic neuropathy, and sciatica

Sensory Cortical Lesions

  • Lesion in the somatic sensory area (SSI):
    • Preserves overall sensation, but loss of fine touch, stereognosis, proprioception, and discrimination of subtle differences in weights and temperature.
    • Pain localization is relatively preserved.
  • Lesion in the somatic sensory association cortex:
    • Astereognosis: Inability to determine shape, size, texture, and weight of objects.
    • Amorphosynthesis/Neglect syndrome: Patient neglects the contralateral side of the body.

Syringomyelia

  • Widening of the central canal of the spinal cord by a fluid-filled cavity (syrinx)
  • Initially damages pain and temperature fibers immediately in front of the central canal. Crude touch is affected later.
  • Bilateral lesion, usually affecting the cervical region
  • Causes "jacket" distribution of loss of pain and temperature sensations, while fine touch (dorsal columns) is largely preserved.

Tabes Dorsalis

  • Neurosyphilitic disease causing slow degeneration of sensory nerves in the dorsal root and dorsal columns, most notably in the lumbosacral spinal cord.
  • Results of degeneration and atrophy of the dorsal columns:
    • Loss of vibration sense
    • Loss of proprioceptive sensation leading to incoordination of voluntary movements (ataxia)
  • Symptoms include: High steppage gait, positive Romberg's sign (inability to maintain balance with eyes closed).

Hyperalgesia

  • Exaggerated pain response
  • Primary hyperalgesia: Occurs in injured/inflamed skin; sensitization of peripheral nociceptors due to inflammatory mediators; lowered pain threshold (like sunburn).
  • Secondary hyperalgesia: Occurs in uninjured surrounding skin; sensitization of central pain neurons; prolonged, severe, and intolerable pain; may involve allodynia (exaggerated pain response to non-painful stimuli) as seen in thalamic pain.

Spinal Cord Hemi-section (Brown-Sequard Syndrome)

  • Results in hemi-section of the spinal cord
  • Symptoms depend on the level of the lesion and the side affected.
  • Lesion at the level of the injury:
    • Sensory loss on the same side as the lesion
    • Motor loss and reflex loss on the same side as the lesion
  • Lesion below the level of the injury:
    • Sensory loss on the same side as the lesion (dorsal column damage)
    • Paralysis and hyperreflexia on the same side as the lesion (corticospinal tract damage)
    • Pain and temperature loss on the opposite side as the lesion (spinothalamic tract damage)

Cerebellar Function in Voluntary Movements

  • Planning and timing of voluntary movements
    • Lateral cerebellum receives afferent impulses from cortical association areas, plans movements along with other CNS areas
    • Cerebellum sends signals to motor cortex via corticospinal tract for movement execution, comparing intended movements to actual movements and providing corrective inputs
    • Lateral cerebellum facilitates smooth transition and timing of movements.

Cerebellar Lesions

  • Ataxia:
    • Marked abnormalities in movements observed when a patient moves
    • Incoordination of voluntary movements (errors in rate, range, force, direction).
  • Lesion to the cerebellar cortex:
    • Abnormalities often resolve with compensation, and movements improve
  • Lesion to cerebellar nuclei:
    • Abnormalities are usually permanent and more widespread.

Stretch Reflex Abnormalities

  • Areflexia/Atonia: Interruption of reflex arc (e.g., peripheral neuritis, tabes dorsalis, poliomyelitis)
  • Hypereflexia/Hypertonia: Interruption of inhibitory impulses (e.g., upper motor neuron lesions, anxiety, hyperthyroidism)
  • Hyporeflexia/Hypotonia: Interruption of facilitatory impulses (e.g., neocerebellar syndrome, sleep, myxoedema)

Cerebellar Function in Equilibrium

  • Flocculonodular lobe is crucial for equilibrium
  • Connected by feedback circuits with the vestibular apparatus
  • Cerebellum receives vestibular inputs, sends signals to brain stem (reticulospinal and vestibulospinal tracts) to alter tone of axial and girdle muscles needed for balance.
  • Damage causes equilibrium disturbances

Physiological Significance of the Stretch Reflex

  • Maintains muscle length
  • Contributes to control of voluntary movements
  • Responsible for muscle tone

Cerebellar Function in Muscle Tone

  • Neocerebellum: Facilitatory to stretch reflexes, prolonging the effect and aiding in posture maintenance
  • Paleocerebellum: Inhibitory to muscle tone via the inhibitory reticular formation

Muscle Spindle Role in Voluntary Movements

  • Servo-assistant function: Coordinated alpha and gamma motor neuron activation during muscle contraction, enabling adaptive adjustments throughout movement.
  • Damping function: Maintaining smooth movements by preventing jerky oscillations commonly seen during voluntary movements; muscle spindles prevent jerky oscillations in movements.

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Thalamic Pain Syndrome, Ataxia, and Peripheral Neuropathy PDF

Description

Explore various neurological conditions including Thalamic Pain Syndrome, ataxia, neuropathies, and the effects of spinal cord injuries. This quiz delves into the pathophysiology of these disorders, their symptoms, and how they differ, particularly focusing on neuropathic pain. Test your knowledge of sensory and motor consequences related to these neurological issues.

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