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Differential diagnosis: Comparison of major types of CNS D/o

LOCATION CEREBRAL CORTEX BASAL GANGLIA: SUBCORTICAL


OF LESION CORTICOSPINAL TRACTS GRAY
Disorder Stroke Parkinsonism
Sensation Impaired or absent: depends on Not affected
location of lesion: contralateral
sensory loss
Tone Hypertonia/spasticity velocity- ↑ uniform resistance: leadpipe
dependent clasp knife initial rigidity
flaccidity: cerebral shock
Rachet-like at wrist or forearm:
cogwheel; independent of rate
Reflexes ↑ hypereflexia Normal or maybe ↓
Strength Contralateral weakness/paralysis: Slowness of movement
hemiplegia
Bulk Normal: acute; disuse atrophy: Normal or disuse atrophy
chronic
Involuntary Spasms Resting tremor
movements
Voluntary Dyssynergic: abnormal timing, Bradykinesia/akinesia slowness,
movements coactivation, activation, lack of spontaneous and automatic
fatigability movements
Postural Impaired or absent, depends on Impaired: stooped
control the lesion location
Gait Impaired: gait deficits due to Impaired: shuffling , festinating gait
abnormal synergies, spasticity,
timing deficits
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 movement
leadpipe 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 limitation
cogwheel 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.
Bradykinesia: extreme slowness and difficulty maintaining movement
Akinesia: inability to initiate or execute movement

Differential diagnosis: comparison of UMN & LMN syndromes


UMN lesion LMN lesion
Location of CNS Cranial nerve nuclei/ nerves
lesion, Cortex, brainstem, corticospinal SC: anterior horn cells,
Structures tracts, spinal cord spinal roots, peripheral
involved nerve
d/o Stroke, TBI, SCI Polio, GBS, PNI, peripheral
neuropathy, radiculopathy
Tone Increased: hypertonia, clonus Decreased or absent:
Velocity dependent hypotonia, flaccidity
Not velocity dependent
Reflexes Increased: hyperreflexia, clonus Decreased or absent:
Exaggerated cutaneous and hyporeflexia
autonomic reflexes + Babinski Cuaneous reflexes
decreased or absent
Involuntary Muscle spasms: flexor or extensor C denervation:
movements fasciculations
Strength Weakness or paralysis: ipsilateral Ltd distribution: segmental
(stroke) or bilateral (SCI) or focal pattern, root-
Corticospinal: contralateral if above innervated pattern
decussation in medulla; ipsilateral if
below
Distribution: never focal
Muscle bulk Variable, disuse atrophy Neurogenic atrophy; rapid,
focal, severe wasting
Voluntary Impaired or absent: dyssynergic Weak or absent if nerve
movements patterns, obligatory synergies 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

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