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TUTORIAL- EXTRA PYRAMIDAL SYSTEM- UMN/LMN

Lecture 6

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Q1. Name the extra pyramidal tract.oRubrospinal tract = arise Red nucleusoVestibulospinal tract = arise Vestibular nuclei oReticulospinal tract = arise Reticular formation oTectospinal tract = arise superior colliculus

Q2. From where extra pyramidal tract arise and where

they end?

• End anterior horn motor neuronsQ3. What are the functions of extra pyramidal system?

1- POSTURE 2- MOVEMENT 3- TONE

Q4. What is the overall effect of extra pyramidal system or γ motor

neuron in anterior horn cell?

inhibitory effect over Gamma

Q5. What will be effect of extra pyramidal lesions? Select one:

a). Hypotonia b). Hypertonia

Q6. Give 3 differences between pyramidal and extra pyramidal system.

PYRAMIDAL TRACTS

- Lateral corticospinal - ventral corticospinal - Corticobulbar

located in precentral gyrus.

descend directly from cerebral

cortex to spinal cord.

80% cross in medulla 20% cross

in spinal cord. Function:- Lateral : fine movement: Eg: needle work- Ventral: Postural movement

EXTRA PYRAMIDAL TRACTS

-Rubrospinal -Vestibulospinal -Reticulospinal -Tectospinal originate in brainstem nuclei No direct control of motor cortex 3- all of them cross except

Vestibulospinal Function: - Control of body posture - involuntary movements muscle

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Q7.What is

i). Upper motor neuron From motor cortex to anterior horn cell of

spinal cord

ii). Lower motor neuron from anterior horn cell and ends on muscle

Q8. What will happen to the following in UMN/LMN lesion?

i). Size (bulk of muscle)

ii). Tone

iii). Power

iv). Tendon reflexes

v). Planter reflex

LMN lesion- Wasting

- Flaccidity. ( hypotonic )

- partial loss of power

- absent

- Babinski sign -ve

UMN lesion - not change

- Increased tone (Spasticity

- Loss of power

- Increased reflexes Clonus

- Babinski sign +ve

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Q9. What is the difference between hemiplegia and hemiparesis?

Where is the lesion?• Hemiplegia – Paralysis (loss of power) of half side of the

body Lesion “ UMN “ ( Cortex )• Hemiparesis – Partial loss of power of half side of the body

Lesion “ LMN “ ( ? )

Q10. What is paraplegia? Where is the lesion?

Paralysis in both legs Lesion “ Lumber or lower thoracic ”

Q11. What is brown sequard syndrome?

Hemicord lesion = right transcection or complete transection • dorsal columns lesion : loss of sensory • lateral corticospinal tract lesion : loss of motor • lateral spinothalamic tract lesion : loss of pain & temp

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Q12. If there is hemisection of spinal cord at L1 on right

side

a). What impairment will occur on right side?

Loss of Sensory : light touch vibration position

Loss of Motor : UMN = below site of lesion

( hypertonia – spastic – hyper reflexia clonus – Babinski

sign – paralysis Monoplegia )

b). What impairment will occur on left side?

Loss of Pain + temperature

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TUTORIALBrain Stem

Lecture 7

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Q1. What are the components of brain stem?

a). Midbrain b). pons c). medulla

Q2. What are the functions of brain stem?• Origin of majority of peripheral cranial nerves• Cardiovascular, respiratory, and digestive control centers• Regulation of muscle reflexes involved with equilibrium and

posture• arousal and activation of cerebral cortex• Role in sleep wake cycle

Q3. What cranial nerve arise from the brainstem

a). Midbrain : 3+4

b). Pons : 5+6+7+8

c). Medulla : 9+ 10+11+12

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Q4. Which cranial nerve causes Pupillary constriction when we put

light in the eye?

• Oculomotor

Q5. What are vegetative functions of brain stem?

• respiration, circulation, and digestion

involuntary functions performed unconsciously

Q6. What is vegetative life?

• loss of higher brain functions, lower brain levels, inconjunction

with supportive therapy that is providing adequate nourishment

can sustain life but person has no awareness or control of life.

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Q7.What is brain death?

irreversible cessation of cerebral functions, both cerebral

hemispheres and brain stem.

Q8. What is the difference between vegetative life and brain death?

in vegetative life Cerebral cortex is damaged While

in brain death The Cerebral cortex and brain stem is damaged

irreversibly.

Q9. What happens to spinal reflexes in brain death?

They are _________ . Select one:

a) Present

b) Lost

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TUTORIALCerebellum

Lecture 8

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Q1 a. What are the functions of Cerebellum?• Maintenance of balance• Enhancement of muscle tone• Coordination and planning of skilled voluntary muscle activity

b. Name three parts of cerebellum.

Vermis - Intermediate zone - Lateral zone

Q2. What are the layers of cerebellar cortex from outside to inside?– Molecular cell layer– Purkinje cell layer– Granular cell layer

Q3. What are • a). Mossy fibers Originate Vestibulo cerebellar, Spino cerebellar and Ponto

cerebellar Make multiple synapses on Purkinje cells b). Climbing fibers Originate from inferior olive in the medulla • Play role in cerebellar motor learning Make multiple synapses on

Purkinje cells

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Q4. What cell type is responsible for cerebellar output? It is exhibitory or

inhibitory?• Purkinje “ inhibitory “

Q5. Name the clinical signs seen in the cerebellar disease.T – Tremor (intention)A – Ataxia (Drunken gait , unsteady gait)N – NystagmusD – Dysdiadokokinesia D – Dysmetria D – Dysarthria

Q6. What is intention tremor? oscillating movements of a limb as it

approaches the object e.g. (finger nose test)

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Q7.What is Dysdiadochokinesia?

• Inability to perform rapid alternate movements smoothly e.g.

doing pronation and supination of one hand on other

Q8. What happens to the gait in cerebellar disease?

• Ataxia “Drunken gait - unsteady gait”

Q9. What happens to speech in cerebellar disease?• Dysarthria

Q10. Is there paralysis in cerebellar disease?

• No but there is hypotonia

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TUTORIALBasal Ganglia

Lecture 9

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Q1. What is difference between basal ganglia and basal nuclei?

basal nuclei = cell bode nucleus masses of gray matter in CNS

basal ganglia = in PNS

Q2. Name the 5 structures which belong to basal ganglia.1. Caudate Nucleus 2. Putamen 3. Globus Palidus4. Subthalamic Nuclei5. Substantia Nigra

Q3. What are the functions of basal nuclei?• Inhibition of muscle tone • Coordination of slow, sustained movements• Suppression of useless pattern of movement

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Q4. In basal nuclei lesion, what happens to

a). Movements: Hypokinesia or Akinesia

Tremor ( Resting )

b). Muscle tone: Increased muscle tone ( Rigidity )

Q5. In Parkinson’s disease, where is the pathology?• basal ganglia (substantia nigra)

Q6. Which neurotransmitter is lost in Parkinson's?

DOPAMINE

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Q7. What are clinical symptoms of Parkinson’s disease?® resting tremor® bradykinesia (generalized slowness of movements) ® muscle rigidity

Q8. What is

a). Lead pipe rigidity • Stiffness of limb movement equal in opposing muscle.

b). Cogwheel rigidity

• When stiffness is combined with tremor.

Q9. What happens to facial expression and blinking?• expressionless, mask like face - Blinking of eyelid is reduced

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Q10. What happens to

a). Posture : STOOP

b). Gait :• becomes hurrying, festinant, short and shuffling with poor arm

swinging• Balance is impaired• Falls are common

Q11. What happens to speech in Parkinsonism?

monotonous, slurring dysarthria

due to combined tremor and rigidity

Q12. Is there any paralysis in Parkinsonism?

No- but slow movement ” bradykinesia “

Q13. Is there any sensory loss in Parkinson’s Disease?

• No sensory loss

Q14. What is Huntington’s chorea? Where is the lesion? • quick, uncontrollable movements due to decrease

neurotransmitter GABA and Acetylcholine

• Lesions of Striatum (Caudate nucleus and Putamen)

Q15. What is Athetosis? Where is the lesion?

• spontaneous writhing ( Twisting ) movements of the hand, arm,

neck, and face - Lesions of Globuspallidus

Q16. What is Hemiballismus? Where is the lesion?

• sudden wild flinging movements of the half of the body. - Lesions

of Subthalamic nuclei21

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TUTORIALThalamus / Hypothalamus

Lecture 10

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Q1. What are the functions of thalamus?• relay sensory input Somatic, auditory, visual , visceral ( except

olfactory ).• sleep- awake cycle

Q2. Can pain be localized by thalamus? No

Q3. What are the functions of Hypothalamus?1. Controls body temperature 2. Controls thirst and urine output 3. Controls food intake(Hunger and Satiety center ) 4. Controls anterior pituitary hormone secretion 5. Produces posterior pituitary hormones 6. Controls uterine contraction and milk ejection 7. Serves as major ANS coordinating center 8. Plays role in emotional and behavioral pattern 9. Participates in the sleep – wake cycle

Q4. What is normal body temperature? 98.4oF (37oC)

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Q5. What is core temperature?• It is temperature of deep tissues of the body. It remains

constant within ±1oF .

Q6. Why there is body temperature?

• oxidation of metabolic fuel derived from food.

Q7. At what temperature can convulsions occur?

• 106oF (41oC)

Q8. Give 4 mechanisms by which heat exchange takes place by the

body to maintain the body temperature.1. Radiation = by heat waves 2. Conduction = by direct contact3. Convection = by air currents4. Evaporation = from the skin surface + respiratory

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Q9. How hypothalamus regulates the body temperature?

• receives afferent information about temperature through

receptors called Thermoreceptors.

Q10. What is the role of posterior region of hypothalamus in

temperature regulation?

• Activated by Cold : to produce heat

Q11. What is the role of anterior region of hypothalamus in

temperature regulation?

• Activated by Heat : to produce cold

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Q12. What is heat exhaustion?• exposed to high temperature combined with increased physical

activity and humidity. (dehydration 40oC fainting ↓bP)

Q13. What is heat stroke?

• breakdown of thermo-regulatory mechanism in hypothalamus

Q14. What will you advise to reduce the risk of heat exhaustion and heat

stroke?• Stay out of sun during hottest part of the day.• Avoid extreme physical exertion.• cold drink - Take cool shower -Keep the environment cool.

Q15. What is frostbite? Why tissue damage occur in frost bite?

excessive cooling of particular part of the body to the point where tissue

in that area is damaged. Due to breaking down of hypothalamus

thermostat under the 30 oC which is responsible for heat regulation.

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TUTORIALLimbic System

Lecture 11

Q1. What are the functions of Limbic System?1. Emotion 2. Behavior3. Motivation 4. Memory

Q2. What structures are included in the limbic system?• Amygdala• Hippocampus• Cingulate gyrus• Portions of hypothalamus• Portions of thalamus• Portions of basal nuclei • Portions of lobes of cerebral cortex [ limbic association cortex]

Q3. Define emotions.

• feelings, mood, anger, happiness, fear,

• and physical responses associated with these feeling e.g. laughing, crying

Q4. Where sensation of fear arises?• Amygdala

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Q5. What are functions of Amgdala?• - Sociability - Fear response - Pleasure - Post traumatic stress - Aggression - Memory

Q6. What are the functions of Hippocampus?– reward and punishment determine whether or not

information will be stored as memory– If no reward or punishment, it is hardly remembered but

a person learns any sensory experience that causes pain or pleasure and makes strong memory trace

– hippocampus provides the drive to rehearse and consolidate these sensory experiences

Q7. In Alzheimer disease, there is memory loss. Which

area is affected first? Hippocampus

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Q8. Where is reward center?

• hypothalamus = lateral & ventromedial

• thalamus and Amygdala

Q9. Where is punishment center?

• hypothalamus + thalamus + Amygdala and

Hippocampus

Q10. Punishment has powerful effect or reward?

• Punishment