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Neurology - Weakness Patterns

This document describes the differences between upper motor neurone and lower motor neurone lesions. It notes that upper motor neurone lesions cause increased tone, pyramidal pattern weakness, reduced coordination, increased reflexes, positive Babinski reflex, and signs like pronator drift and clasp knife response. Lower motor neurone lesions cause decreased tone, focal pattern weakness only in muscles innervated by the damaged neurone, reduced or absent reflexes, and negative Babinski reflex and signs like muscle wasting and fasciculations. The document provides a table contrasting the features of upper and lower motor neurone lesions.

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Anisah Ali
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91 views2 pages

Neurology - Weakness Patterns

This document describes the differences between upper motor neurone and lower motor neurone lesions. It notes that upper motor neurone lesions cause increased tone, pyramidal pattern weakness, reduced coordination, increased reflexes, positive Babinski reflex, and signs like pronator drift and clasp knife response. Lower motor neurone lesions cause decreased tone, focal pattern weakness only in muscles innervated by the damaged neurone, reduced or absent reflexes, and negative Babinski reflex and signs like muscle wasting and fasciculations. The document provides a table contrasting the features of upper and lower motor neurone lesions.

Uploaded by

Anisah Ali
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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NEUROLOGY

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
Reflexes Increased Reduced/ Absent
Babinski Positive Negative
Others Pronator drift Muscle wasting
Clasp knife response (to removal of Fasciculations
force) Fibrillations
Causes Stroke/ traumatic brain injury Myasthenia gravis
Motor Neurone Disease Motor Neurone Disease
Multiple Sclerosis
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.
 Akathisia- feeling of internal restlessness
 Drug induced Parkinsonism- tremor, rigidity etc.
 Tardive dyskinesia- 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
Dysphagia/ choking/ nasal regurgitation Dysphagia/ choking
Dysarthria Dysarthria
Dysphonia Dysphonia
Signs Rasping speech (unilateral) Slow, indistinct speech
Nasal speech (bilateral) Stiff, spastic tongue
Atrophic tongue/ fasciculations Emotions labile
Drooling Brisk jaw reflex (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 brainstem 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

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