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Upper & Lower motor neuron syndroms

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mina alemam

on 2 December 2015

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Transcript of Upper & Lower motor neuron syndroms

Pseudobulbar plasy
characterized by degeneration of upper motor neurons that transmit signals to the lower motor neurons in the brain stem.
progressive loss of the ability to speak, chew, and swallow. Progressive weakness in facial muscles leads to an expressionless face.

a harsh voice and an increased gag reflex. The tongue may become immobile and unable to protrude from the mouth. Individuals may have outbursts of laughing or crying.
Upper Motor Neuron Signs
The clinical aspect of Upper & Lower motor neuron syndroms
Upper Motor Neurons That Initiate Complex Voluntary Movements
Gag Reflex/dysphagia in stroke patients
Pseudobulbar palsy
Extrapyramidal system

rubrospinal tract
pontine reticulospinal tract
medullary reticulospinal tract
lateral vestibulospinal tract
tectospinal tract
Diseases with upper motor neuron lesions
Ischemic: Cerebrovascular events
Infection: Brain abcess, meningoencephalitis
Demylination: Mutiple sclerosis
Motor Neuron disease: (may have LMN presentation or combination of UMN &LMN)
Gag reflex – increased or normal
Tongue – spastic
“it cannot be protruded, lies on the floor of the mouth and is small and tight”.
Palatal movement – absent.
Jaw jerk – increased
Speech – spastic: “a monotonous, slurred, high-pitched, ‘Donald Duck’ dysarthria” that “sounds as if the patient is trying to squeeze out words from tight lips”.
The commonest cause is bilateral CVAs affecting the internal capsule.

Other causes include:

Multiple sclerosis
Motor neurone disease
High brainstem tumours
Head injury
Facial asymmetry

Atrophy of muscles of lower portion of the face on affected side*

No eyebrow droop*

Intact folds on forehead*

Intact conjunctival reflex (orbicularis oculi innervation is intact)

Smoothing of nasolabial folds on affected side

Lips cannot be held tightly together or pursed

Difficulty keeping food in mouth while chewing on affected side

Lower motor neuron
cranial nerve nucleus in brain stem, and alpha and gamma motor neurons of the spinal cord
It consists of LMN signs in regions innervated by the facial (VII), glossopharyngeal (IX), Vagus (X) and hypoglossal (XII) -
bulbar plasy
Palsy of:
Facial muscles
Sign appear like LMN signs:
Flaccid, fasciculating tongue (‘bag of worms)
Jaw jerk is normal - shows trigeminal is still intact
Speech may be quiet, nasal

Guillian-Barre Syndrome
Brainstem tumours
Myasthenia gravis
Myotonic Dystrophy
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