Ch.16

Brain Death (Brainstem Death

+ Body cannot maintain internal homeostasis + Brain death criteria -Completion of all appropriate, therapeutic procedures -Unresponsive coma (absence of motor and reflex responses) -No spontaneous respirations (apnea) - Doctors take you off the machine and they check if CO2 Builds up -No cephalic (ocular or caloric) reflexes -Isoelectric EEG -Persistence for 1 hour and 6 hours after onset of coma and apnea

Seizures: Consequences

+250% increase in adenosine triphosphate (ATP) +Cerebral oxygen consumption increased by 60% +Cerebral blood flow also increases approximately 250% +Available glucose and oxygen are depleted With severe seizures the brain tissue may require more ATP than can be produced Lactate accumulates in the brain tissues May produce secondary hypoxia, acidosis, and lactate accumulation May result in progressive brain tissue injury and destruction Cellular exhaustion and destruction

Alterations in Awareness - Selective attention

+Ability to select from available competing environmental and internal stimuli +Sensory inattentiveness Extinction Neglect syndrome +Selective attention deficit

Acute Confusional States

+Acquired mental disorder with deficits in attention and coherence of thoughts and action -Secondary to drug intoxication, metabolic disorder, or nervous system disease -Disruption of reticular activating system of upper brainstem and its projections to thalamus, basal ganglion, and specific areas of the cortex and limbic areas -Abrupt onset

Extrapyramidal Motor Syndromes

+Basal ganglia motor syndromes +Cerebellar motor syndromes -Rostral vermis -Caudal vermis -Neocerebellar syndrome

what is a Seizures

+Disruption in balance of excitation and inhibition +Sudden, transient alteration of brain function caused by an abrupt explosive, disorderly discharge of cerebral neurons +Motor, sensory, autonomic, or psychic +Convulsion -Tonic-clonic (jerky, contract-relax) movements associated with some seizures

Disorders of Posture (Stance) - Dysonia

+Dystonic postures and movements +Decorticate posture - Rembeber your decorating your body with arms. -Upper extremity flexion -Damage above midbrain +Decerebrate posture - Remember Celebrate and everything is extended -Extensor responses in upper and lower extremities -Damage in caudal diencephalon or midbrain +Basal ganglion posture +Senile posture

What is Alzheimer Disease?

+Familial, early and late onset +Nonhereditary (sporadic, late onset) +Theories -Mutation for encoding amyloid precursor protein -Alteration in apolipoprotein E -Pathologic activation of N-methyl-D-aspartate (NMDA) - Linked to Down-Syndrome

Alterations in Movement - Lower motor neuron syndromes

+Flaccid paresis or flaccid paralysis +Hyporeflexia or areflexia - No reflexes +Gamma neuropathies +Fibrillation

Lower Motor Neuron Syndromes - Amyotrophies

+Hard to recognize due to multiple nerve innervation +Fasciculations and muscle cramps- Fancy way of saying Twitching. +Paralytic poliomyelitis +Nuclear palsies +Progressive spinal muscular atrophy +Progressive bulbar palsy +Bulbar palsy

What are the effects of Alzheimer Disease?

+Neurofibrillary tangles +Senile plaques +Clinical manifestations -Forgetfulness, emotional upset, disorientation, confusion, lack of concentration, decline in abstraction, problem solving, and judgment -Insidious onset +Diagnosis made by ruling out other causes of dementia

Explain the communication of the Hydrocephalus?

+Noncommunicating hydrocephalus +Communicating (extraventricular) hydrocephalus -Hydrocephalus ex vacuo -Normal-pressure hydrocephalus

What is the Stages and effects fo Increased Intracranial Pressure?

+Normal 5 to 15 mmHg +Caused by increased intracranial content -Tumor growth, edema, excessive CSF, or hemorrhage +Stage one CSF reduction, vasoconstriction +Stage two Increase in systemic pressure +Stage three Sluggish pupils, wide pulse pressure, altered respirations +Stage four-brain herniation

Cerebral Death - Survivors of cerebral death

+Remain in coma +Emerge into a vegetative state ("wakeful unconscious state") -Can digest, breath, eye open, no purposeful motor activity +Progress into a minimal conscious state -Akinetic mutism (AM)- visual tracking. Lack of motivation. -Locked-in syndrome- no verbal/gestures. Can blink like the guy he wrote a whole book just blinking the morse code. +The longer it takes to come out of a coma the more severe the damage

Parkinson Disease

+Severe degeneration of the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway -Parkinsonian rigidity -Parkinsonian bradykinesia -Parkinsonian tremor -Postural abnormalities -Autonomic and neuroendocrine symptoms -Cognitive-affective symptoms

Seizure Syndromes - Epilepsy

+To be seized by a force from without" +Types -Idiopathic - more than half the time -Symptomatic -one third of the time Cryptogenic

What is Hydrocephalus?

+Variety of conditions +Excess fluid within the cranial vault, subarachnoid space, or both +Caused by interference in CSF flow -Decreased reabsorption -Aranoid villi -Increased fluid production -Ventricles -Obstruction within the ventricular system

Alterations in Arousal - Clinical manifestations - Pattern of breathing

- Posthyperventilation apnea (PHVA) +respirations stop after hyperventilation +PCO2 driven - Cheyne-Stokes respirations (CSR) +A smooth increase in rate and depth followed by a gradual smooth decrease in rate and depth

Huntington disease

-Also known as chorea -Autosomal dominant hereditary-degenerative disorder - All it takes is One parent to have a 50/50 chance. -Severe degeneration of the basal ganglia (caudate and putamen nuclei) and frontal cerebral cortex - This comes from Parkinsons/Dopamine and Huntingsons/Gaba. -Depletion of gamma-aminobutyric acid (GABA) -Choreiform movemets -Disrupted thought processes

Cerebral Death

-Cerebral death (irreversible coma): death of the cerebral hemispheres exclusive of the brainstem and cerebellum -No behavioral or environmental responses -The brain can continue to maintain normal respiratory and cardiovascular functions, temperature control, and GI function

Hypokinesia

-Decreased movement -Akinesia - No Movement -Bradykinesia - Slow -Loss of associated movement

Abnormal Movements - Hyperkinesia

-Excessive movement -Chorea means huntingsons, wandering, tremor at rest, postural tremor, etc.

Abnormal Movements - Tardive dyskinesia

-Involuntary movement of face, trunk, and extremities -Can be caused by antipsychotic drugs because they mimic an increase in dopamine

Alterations in Awareness - Dysmnesia

-Retrograde amnesia - Forgot things that happened in the past -Anterograde amnesia - you cant make new memories

Abnormal Movements - Paroxysmal dyskinesias

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Alterations in Arousal - Metabolic

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Alterations in Arousal- Psychogenic

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Herniation Syndromes - Infratentorial herniation Cerebral Edema

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Parkinson and Dementia

50% of persons have depression, an inherent part of the pathologic state and not a situational response 30% treated on outpatient basis have dementia; 80% of persons requiring institutional care have dementia Disorientation, confusion, memory loss, distractibility, and difficulty with concept formation, abstraction, calculations, thinking, and judgment Symptoms fluctuate, but they progressively worsen Anxiety disorders; impulse-control disorders; and punding, a disorder of stereotypic motor behavior in which there is intense fascination with repetitive handling and examining of mechanical objects Excessive daytime sleepiness is experienced in more than 50% of persons

What is 8, 10 ,10

80% of your Skull is full of Brain. 10% is CSF 10% is Blood

Data Processing Deficits - Aphasia

A Means No - No written and spoken language

A person is experiencing difficulty in recognizing a pattern. He cannot recognize the form and nature of objects. Which of the following is the term that describes this condition? A. Agnosia B. Aphasia C. Dysphasia D. Alzheimer

A. Agnosia is a defect of pattern recognition. Aphasia is the complete absence of speech. Dysphasia is impairment of comprehension or production of language. Alzheimer is a disease of dementia.

Which of the following is NOT a characteristic of Alzheimer disease? A. Rapid onset B. Memory loss C. Increased irritability D. Anxiety and depression

A. Alzheimer and other forms of dementia have a slow onset. The other choices are all correct.

A person is in status epilepticus. What is the greatest concern when treating these individuals? A. Cerebral hypoxia B. Aspiration C. Bleeding of the tongue D. Musculoskeletal trauma

A. Cerebral hypoxia is of critical importance; if not corrected, mental retardation, dementia, and further brain damage may result.

A person experiences clonus. Which of the following BEST describes this? A. Spreading of spasticity accompanied by increased deep tendon reflexes B. Resistance to passive movement C. Tonic reflex activity D. Weakness with impairment of motor function

A. Clonus is spasticity accompanied by increased deep tendon reflexes that spread. Gegenhalten or paratonia is the resistance to passive movement that varies in direct proportion to the force applied. It is also associated with frontal lobe injury. Rigidity is produced by tonic reflex activity. Paresis is weakness or impaired motor function.

A woman sustains a CVA. She has paralysis on the left side. Which of the following BEST describes this condition? A. Hemiplegia B. Paraplegia C. Diplegia D. Quadriplegia

A. Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to loss of motor function of the lower extremities. Diplegia is the paralysis of both upper or both lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to paralysis of all four extremities.

Which of the following is the BEST definition of a person with akinetic mutism? A. Has severe disturbance in motivation B. Can follow simple commands and manipulate objects C. Is in a wakeful unconsciousness D. Is unarousable and unresponsive

A. The definition of akinetic mutism is a state characterized by a severe disturbance in behavioral drive. Unarousable and unresponsive describes coma. Wakeful unconsciousness is the vegetative state. The ability to follow simple commands and manipulate objects is minimally conscious.

A person is diagnosed with Cheyne-Stokes respirations (CSR). Which of the following is a TRUE statement? A. Pathophysiology involves an increased ventilatory response. B. There is hypocapnia and increased ventilatory stimulus. C. Changes in PaO2 produce irregular breathing. D. The PaCO2 level increases when overbreathing occurs.

A. The pathophysiology of CSR includes an increased ventilatory response to carbon dioxide stimulation. This causes hypercapnia and diminished ventilatory stimulus. Changes in PaCO2 produce irregular breathing, not changes in PaO2. The PaCO2 level decreases to below normal when overbreathing occurs.

A person is having a seizure and is currently in the tonic phase. Which of the following BEST describes this phase of a seizure? A. Phase of muscle contraction with increased muscle tone B. Phase of alternating contraction and relaxation of muscle C. Phase immediately following seizure D. Phase of complete paralysis

A. The phase of muscle contraction with increased muscle tone is the tonic phase. Alternating contraction and muscle relaxation represents the clonic phase. The postictal phase immediately follows the seizure. There is no phase of complete paralysis in a seizure.

Classifications of Dementia - Cortical

Alzheimer and Pick diseases Loss of memory Alzehiemer starts mentally and ends Physically

Where does CSF Drain?

Aranoid Villi

Which term describes a person who is experiencing a loss of comprehension or production of language? A. Dysphasia B. Aphasia C. Expressive dysphasia D. Transcortical dysphasia

B. Aphasia is complete inability to speak or to comprehend language. Dysphasia is impairment in comprehension or production of language. Expressive dysphasia is characterized primarily by expressive deficits, but comprehension may be present. Transcortical dysphasia involves the ability to repeat and to recite.

A person experiences a traumatic brain injury and has herniation of the brain that is straight downward through the tentorial notch. Which of the following types of herniation is this? A. Supratentorial B. Central C. Cingulate D. Uncal

B. Central herniation is the straight downward shift of the diencephalon through the tentorial notch. Uncal herniation occurs when the hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa. Supratentorial herniation is a general category that includes uncal, central, and cingulate herniation. Cingulate occurs when the cingulate gyrus shifts under the falx cerebri.

A person is describing a loss of past memories. For which of the following disorders is this a characteristic? A. Extinction B. Dysmnesia C. Sensory inattentiveness D. Nondeclarative memory

B. Dysmnesia is a disorder of the declarative memory network. This disorder is a loss of past memories with an inability to form new memories. Nondeclarative memory is memory involved in how to carry out activities. Sensory inattentiveness is a form of neglect and may be visual, auditory, or tactile. Extinction is when an individual with sensory inattentiveness ignores sensory input from the dysfunctional side.

A person has a structural problem that is located within the brain tissue, and it is causing a decreased level of consciousness. Which of the following terms BEST describes this location? A. Infratentorial B. Intracerebral C. Extracerebral D. Subdural

B. Intracerebral is a term that means "within the brain tissue." Intracerebral disorders function primarily as masses. Infratentorial is below the tentorium cerebelli. Subdural is located below the dura mater. Extracerebral is outside the brain tissue.

A person experiences a unilateral, focal seizure and maintains consciousness. Which of the following is the appropriate term for this type of seizure? A. Generalized B. Partial C. Secondary D. Status epilepticus

B. Partial seizures involve neurons only unilaterally. They often have a local (focal) onset. Consciousness may be maintained. In generalized seizures consciousness is almost always impaired. When partial seizures become generalized to involve neurons of other hemispheres, this is called secondary generation. Status epilepticus is the experience of a second seizure, a third seizure, and often subsequent seizures before the person has fully regained consciousness.

A man is diagnosed with Parkinson disease. Which of the following symptoms would he expect to appear first in the course of his illness? A. Inability to walk B. Tremor C. Postural instability D. Rigidity

B. Tremor is often the first symptom to appear. This progresses to include gait, postural instability, and inability to walk. The symptoms are often unilateral and then become bilateral.

Alterations in Motor Function - Rigidity

Being Rigid

Alterations in Motor Function - Spasticity

Being Spastic

What is a Generalized seizure?

Bilat, no focal point, altered Level of conscienceness LOC. A person who shakes on the floor.

Which of the following is TRUE regarding Alzheimer disease? A. Uncommon neurologic disorder B. No genetic relationship C. Associated with Down syndrome D. Plaques increase nerve impulse transmission

C. Alzheimer disease is associated with Down syndrome. There is a genetic relationship in late-onset familial Alzheimer dementia. It is a common neurologic disorder; nearly 5 million Americans had the disease in 2006 With the formation of plaques, there is decreased nerve impulse transmission.

A man has a contusion that has developed over 2 to 3 days. He is restless and irritable. He is brought to the physician's office. Which of the following best describes this condition? A. Alzheimer B. Dementia C. Delirium D. Coma

C. Delirium is an acute state of confusion. It is abrupt in its onset (over 2 to 3 days). The person may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Dementia is a more chronic problem in which there is progressive failure of many cerebral functions. Alzheimer is a type of dementia. A coma is a loss of consciousness.

A person is diagnosed with Huntington disease. Which of the following is TRUE? A. Occurs commonly B. Is a nonhereditary disease C. Is also known as chorea D. Onset usually between the ages of 50 and 70 years

C. Huntington disease is also called chorea. It is relatively rare and is a hereditary degenerative disorder. It most commonly affects those between the ages of 25 and 45.

An individual in a coma presents with pinhole-sized pupils. Which medication would produce this size pupil? A. Atropine B. Scopolamine C. Opiates D. Amphetamines

C. Opiates (heroin and morphine) cause pinhole pupils. The other choices cause large, dilated pupils.

Which of the following is NOT one of the five categories of neurologic function that are classified as critical for evaluation? A. Level of consciousness B. Pattern of breathing C. Heart rate D. Eye position

C. The five categories that are critical for the evaluation process for neurologic function include (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) skeletal muscle motor responses. Although heart rate is a vital sign, it is not always indicative of neurologic status.

Which of the following is NOT a means of classifying a seizure? A. Clinical manifestations B. Site of origin C. Length of activity D. EEG correlates

C. The following are ways to classify seizures: (1) clinical manifestations, (2) site or origin, (3) EEG correlates, and (4) response to therapy.

A woman has sustained a traumatic brain injury. She is able to follow simple commands and can manipulate objects. Which of the following terms BEST describes this state? A. Coma B. Vegetative C. Minimally conscious D. Locked-in syndrome

C. The term minimally conscious applies to a severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness. The clinical features include following simple commands, manipulation of objects, gestural or verbal yes/no responses, intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement. Coma is a state of unarousable neurobehavioral unresponsiveness. Vegetative state is a wakeful unconscious state.

An individual experiences significant vomiting with a CNS injury. Which of the following is TRUE regarding CNS injury and vomiting? A. Impinges directly on the floor of the third ventricle B. Causes a decrease in intracranial pressure C. Involves the vestibular nuclei D. Vomiting with no nausea indicates abdominal involvement

C. Vomiting associated with CNS injuries involves the vestibular nuclei. It can be caused by impingement on the fourth ventricle. It can cause an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms.

Alterations in Movement - Spinal Shock

CAn be resolved or you can have permanent damage.

Herniation Syndromes -Supratentorial herniation - Cingulate

Cingulate gyrus shifts under the falx cerebri

Alterations in Cognitive Systems - Awareness

Cognitive functions that embody awareness of self, environment, and affective states (i.e., moods) Content of thought

Alterations in Arousal

Coma is produced by either: Bilateral hemisphere damage or suppression Brainstem lesions or metabolic derangement that damages or suppresses the reticular activating system

Which of the following is NOT one of the mechanisms in the dementing process? A. Degeneration possibly caused by genetics B. Atherosclerosis C. Trauma D. Decreased intracranial pressure

D. An increase in intracranial pressure is a mechanism in the dementing process. All the other choices are correct.

A person experiences edema in the brain caused by movement of CSF from the ventricles into the extracellular space. What type of edema does this describe? A. Vasogenic B. Cytotoxic C. Ischemic D. Interstitial

D. Interstitial edema is caused by transependymal movement of CSF from the ventricles into the extracellular spaces of the brain tissues. Vasogenic edema is caused by the increased permeability of the capillary endothelium. Cytotoxic edema occurs when toxic factors cause active transport systems to fail. The cells lose control of their potassium and sodium. Water follows into the cells and causes them to swell. Ischemic edema occurs after infarction and has components of vasogenic and cytotoxic edema.

Which of the following is NOT a basic neural system essential for the cognitive sphere? A. Attentional systems B. Memory and language systems C. Affective or emotive systems D. Sensory systems

D. The three basic (core) neural systems to the cognitive sphere include attentional systems that provide arousal and maintenance of attention over time, memory and language systems by which information is communicated, and affective or emotive systems that mediate feeling.

Which of the following is NOT a criterion when determining brain death? A. Unresponsive coma B. No spontaneous respiration C. Isoelectric EEG D. Ocular response to head turning

D.There is no ocular response to head turning, and pupils are often fixed and dilated. The following criteria determine brain death: 1. Completion of all appropriate therapeutic procedures 2. Unresponsive coma 3. No spontaneous respiration (apnea) 4. Absent cephalic reflexes 5. Isoelectric EEG 6. Persistence of these signs for 30 minutes to 1 hour and for 6 hours after onset of coma and apnea

Alterations in Motor Function - Gegenhalten (paratonia)

Dont worry about it

Herniation Syndromes - Supratentorial herniation - Central

Downward shift of the diencephalon through the tentorial notch

Data Processing Deficits - Dysphasia

Dys means something gone wrong - Most related to CVA of middle cerebral artery Expressive dysphasia Receptive dysphasia

Type of Seizure - Status epilepticus

Experience of a second seizure before the person has fully regained consciousness from the preceding seizure or a single seizure lasting more than 30 minutes. So, One big seizure or multiples. Seizures are very bad because the Cerebral is not getting O2, its suffering from Hypoxia. Brain Loves Oxygen.

Alterations in Awareness - Declarative memory

First Love, graduating high school

Cerebral Edema - Ischemic

Follows cerebral infarction - Something that is blocked. Schemia is a blockage

Epileptogenic focus

Group of neurons that appear to be hypersensitive to paroxysmal depolarization

What is Cerebral Edema

Increase in the fluid (intracellular or extracellular) within the brain

Cerebral Edema - Vasogenic

Increased permeability of capillary endothelium - Fancy way of saying pipes are leaky and fluid can flow in.

Classifications of Dementia - Cortical and Subcortical

Infectious and Creutzfeldt-Jakob diseases This is like human mad cow. Caused by a protein you contract it and causes ditearation of the brain. Very Sad

Alterations in Motor Function - Hypotonia

Less Tone

Alterations in Motor Function - Hypertonia

More Tone

Alterations in Arousal - Clinical manifestations - Level of consciousness changes

Most critical index of nervous system

Alterations in Arousal - Clinical manifestations - Pupillary changes

Opiates which is your Herione and Morophone will cause your pupils to Pinpoint. Achermine and fetamines Like Meth dilates pupils.

Classifications of Dementia - Subcortical

Parkinson and Huntington diseases. Parkinsons starts physically and ends mentally.

Alterations in Arousal - Clinical manifestations - Motor responses

Placing Ice Cold WAter in the eye for motor response. Patient should be able to squeeze hand, sucking, etc. etc.

Dementia

Progressive failure of cerebral functions not caused by an impaired level of consciousness

Seizures

Resting potential instability Bursts of action potentials (hypersynchronization)

Cerebral Edema -Type Interstitial

Seen with noncommunicating hydrocephalus This is when you see the intersitital cerebral edema

Alterations in Awareness - Nondeclarative memory

Skills you know, Like brushing your teeth

Type of Seizure - Secondary generalization

Starts has a Partial and Spreads to Generalized.

Alterations in Cognitive Systems - Arousal vs. awareness

State of wakefulness Mediated by the reticular activating system

Postictal state

State that follows the seizure

Alterations in Arousal - Structural

Supratentorial Infratentorial Subdural Extracerebral Intracerebral

Data Processing Deficits - Agnosia

Tactile, visual, auditory, etc. Related to injury in the lobe of origin - Tactile happens in the Parietal lobe because thats were the receptors are for touch.

A 19-year-old woman sustains a nontraumatic brain injury. Which of the following is a TRUE statement regarding prognostic indicators? A. She has a 91% death rate if pupils are nonreactive at 24 hours. B. She has a 95% death rate when pupillary reflexes are absent at 6 hours. C. Prognosis is established later in the course versus the prognosis of traumatic brain injury. D. Absence of eye opening at 24 hours predicts death or severe disability.

The absence of eye opening at 24 hours predicts death or severe disability. Choices A and B are true for traumatic brain injury. Prognosis for nontraumatic brain injury is established earlier than for traumatic brain injury.

Alterations in Cognitive Systems - Consciousness

The most critical index of nervous system dysfunction

Chapter 16 - Concepts of Neurological Dysfunction -

This chapter deals with what happens when there are pathologic changes in the neurologic system such as coma, seizures, and other deficites. Note what happens with increased intracranial pressure leading to herniation of the brain. Alterations in emotions and mood as well as motor function are discussed.

Alterations in Arousal - Clinical manifestations - Oculomotor responses (Doll's eyes)

This where you can check to see if a person is brain dead by turning there head and checking to see if there eyes are fixed to one position. If normal the eyes will move to the corner.

Cerebral Edema - Cytotoxic

Toxic factors

Herniation Syndromes - Supratentorial herniation - Uncal

Uncus or hippocampal gyrus (or both) shifts from the middle fossa through the tentorial notch into the posterior fossa

Partial (focal) seizures

Unilat, consciousness may or not may not be lost, repetitive movements. A person with seizures in one location and then spreads.

Where is CSF Produced?

Ventricles

Alterations in Awareness -

Vigilance, detection, and working memory deficits

Alterations in Movement - Paresis

Weakness

Disorders of Gait - Cerebellar (ataxic)gait

a wide-based gait with feet apart and often turned outward or inward for stability; pelvis is stiff, individual staggers

Clonic phase

alternates contraction/relaxation

Tonic phase-

contraction with increase tone

Seizure Syndromes - Aura

gustatory, visual, or auditory experience

Alterations in Movement - Paralysis

inability to move. Paraplegia - Two Extremities (superior or inferior) Quadriplegia - All four extremities

Disorders of Gait - Basal ganglion gait

individual walks with small steps and decreased arm swing. the head and body are flexed and the arms semi flexed and abducted while the legs are flexed and rigid in more advanceed states.

Disorders of Gait - Senile gait

individual walks with small steps and decreased arm swing. the head and body are flexed and the arms semi flexed and abducted while the legs are flexed and rigid in more advanceed states.

Seizure Syndromes - Prodroma

malaise, headache, depression

Disorders of Gait - Scissors gait

upper motor neuron dysfunction

Disorders of Gait - Spastic gait

upper motor neuron dysfunction