1 Flashcards
The _____ in the posterior frontal lobe is responsible for planning and controlling voluntary movements on the contra lateral side of the body. especially precise movement of hands and muscles of speech
motor cortex
____(1)_________ area in the dominant (usually left) _____(2)_______ is important for the production of written and spoken language
- broca’s area
2. frontal lobe
This area is involved in planning, concentration, and bringing ideas and memories together in order to carry out goal directed behaviors.
pre-fronal cortex
The prefrontal cortex also influences what?
personality, insight, initiative, mortality, impulse control, and appropriateness of emotional display
A major function of the _________ lobe is perception of somatosensory information (touch, pain, temp, tactile discrimination, and proprioception) from the contralateral side of the head, trunk, and extremities.
parietal lobe
the remainder of the parietal lobe, posterior to the somatosensory cortex is involved in the, what?
and what is it sometimes referred to as?
higher level analysis of sensory information.
termporoparietal association area
The _____ parietal lobe also plays an important role in spatial orientation and higher intellectual functioning such as reasoning, math, language comprehension.
posterior parietal lobe
Where is Wernicke’s area located?
posterior inferior parietal lobe and superior temporal lobe of the dominant cerebral
what does wernicke’s area do?
converts thoughts and ideas into words and passes the information on to Broca’s area in the frontal lobe for expression as written or verbal language
What lobe is exclusively involved in the perception of visual info?
occipital
visual impulses are conducted from the eyes to the ___________
primary visual cortex
after the impulse travels to the primary cisual cortex it is then passed on to the _____ where visual stimuli are analyzed in terms of color, size, shape, and movement
visual association areas
where are the primary auditory cortex and auditory association areas located?
superior regions of the temporal lobe
the part of Wernicke’s area located in the temporal lobe is responsible for what?
language comprehension
what do the inferior regions of the temporal lobe do?
They assist the occiptal lobe in the higher order processing of visual information
the middle regions of the temporal lobe do what?
contain the hippocampus and amygdala, which are involved in learning and memory
where is the “limbic lobe” located and what does it do?
not a distinct area as it is a functional area of cerebrum. Important for emotional responses and drive behaviors. It aslo associates emotions with sensory experiences and stores that information for future recall.
provides motor programs for controlling the timing and sequencing of voluntary muscualr activity- especially those fo antagonistic flexor and extensor muscles. Imporant role in controlling muscle tone, balance, and equilibrium. Helps smooth out rapid and complex movements
cerebellum
Provides motor programs for complex, learned motor activity, Modulates the activity of cortical motor neurons so that muscle tone is appropriate to any given planned movement. also important for initiating voluntary movement
basal ganglia
Contains pathways conducting sensory and motor impulses between the cerebrum and the spinal cord, and between the cerebellum and the cerebrum.
The brainstem
Sympathetic innervation of the eyes relies on pathways that pass through, where?
the brainstem
This area contains groups of neurons (reticular formation) which control cardiorespiratory reflexes, regulate consciousness and the sleep-wake cycle, and help control balance and equlibrium.
the brainstem
the brainstem contains the nuclei for what cranial nerves
III-XII
Midbrain = III and IV
Pons= V, VI, VII, VIII
Mdulla= IX, X, XI, XII
what are the 8 parts to the mental health exam?
- LOC
- speech and language
- sttention
- orientation
- recent and remote memory
- cogntion
- visuospatial skills
- mood/ personality
LOC level: fully aware of normal stimuli, interacts normally with examiner
Awake and alert
LOC level: lethargic or somnolent
tends to drift off to sleep unless actively simulated
LOC level; obtunded
difficult to arouse, when aroused is confused and unable to fully cooperated
LOC level: Stuporous
Responds only to viorus persistent stimuli with groans and mumbling
LOC level: Unconsious.
Unable to respond to command or painful stimulus
How to test for attention?
can be assessed by observing the patients ability to cooperate with the history and physical examination. Also can have patient repeat a number back. usually patient can say 5-7 digit number easy
How to test for fluency
have patient say as many animals that begin with a certain letter in 60 seconds. Inability to list 12 suggests reduced verbal fluency
How do you test for comprehension
Ask them to point to door or chair. Or ask a yes or no quesion
how do you test for orientation
person, place, time quesions
memory test?
recent memory is tested by having them remeber 3 unrelated objects and recalling them. remote memory is having them recall personal or historic events; where were you born, what are the last 3 presidents
executive function (cognition)
asking the patient to interpret similarities and proerbs. Can the patient tell you the absract meaning or what an apple and banana have in common. What does the phrase “don’t cry over spilled milk mean?” also test by having them do simple math problems
visuospatial skills
ability to dray simple two dimensional and three dimensional shapes
Mood and personality
observe pt or questioning a spouse
With cerebrum (cortical) lesions. Usually the upper and lower extremities are not affected equally. What part of arms and legs are usually more affected?
arms = extensors legs= flexors
extinction, impairred two-point discrimination, astereognosis, agraphesthesia, tinic deviation of eyes to side of lesion
left or right sided cortical lesion
aphasia, apraxia (inability to carry out motor commands), gerstmann’s syndrome (agraphia, acalculia, L-R disorientation, and finger agnosia)
left hemishere lesion of cortical
constructional apraxia (dificulty drawing from memory or copying simple ine drawings) left hemi-neglect, anosgnosia (denial of neruo deficit), patient may demonstrate remarkable lack of concern about neurological deficit or may display flattened affect
right hemishere lesion
cortical blindess, visual agnosia, cortical blindness is manifested by loss of sight but with preservation of normal pupillary light reflexes
occipital lobe
Upper motor neuron weakness of sensory loss affecting contralateral face and upper extremity, lower extremity, or hemibody. Unlike cortical injury where both motor and sensor decits are common____ injury often produces pure motor or pure sensor deficits. Cortical findings are absent in deep cerebral hemispheric lesions
subcortical
Widespread bilateral loss of cortical neurons. Impaired attention disorientation memory deficits = recent > longterm impaired higher cognitive functions visual hallucinations altered level of consciousness primitive reflexes
cerebrum (global)
examples: alzheimer disase, b12 def, delirium, hepatic encephalopathy
Ataxia, intention tremor, disequilibrium, nystagmus, dysmetria (problem with finger to nose, heal to shin) uncordinated rapid alternating movements, hypotonia and decreased DTR’s amy occur
cerebellum
examples: stroke, tumor, cerbellar degeneration syndrome
Involuntary movements (chorea, hemiballismus, athetosis), dystonic muscle contraction (abnormal, sustained muscle contraction) parkinsonism (muscle rigidity, resting tremor, bradykinesia, festing gait)
basal ganglia
example; parkinsonse disease, huntingtons chorea,. Most common encountered form of dystonia occurs as a reaction to anti-psychotic drugs (phenothiazines)
motor problems in the contralateal trunk and extremities. paresis or paralysis in UMN pattern (hyper- reflexia and babinski) cerebellar involvement may be present. Horner’s syndrome
brain stem.
example: stroke, tumor, herniation syndromes arising from increased crainial pressure
sensory deficit and muscle weakness below the level of the lesion. Specific sensory deficit depends on the tract affected. Sensory deficit usually demonstrated both anteriorly and posteriorly. may have bowel/bladder dysfunction and decreased rectal tone. If the lesion is acute DTR’s are diminished or absent. if the lesion slower in onsent or present for a period of time there may be increased muscle tone
spinal cord
Some combination of LMN muscle weakness and sensory changes (numbness, paresthesias, pain) in distribution of a particualr periphreal nerve. Unusual to loose all sensation. distal limbs> upper. earl loss of vibratory sensation is common. Decreased proprioception may cause ataxia.
peripheral neuropathy
pain and sensor changes in the distribution of the affected nerve root (dermatomal pattern) lower motor neuron muscle weaknesss. Diminished or absent DTR.
Radiculopathy
example: cervical spondylosis or HNP (herniated nucleus pulposus
ptosis and diplopia are common, especially after prolonged use of eyes. Dysphagia, facial wekeness, nasal speech, and soft voice may occu. Neck flexors and extesnors may be weak. DTR’s are normal. No sensory changes or muscel fasciculations. Pupils are normal
neuromusclular junction
example: myasthenia gravis, lambert eaton syndrome
symmetric proximal muslce weakness of all limbs, difficulty raising arms over head and rishing from chair. normal deep tendon reflexes,
Muslce
example: muscluar dystrophy
