1 - Neurology History, Examination and Localisation Flashcards

Question

How do you calculate GCS? IMPORTANT CARD

Answer 1

Evaluates the level of consciousness of a patient If cannot do one of the sections e.g oedema round eyes, paralysed, then write NOT TESTABLE (NT) 3 is lowest, 15 is highest. Always record in notes and say what they score for each

Answer 2

**_Decorticate_** - Abnormal flexion - Adduction of the arm, internal rotation of the shoulder, pronation of the forearm and wrist flexion - Indicates ***damage to cerebral hemispheres, internal capsule and thalamus*** **_Decebrate_** - Abnormal extension - Head is extended, arms and legs also extended and internally rotated. Patient appears rigid with teeth clenched ***- Indicates damage to brainstem*** ***- Progression from decorticate to decebrate suggests uncal or tonsillar herniation***

Answer 3

3 Gravity (Rhymes) Remember Neil laying on side for 2

Answer 4

TOPCARS and SWIFT **- Introduce:** any pain, exposure **- Inspection:** gait, tremor, wasting, SWIFT **- Tone:** leg roll and clonus **- Power:** isolate/stabilise joint **- Coordination:** heel to shin, toe tap **- Reflexes:** knee, ankle, plantar **- Sensation and Proprioception:** cotton wool, neurotip, vibration (BIGGER ONE - 128Hz), joint position

Answer 5

**- Introduction:** any pain? exposure **- SWIFT** **- Pronator drift** **- Tone** **- Power** **- Coordination:** dysdiadochokinesis, finger nose **- Reflexes**: biceps, triceps, supinator **- Sensation and Proprioception:** bigger tuning fork!! make sure they close their eyes!!!! did it feel the same both sides?

Answer 6

**- Inspection:** gait, resting tremor with eyes closed and counting back from 20 (asymmetrical resting pill rolling, begins distally, reduced with finger to nose testing), intention tremor **_Work downwards:_** **- Face:** Hypomimia, Glabella Tap (Myerson's sign), Hypophonic speech **- Upper limbs**: Tone (lead pipe or cogwheel tremor on increased tone) and Bradykinesia - **Lower limbs:** toe tap **- Others:** micrographia (write sentence, draw spiral), undo buttons on shirt

Answer 7

Resting tremors occur **when a body part is at complete rest against gravity** and **cease during active movement**

Answer 8

**Head Impulse, Nystagmus, Test of Skew** examination Way to assess a patient to see if **central or peripheral vertigo**

Answer 9

1. Mental Status 2. Cranial Nerves 3. Motor Function 4. Reflexes 5. sENSATION

Answer 10

1. Level of consciousness (GCS) 2. Pupil responses 3. Fundoscopy 4. Brain stem reflexes 5. Deep tendon reflexes 6. Plantar response

Answer 11

D - Dysdiadochokinesis A - Ataxic gait N - Nystagmus I - Intention tremor S - Slurred/Staccato speech H - Hypotonia and reduced power

Answer 12

- Need to think cortex, corona radiata, internal capsule, brainstem, cord, roots, peripheral nerves, neuromuscular junction, muscles - Is it UMN or LMN? - Is it unilateral or bilateral?

Answer 13

**_Corticospinal tracts (pyramidal)_** - Skilled, intricate, strong and organised movements - Defectiveness: loss of skilled voluntary movement, spasticity and reflex changes. Such as hemiparesis, hemiplegia or paraparesis **_Extrapyramidal_** - Fast, fluid movements that the corticospinal system has generated - Doesn't directly innervate motor neurones - Defectiveness: bradykinesia, rigidity, tremor, chorea **_Cerebelllum_** - Co-ordinating smooth and learned movement initiated by the pyradimal system and in posture and balance control - Defectiveness: ataxia, past pointing, action tremor and incoordination

Answer 14

- At the level of the lesion LMN - Below level of lesion UMN

Answer 15

The brainstem on the side of the cranial nerve palsy

Answer 16

**Peripheral nerves:** sensation from dorsal roots to cord **Dorsal columns:** - Vibration, joint position, light touch and point discrimination - Decussate in medulla passing to the thalamus **Spinothalamic tracts:** - Pain and temperature - Decussate in the cord and pass in the spinothalamic tracts to the thalamus and reticular formation **Sensory cortex:** Fibres from thalamus pass to parietal region sensory cortex and motor cortex

Answer 17

- **Tone**: Hypertonia and Clonus **- Reflexes:** Hyperreflexia and Babinski **- Atrophy:** Late and due to disuse **- Spasticity** **- Hoffman's reflex positive** **- Clasp knife rigidity** UMN MAY APPEAR AS LMN FOR FIRST FEW HOURS AFTER INJURY (ACUTE FLACCID PARALYSIS)

Answer 18

**- Hyporeflexia** **- Hypotonia/Flaccid** **- Absent reflexes** **- Fasiculations** **- Severe dennervation atropy**

Answer 19

**Muscle disease:** will be bilateral and no sensory loss **Peripheral neuropathy:** sensory loss and reflexes lost faster

Answer 20

**Negative:** bradykinesia, loss of postural reflexes **Positive:** tremor, rigidity, involuntary movements e.g chorea, hemiballismus

Answer 21

**Circle of Willis** - Anastomosis of vertebral artery and ICAs - Anterior and Middle cerebral arteries come from ICA. Posterior cerebral artery comes from vertebral

Answer 22

**_ACA:_** Weak numb contralateral leg +/- same with arm. Face sparing **_MCA:_** Contralateral hemiparesis, hemisensory loss, contralateral homonymous hemianopia (optic radiations involved), dysphasia, visuo-spatial disturbance **_PCA:_** Supplies occipital so contralateral homonymous hemianopia with macular sparing

Answer 23

**- Amino acids:** Glutamate and Aspartate are excitatory, GABA is inhibitory ## Footnote **- Dopamine** **- Serotonin** **- Adrenaline and Noradrenaline** **- Acetylcholine**

Answer 24

In UMN lesions - Extensors weaker than flexors in arms - Flexors weaker than extensors in legs STROKE - HEMIPARESIS

Answer 25

Both in **hypertonia**, think about **velocity** **- Spasticity (resistance more in one movement):** stroke, MND **- Rigidity (resistance same for all movement, not velocity dependent):** PD, neuroleptic syndrome

Answer 26

**- Mononeuropathy:** Area supplied by one nerve **- Peripheral neuropathy:** Symmetrical glove and stocking **- Radiculopathy:** Dermatomal **- Spinal cord damage:** At and below level in dermatomal pattern **- Thalmic lesions e.g stroke:** Contralateral loss **- Myopathy:** No loss of sensory, just motor