2.3 Neuro exam lecture Flashcards
what dzs are associated with abrupt onset neurological sxs
cerebral hemorrhage
vascular dz
infection
head trauma
what dzs are associated with progressive neurological sxs
neoplasm
degenerative dz
what dzs are associated with intermittent neurological sxs
demyelinating dz
what must be eliminated before dementia can be dx
depression and delerium
what do you have to do before testing CN I
make sure nasal passages are clear
what is evaluated by the near response
- pupillary constriction
- medial rectus (convergence)
- ciliary m (lens accomodation)
what is presbyopia
farsightedness AKA impaired NEAR vision
what is the progression of CN III sxs from space occupying masses
first pupil dilation and fixation
THEN down and out position
what CN is responsible for inward rotation, downward and lateral movement
CN IV
what CN is responsible for only lateral movement
CN VI
what CN lesion is assoc w/ vertical diplopia and how might this present
CN IV, difficulty reading for walking down stairs
in CN IV which way does the head tilt
opposite to the lesion
what is the most common isolated nerve palsy
VI
what CN lesion is associated with convergent strabisus or esotropia (inability to abduct eye)?
CN VI
what CN lesion is assoc w/ horizontal diplopia
CN VI
when is physiologic nystagmus seen? which direction is the beat?
seen in extreme deviation of gaze
eye beats in opposite direction of gaze
what CNs are evaluated by the corneal reflex
V and VII
which way does the jaw deviate in a trigeminal lesion
toward the weak side
what CN is responsible for saliva and tear secretion
VII
what CN lesion causes hyperacusis (inc sensitivity to sound)
VII
aberrant regeneration of what CN causes crying w/ chewing
VII
supranuclear or central facial palsy spares what part of the face
upper and usually associated with hemiplegia (weakness to one side of body)
-important in determining if weakness is central or peripheral
what CN lesion is associated w/ disequilibrium and nystagmus
vestibular division of CN VIII
what CN lesion is assoc with sensorineural hearing loss and tinnitus
cochlear div of CN VIII
if the pt can swallow, what CN lesions can be ruled out
IX and X
how does CN XII lesion present on exam
tongue deviates ipsi
cannot push tongue into CONTRA cheek
what muscle and spinal level are responsible for plantarflexion
gastrocnemius, S1
what muscle and spinal level are responsible for dorsiflexion
tibialis anterior (L4, L5)
what is a pattern of weak EXTENSION of the arms and weak FLEXION of the legs called and what lesion is it assoc w/
pyramidal pattern of weakness
UMN lesion
what is a pattern of weak FLEXION of the arms and weak EXTENSION of the legs called and what lesion is it assoc w/
peripheral pattern of weakness
LMN dz
heel walking and pronator drift test for lesions of what tract
CST
in what dzs is a scissoring gait seen
cerebral palsy and MS
what is a gait with high stepping and a broad base called and when is it seen
sensory ataxia, seen in posterior column damage and peripheral neuropathy
in what dzs is a magnetic gait seen
frontal lobe processes
hydrocephalus
what is indicated by a waddling pelvis
myopathy
how is a positive babinski sign recorded
toe up going
is clonus associated with UMN or LMN lesion
UMN
what dermatomes are evaluated by the abd reflex
T10-12
what is kernigs sign
pt has neck pain with hip flexion
+ meningitis
what is brudzinski’s sign
pts knees raise when you lift their head
+ meningitis
Dysarthria
defect in speech, usually from defect in motor control of speech apparatus
Aphasia
disorder in producing or understanding language, usually lesion to dominant hemisphere (usually left)
Nystagmus
rhythmic oscillation of eyes
potential causes for nystagmus
- vision impairment at early age
- disorders of labyrinth or cerebellar systems
- drug toxicity
Hyperacusis
increased sensitivity to sound
What does it mean when you chart, “CN are grossly intact”
you have spent enough time talking with the patient that you haven’t seen anything that warrants an actual CN test, meaning you haven’t noticed drooling, ptosis, facial droop, difficulty with articulation, etc
What does it mean when you chart, “CN II-XII are intact to testing”?
you went through the actual confrontation of each nerve bilaterally
What sensory dermatome is on the auricle?
C2
What sensory dermatome is on the earlobe, posterior/ant neck?
C3
What sensory dermatome is on the shoulder top?
C4
What sensory dermatome is on the Radial aspect of forearm?
C6
What sensory dermatome is on the long finger?
C7
What sensory dermatome is on the little finger?
C8
What sensory dermatome is on the Nipple?
T4
What sensory dermatome is on the umbilicus?
T10
What sensory dermatome is on the inguinal?
L1
What sensory dermatome is on the Patella, medial calf?
L4
What sensory dermatome is on the Anterolateral calf, great toe?
L5
What sensory dermatome is on the posterolateral calf/little toe?
S1
Sterognosis
ability to id shapes of objects or recognize objects placed in hand
Graphesthesia
ability to id numbers written on palm
2 pt discrimination
ability to distinguish being touched by 1 or 2 pts
double simultaneous stimulation (extinction)
ability to feel 2 locations being touched simultaneously
thalamic patterns of sensory loss
hemisensory loss of all modalities
cortical sensory loss
intact primary sensations but loss of cortical sensations
functional sensory loss
non-anatomical distribution
Cerebellar ataxia gait
staggering, unsteady, feet wide apart, other cerebellar sigs usually present
sensory ataxia gait
unsteady, feet wide apart, feet thrown forward and slapped down 1st on heels then forefoot, pt watch ground when walking
parkinsonian gait
stooped forward, short steps commonly called “shuffling gait”
What CN is most vulnerable to head trauma? What deficit would you see with damage to this?
CN IV- exotropia (lateral eye drift) and weakness of downward gaze, vertical diplopia, and head tilt to side opposite lesion
What is the most common isolated CN and why?
What patients do you see damage in?
What deficit would you see with damage to this?
- CN VI, long peripheral course
- subarachnoid hemorrhage, late syphilis, trauma
- convergent strabismus (estropia): inability to abduct eye and horizontal diplopia
potential causes of nystagmus
- vision impairment at early age
- disorder of labyrinth or cerebella systems
- drug toxicity
how do you test for pain and what is this testing?
pt eye are closed and use a broken tongue depressor on skin, testing spinothalamic tract
how do you test for temp of the sensory system?
pt eyes are closed and used test tubes filled with hot and cold water- spinothalamic
how to you test vibration sense and what is it testing?
use a 128 hz tuning fork on bony prominence- PCMLS
how to you test proprioception sense and what is it testing?
- grab pt’s big toe b/t thumb and index finger and move through an arc
- when pt’s eyes are closed, ask them if the toe is up or down
- testing PCMLS
what are the 4 discriminative (cortical) sensations?
- stereognosis: ID shape of object or recognize if in hand
- graphesthesia: ID number written on palm
- 2 pt discrimination
- double simultaneous stimulation (extinction): ability to feel 2 locations being touch simultaneously
pattern of single nerve loss
limited to distribution of single nerve
pattern of root loss
loss in different nerve distributions with common root
pattern of sensory loss for thalamic path
hemisensory loss of all modalities
pattern of sensory loss for cortical path
intact primary sensation but loss of cortical sensation
what nerve does the brudzinski’s sign stretch?
femoral
what nerve does the kernig’s sign stretch?
sciatic
