25 - Neurological Flashcards
Central nervous system (CNS):
brain + spinal chord
Frontal lobe
personality, behaviour, emotion, intellectual function. Contains brocas area + precentral gyrus (primary motor area)
Parietal lobe
sensation. Contants postcentral gyrus (primary sensory area)
Occipital lobe
visual reception
Temporal Lobe
hearing, taste, smell. Contains Wenike’s area
Cerebellum
motor coordination, equilibrium, balance
Wenike’s area
associated with language comprehension
Brocas area
mediates the motor speach
Basal Ganglia
grey matter that initate/coordinates movement
Thalamus
relay station. Sensory pathways form synapses on way to cerebral cortex
Hypothalamus
Major respiratory center. Regulate temperature, heart rate, blood pressure, sleep, appitte
Spinal Cord
mediates posture control, urination and pain responce
Crossed representation
left cerebral cortex receives sensory info from and controls motor function to the right side of the body and vice versa.
Spinothalamic tract
sensory fibers that transmit sensations of pain, temperature, touch.
Posterior (dorsal) column
conduct sensation for localized touch (seriognosis), position and vibration, proprioception. Enter dorsal root medulla thallmus sensory cortex
Corticospinal or pyramidal tract
voluntary puposfull movementment (like writing).
Extrapyramidal tracts
muscle tone control of body movements like gross motor movements like walking
Cerebellar system
coordinated movement, maintains posture
Upper motor neurons
in CNS, Ex. Corticospinal, Extrapyramidal tracts, corticobulbar. Diseases use ALS, MS
Lower motor neurons
in PNS, ex. Cranial nerves, spinal nerves of PNS. Diseases are spinal chord lesions, poliomucelitis, amyotrophic lateral sclerosis
Nerve
bundles of fibers that exist outside of CNS
Reflex
basic defense mechanisms of the nervous system, involuntary and offer quick reaction to potential harm
Peripheral Nervous System
Outside of the CNS
Carries input to the CNS
Delivers output from the CNS
Syncope
medical term for fainting or passing out.
sudden loss of strength and temportary loss of consciousness (fainting) caused by lack of cerebral blood flow like with low bp
Vertigo
sensation of rotational spinning
Screening neurological examination
screening on healthy patient
Complete neurological examination
done on patient with neurological concerns
Neurological recheck examination
done on patients with demonstrated neurological deficts who require periodic assessments
Corneal Reflex
touch coreal area with bit of cotton and it should automatically close.
Gait
normally smooth, rhythmic ad effortless with swinging arms. Step length is approx.. 30cms from heel to toe
Cerebellar function
Balance tests
Tandem walking
patient walks in a straight line in a heel-to-toe manner. This decreases base of support and accentuates problems with coordination
Cerebellar function
Balance tests
Rapid Alternating Movements
pat knee with both palms, then flip to the back on hands and pat with those. Repeat increasing speed. Or. touch thumb to each finger on same hand then reverse firsction
Cerebellar function
Coordination and skilled movements
Finger-to-finger Test
with eyes open, ask patient to touch your finger than their own nose. Move your finger to a dif location
Cerebellar function
Coordination and skilled movements
Finger-to-Nose Test
ask patient to close eyes, stretch out arms then touch nose with each index figner, alternating hanfs.
Cerebellar function
Coordination and skilled movements
Heel-to-Shin Test
patient lies down, places heel on the opposite knee, run it down fthe shin from knee to ankle, switch legs.
Cerebellar function
Coordination and skilled movements
Vibration
close eyes, hold tuning fork at base of joint finger/big toe and ask what they feel. If they feel that the nerve is in tact. Then move up the nerve. If the nerve is intact distally it’s also intact proximally.
Posterior column tract
Proprioception
with their eyes close you move their finger/toe up/down and ask which direction it’s moved
Posterior column tract
Stereognosis
patients ability to recognize objects by feeling their form, size, weight with eyes closed
Posterior column tract
Tactile discrimination
Graphesthesia
ability to read a number by having it traced on the skin. Close eyes then use blunt instrument to trace letters on patients palm
Posterior column tract
Tactile discrimination
Two-point discrimination
patients ability to distinguish two simultaneous pinpoints on skin. Apply two points of an open paper clip lightly to skin in ever-closing distances. Distances is most sentitive in fingertips and lest sensitive in upper arms/tight/back
Posterior column tract
Tactile discrimination
Extinction
simultaneously touch both sides of the body at the same point. Ask patient to state how many sensations felt. Normally both sides are felt.
Posterior column tract
Tactile discrimination
Point location
touch the skin and withdraw stimulus promptly. Tell the patient to point where they were touched.
Posterior column tract
Tactile discrimination
Clonus
set of rapid, rhythmic contractions of the same muscle
Hyper-reflexia
exaggerated reflex that occurs when the monosynaptic reflex arch is released from usually inhibiting influence of higher cortical levels.
Hyporeflexia
reduced functioning of a reflex. Soemtimes reflex absent
Biceps Reflex
but your thumb on bicepts tendon and stike your thumb. Normal: bicep contracts, forearm flex
Triceps Reflex
strike tricepts tendon directly above elbow. Normal: forarm extension
Brachioradialis Reflex
stike forarm aprox 2-3cm above radial styloid process. Normal: flexion of forearm and supination of palm (palm turns up)
Patellar Reflex
stike tendion just below patella. Normal: extension of lower leg
Achilles Reflex
strike achieles tendion. Normal: foot plantar flexes (push down) against your hand (you fordoflex the foot holding it up them the reflex)
Reinforcement
technique to relax the muscles and enhance the response.
Abdominal Reflex
lightly strike the abdomen on each side above and below the umbilicus and abdominal muscle will contract and umbilicus will deviate towards the side that’s beign tested. (doesn’t work for pregnancy/obsese)
Cremasteric Reflex
lighght touch inner thigh and the testes will life up/contract. Causes the creamasteric muscle to contract.
Plantar Reflex
end of reflex hammer and stoke foot from heel to ball of foot curing inwards at toe. Normal: the toe should flex Abnoraml is Babinski (dorsiflexion/extension of toe)
Kernig’s sign
raise on leg and flex at knee/hip. Ask them to straighten their leg.
Normal: Discomfort behind knee.
Abnormal: Pain in hamstring/resistance to extention is seen in meningeal irritation
**also McMurry Test
Dyskinesias
involuntary movement
Glasgow coma scale
Assess the functional state of the brain Standardized assessment Numerical value Normal is 15 <7=coma
fasciculation
Rapid, continuous twitching of resting muscle
Fine:
Occurs with lower motor neuron disease, associated with atrophy and weakness
Coarse:
Occurs with cold or fatigue
paralysis
Decrease or loss of motor power
Motor nerve or muscle fibre problems
Acute causes: ex. trauma, spinal cord injury, CVA, Belly’s palsy
> Hemiplegia - being paralyzed on one side of the body
> Paraplegia - being paralyzed from the waist down
> Quadriplegia - paralysis of arms and legs
> Paresis - muscle movement has become weakened or impaired (mild/moderate)
> Monoplegia - paralysis in one limb
Tic
Involuntary, compulsive, repetitive twitching of a muscle group
Neurological cause, tardive dyskinesias, Tourette’s syndrome, psychogenic cause
myoclonus
Rapid, sudden jerk or a short series of jerks at fairly regular intervals
Can be mild or severe (hiccup, seizures)
Tremor
Involuntary contraction of opposing muscle groups
Rhythmic, back and forth movement
Disappear during sleep
May be slow or fast
Rest Tremor
when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a person’s hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers
Coarse and slow
Partly or completely disappears with voluntary movement
Parkinsonism
Intention tremor
a rhythmic, oscillatory, and high amplitude tremor during a directed and purposeful motor movement, worsening before reaching the endpoint.
Worse with voluntary movement
Occurs with cerebellar disease and MS
Essential tremor (familial)- more common in older adults, benign
Chorea
Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
Not rhythmic or repetitive
More compulsive than a tic
Huntington’s
Athetosis
Slow, twisting, writhing, continuous movement
Resembles a snake or worm
Cerebral Palsy
