Appraoch to Neuro Exam Flashcards
What is the first thing you do before doing a neurological exam?
Check the patients alertness because a neuro exam requires feedback from the patient
What is aphasia?
disorder in producing or undrerstanding language
What is dysarthria?
Defective articulation caused by defect in motor control of speech apparatus
What is A&O x4?
Oriented x1 is person oriented x2 is person and place Oriented x3 is person place time Oriented x4 is event
How do you look for depression?
Asking if they have felt down, depressed or hopeless lately. Adk if they have felt little interest or pleasure in doing things.
What is delirium?
It is REVERSIBLE common in older adults with hospitilizaiton
What is dementia?
Must eliminate depression and delirium before making diagnosis and medication can slow progression
How do you do a CN exam?
Have a pattern and do it the same every time. You only need light for pupillary reflex and app for snellen eye chart for visual acuity
How do you test CN I-IV?
- Smell
- Visual acuity
- Raide eyelids, pupil constriction/dilation and most extraocular movements
- Downward internal rotation of eyes (look to nose)
How do you test CN V-XII?
- Check sensory dermatomes check motor with clencthing jaw, corneal reflex
- Lateral deviatiohn of eye (TEST)
- Motor facial movments including expression closing of eye and mouth Sensory taste for anterior 2/3 tongue
- Hearing in tact?
- Phonation and sensory posterior 1/3 taste, gag reflex
- Raise palate, motor function of palate, pharynx
- Shrug shoulders and turn head against resistance
- Motor involvemnt of tongue, is it midline
What causes ptosis?
- Drooping of the eye due to levator palpebrae weakness from a CN III lesion
What causes pupillary deilation or asymmetry?
- disruption of ciliary plexus specifically parasymp innervation of pupil for miosis (constriction). If severe you see fixed dilated pupil.
- Due to CN III lesion
Opthalmoplegia?
- Denervation of majority of extraocuular mms Down and Out gaze
- Due to CN III lesion
How does occulomotor palsy prestent?
Sudden unilateral ptosis and opthaolmoplegia. Diplopia can be masked by severity of ptosis
Hypertropia?
Eye drifts upwards
Trochlear lesion
Weakness of downward gaze?
- due to weakness of SO mm eye drifts upwards
- trochlear nerve lesion
Vertical diplopia?
- Double vision that increases looking down
- CN IV palsy
How does CN IV palsy present?
Vertical diplopia difficulty reading or walking down staris. Also tortiocllis secondary to head tilting opposite to the lesion side
CN VI Palsy?
- Convergent medial strabismus : inability to abduct eye due to LR mm
- Horizontal diplopia: maximal separation of images when looking toward the paralyzed mm
CN V lesion?
- Decreased sensation of face and mucous mem
- Loss of corneal reflex
- Jaw deviation to the weak side
What is Trigeminal Neuralgia?
- Recurrent brief episodes of unilateral shocking pains along dermatomes of trigeminal
- Debilitating and triggered by innocuous stimuli
- Most cases caused by aberrant vein or artery compression on nerve
How does CN VII palsy present?
- Paralysis of mm of facial expressions
- Loss of corneal reflex efferent limb (closes eye)
- Hyperacusis (increased sensitivity to sound- stapedieus mm)
- Crocodile tears syndrome due to aberrant regeneration of nerve after trauma patients shed tears when they chew (not tested)
What is Bell’s Palsy?
- Peripheral facial paralysis
- caused by trauma or infection, but most cacses are idiopathic and it is very rare that it is bilateral
- complete knockout of one side of the face
When do bilateral facial palsies occur?
Varient of Guillain Barre Syndrome
How do you test CN VIII?
Rub fingers together and see if they hear it
Whisper behind them
Weber Rinne test
What does a lesion in the vestibular poriton of VIII?
- Disequilibrium
- Nystagmus
What doesa cochlear lesion of VIII look like?
- Destructive lesions lead to sensorineural hearing loss
- Irritative lesions cause tinnitus
Tessting IX and X?
- Listen to hoarsness nasal tone
- Gag reflex ( IX)
- Slight dysphagia (IX)
- loss of sensation in pharynx and posterior 1/3 tongue (IX)
- Dysphonia dysphagia dyspnea loss of gag or cough reflex (X)
How do you test XI SCM and trapezius?
- SCM: have patient turn head against mild resistance
- Traps: shrug shoulders against mild resistance
- Lesion of SCM: paralysis results inf difficulty turning head to opposite side
- Lesion of traps weakness results in shoulder droop
What dermatome is the auricle, earlobe,ant/post neck?
- C2 is auricle
- C3 is rest
When you are testing sensory system what tract is being stimulated with Pain and Temperature?
- Spinothalamic Tract
What tract is being tested when you test vibratiory sensation and proptioception?
Posteior columns
What is Stereognosis?
Ability to ID shapes of objects or recognize objects in hand
Graphesthesia?
ID numbers letters shapes drawn on hands
Two point discrimination?
Ability to distinguish being touched by one or two points
Single nerve loss?
Loss limited to distribution of a single nerve
Roots sensory loss?
Loss in different nerve distributions with comomon root
- C5,6,7 common in arms
- L4,5 S1 common in legs
Thalamic sensory loss?
Loss of all modalities hemisensory
Cortical loss of sensory loss?
Intact primary sensations obut loss of cortical sensations
How do you test cerebellar function?
- Rapid alternating movements such as finger to nose heel to shin
- Gain
- Stance
- Romberg test: test proprioception vestibular system and vision NOT CEREBELLAR, need two of three inputs to maintain balance. If you close eyes you’re relying on proprioception and vestibular systems, if they are not fxning they will fall over.
Cerebellar ataxia?
- Staggering unsteady feet wide apart
Sensory Ataxia?
Unsteady feet wide apart feet thrown forward and slapped down first on heels and then forefoot, patients watch ground
What is normal and abnormal plantar reflex?
- normal is toes down flexion
- abnormal is fanning of toes (babinski)
What is Brudzinski sign? (Will be on test)
- Patient supine examiner slowly flexes patients neck to chest and a positive sign is involuntary flexion of patients hips and knees flex
Meningeal signs
Kernigs sign?
(Will be on test)
- Examiner flexes patients hip and knee then slowly extends elg and straightens knee keeping hip flexed
- positive sign is pain or increased resistance to knee extension and can cause passive flexion of th neck
Remember K in Kernig with K in knee
Testing meningeal signs
