Approach To Neuro Complaint

Question 1

What do you look for in terms of mental status, speech & language?

Answer 1

Alertness
Speech (easily understood?)
Oriented x 1-4

Question 2

Dysarthria

Answer 2

Defective articulation, usually caused by defect in motor control of speech apparatus

Question 3

Aphasia

Answer 3

Disorder in producing or understanding language, usually caused by lesions in dominant hemisphere

Question 4

What is A&O x 4?

Answer 4

Person
Place
Time
Event

Question 5

Depression (2 questions)

Answer 5

Have you been feeling down, depressed or hopeless?

Have you felt little interest or pleasure in doing things?

Question 6

Delirium

Answer 6

Reversible condition (common in older adults during hospitalization)

Question 7

Dementia

Answer 7

Not reversible condition

Must eliminate both depression & delirium before diagnose w/ dementia

Question 8

Lesions assoc / CN III

Answer 8

Ptosis
Pupillary dilation or asymmetry
Compressive brain stem lesions

Question 9

Compressive brainstem lesions

Answer 9

Space occupying or masses may cause brain to herniate thru dural openings in cranium

Compression of pupilloconstrictor fibers of CN III causing dilation & fixation of pupil

2nd effect on somatic efferent fibers supplying extraocular ms

Question 10

Lesions of CN IV

Answer 10

CN IV vulnerable to head trauma

Exotropia
Vertical diplopia
Head tilting

Question 11

Exotropia

Answer 11

Eye position drifts laterally

Question 12

Lesions w/ CN VI

Answer 12

Most common isolated CN palsy b/c long peripheral course (subarachnoid hemorrhage, trauma)

Convergent strabismus
Horizontal diplopia

Question 13

Convergent strabismus

Answer 13

Inability to abduct the eye (lateral rectus muscle weakness)

Question 14

Nystagmus

Answer 14

Rhythmic oscillation of eyes & can be seen in extreme lateraling of gaze

Horizontal, vertical, rotatory

Question 15

Lesions of CN V

Answer 15

Decreased sensation of face/mucous membranes
Loss of corneal reflex
Weakness of muscles of mastication
Jaw deviation (toward weak side)

Question 16

Trigeminal Neuralgia

Answer 16

Recurrent brief episodes of unilateral shock-like pains along 1 or more distributions of CN V (can be debilitating)

Question 17

Lesions w/ CN VII

Answer 17

Paralysis of muscles of facial expression (Bell’s Palsy)
Loss of corneal reflex (efferent)
Hyperacusis (increased sensitivity to sound)
Crocodile tears syndrome (tearing w/ chewing)

Question 18

Bell’s Palsy

Answer 18

Peripheral facial paralysis can be caused by trauma or infection but usually idiopathic

Question 19

Supranuclear facial palsy

Answer 19

Spares the upper face & usually assoc w/ weakness to 1 side of body (hemiplegia)

**important to determine if weakness is central or peripheral in nature

Question 20

How to test CN VIII…

Answer 20

Whisper test
Finger rub test
Weber Rinne test

Question 21

Vestibular division lesions of CN VIII

Answer 21

Disequilibrium (imbalance)

Nystagmus (rapid involuntary & rhythmic movement of eye)

Question 22

Cochlear division lesions of CN VIII

Answer 22

Destructive lesions lead to sensorineural hearing loss

Irritative lesions can cause tinnitus (ringing in ears)

Question 23

How to test for CN IX & X

Answer 23

Listen to voice for hoarseness & nasal tone (palatal weakness)
Check gag reflex
Check for difficulty swallowing
Look for elevation of soft palate & uvula position
(Unilateral loss indicates ipsilateral CN X lesion)

Question 24

Lesions specific to CN IX

Answer 24

Loss of gag reflex
Loss of sensation in pharynx & posterior 1/3 tongue
Slight dysphagia

Question 25

Lesions specific to CN X

Answer 25

Dysphonia Dysphagia Dyspnea Loss of gag or cough reflex

Question 26

Testing of CN XI

Answer 26

SCM: Pt attempt to turn head v mild resistance Trapezius: Pt shrugs shoulders

Question 27

Testing CN XII lesion

Answer 27

Have pt protrude tongue & have pt push against cheeks v resistance (If lesion, tongue will deviate to weak side & pt will not be able to push tongue to opposite side)

Question 28

CN II-XII are intact to testing means

Answer 28

You went through the actual confrontation & testing of each nerve BILATERALLY

Question 29

How to test the sensory system

Answer 29

Pt eyes should be closed! Pain Temp Vibration Proprioception

Question 30

Discriminative sensations

Answer 30

Stereognosis Graphesthesia Two point discrimination Double simultaneous stimulation

Question 31

Stereognosis

Answer 31

Ability to identify shapes of objects or recognizing objects placed in hand

Question 32

Graphesthesia

Answer 32

Ability to identify numbers written on palm

Question 33

2 point discrimination

Answer 33

Ability to distinguish being touched by 1 or 2 points

Question 34

Double simultaneous stimulation

Answer 34

Ability to feel 2 locations being touched simultaneously

Question 35

Sensory loss assoc w/ spinal cord

Answer 35

Complete transverse section, hemisection of cord, posterior column, anterior spinal syndrome

Question 36

Sensory loss assoc w/ brainstem

Answer 36

Crossed findings w/ ipsilateral loss in face & contralateral in body

Question 37

Thalamic

Answer 37

Hemisensory loss of all modalities

Question 38

Cortical loss

Answer 38

Intact primary sensations but loss of critical sensations

Question 39

Functional loss

Answer 39

Non-anatomical distribution

Question 40

What is cerebellar/coordination testing?

Answer 40

``` Rapid alternating movements Finger to nose Heel to shin Gait Stance ```

Question 41

How do you test the motor system?

Answer 41

``` Starts w/ observation: Gait Body position Involuntary movements Muscle bulk Muscle tone ```

Question 42

What is a wide based stance?

Answer 42

Distance between the feet is greater than normal

Question 43

Cerebellar Ataxia

Answer 43

Staggering, unsteady, feet wide apart

Question 44

Sensory ataxia

Answer 44

Unsteady, feet wide apart, feet thrown forward & slapped down first on heels then forefoot, pts watch ground when walking

Question 45

Parkinsonian

Answer 45

Stooped forward, short steps commonly called “shuffling gait” w/ involuntary hesitation, decreased arm swing

Question 46

What is the abdominal reflex?

Answer 46

Cutaneous or superficial reflex, stroke abdomen & muscles should contract toward umbillicus

Question 47

Plantar Response

Answer 47

Cutaneous & superficial reflex that when apply pressure from heel to toe on plantar surface of foot, the big toe should flex down

Question 48

Meningeal signs

Answer 48

Nuchal rigidity Brudzinski sign Kernig sign

Question 49

Nuchal rigidity

Answer 49

Neck stiffness w/ resistance to flexion (84% pt w/ acute bacterial meningitis)

Question 50

Brudzinski sign

Answer 50

Stretches the FEMORAL nerve + sign is pt hips & knees flex when flex neck

Question 51

Kernig sign

Answer 51

Stretches the SCIATIC nerve + sign: pain or increased resistance to knee extension beyond 135 degrees