Approach to Neuro Exam Flashcards
Dysarthria vs. Aphasia
- Dysarthria - defective articulation, due to neuro or non neuro issue
- Aphasia - cannot produce or understand speech, neuro issue
Describe what is meant by AxOx4
Alert Oriented to: - Person (x1) - Place (x2) - Time (x3) - Situation (x4)
What is anhedonia? What condition is this associated with?
cannot feel pleasure, assoc w depression
Delirium vs. Dementia
- Delirium - reversible (ex: ICU delirium)
2. Dementia - not reversible (ELIMINATE delirium and depression before dx)
What lesions are assoc with CN III?
ptosis (Horners), pulpillary dilation/asymm, compressive brain stem lesions
What lesions are assoc with CN IV?
- exotropia (eyes drift laterally), weakness downward gaze
- visual diplopia (worse when looking down)
- head tilting (to opp side lesion, do not misdx as torticollis)
What lesions are assoc with CN VI? What diseases is this commonly assoc with?
Dz: SAH, late syphilis, trauma
- medial strabismus (esotropia)
- horizontal diplopia
What lesions are assoc with CN V?
- loss of corneal reflex
- weakness mastic m
- dec sens face
- jaw deviation (toward weak side)
What lesions are assoc with CN VII?
- Bell’s Palsy
- Hyperacusis
- Crocodile tears syndrome - tears while chewing
What lesions are assoc with CN VIII?
- dysequilibrium
- nystagmus
- sensorineural hearing loss
- tinnitus
What lesions are assoc with CN IX?
- loss of gag reflex
- loss of sensation in pharynx and post 1/3 tongue
- slight dysphagia
What lesions area assoc with CN X?
- hoarseness (dysphonia)
- dysphagia
- dyspnea
- loss of gag or cough reflex
- asymm palatal elevation
What lesions are assoc with CN XI?
SCM - difficulty turning head to opp side
Trap - shoulder droop
What lesions are assoc with CN XII?
tongue deviation to weak side
How should you document CN testing?
Ideal: “CN II-XII are intact to testing” - went thru each b/l
Ok: “CN are grossly intact” -talking to pt and havent seen anything that would demonstrate CN are not intact, did not actually test them
Sensory Dermatomes to know
C2 - auricle C3 - earlobe, ant/post neck C6 - radial aspect forearm C8 - 5th digit T4 - nipple T10 - umbilicus L1 - inguinal L4 - patella L5 - anterolateral calf, great toe S5 - perianal area
What 4 modalities should you test during sensory exam?
- Pain - broken tongue depressor
- Temp - test tubes w warm or cold water
- Vibration - tuning fork bony prominences
- Proprioception - move big toe up an down w eyes closed
Sterogenesis
ability to ID objects in hand (discriminative sens)
Graphesthesia
ability to ID numbers written on you hand (discriminative sens)
2 - pt discrimination
can distinguish being touched by one or two points (discriminative sens)
Double simultaneous stimulation (extinction)
ability to feel two locations being touched simultaneously
Patterns of Sensory Loss
- Thalamic - hemisensory all modalities
- Cortical - intact primary sensations, loss of cortical sensations (discrim sens)
- Functional loss- non anatomical distribution (ex: diabetic neuropathy)
Muscle bulk vs. muscle tone
bulk - atrophy, hypertrophy
tone - musc that is relaxed voluntarily retains slight tone
Cerebellar ataxia
staggering, unsteady, feet wide
Sensory ataxia
unsteady, feet wide, feet slapped down on ground
Parkinsonian
stooped forward, shuffle, invol hesitation (festination), dec arm swing
Abdominal Reflex
swipe finger across abd and muscles contract
Anal Reflex
anus “winks” in response to stimuli
Nuchal Rigidity
- neck stiffness w resistance to flexion
- common w meningitis and SAH
Brudzinski Sign
stretches FEMORAL n.
+ sign = pt hips and knees flex
Kernig Sign
stretches SCIATIC n.
+ sign = pain or increased resistance to knee ext
