Aspects of Neurological Examination Flashcards

1
Q

What are the different criteria for an eye score in GCS?

A
  • 4 - opens voluntarily
  • 3 - opens to voice
  • 2 - opens eyes to pain
  • 1 - does not open eyes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the criteria for scoring the motor score for GCS?

A
  • 6 - following commands
  • 5 - localising to pain
  • 4 - normal flexing to pain
  • 3 - Abnormal (decorticate) flexion to pain
  • 2 - Abnormal (decerebrate) extension to pain
  • 1 - No movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different criteria for the verbal scoring of GCS?

A
  • 5 - Speaking normally
  • 4 - confused
  • 3 - abnormal words/ incomplete sentences
  • 2 - mumbling/noises
  • 1 - no sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How would you note a brisk or exaggerated reflex in case notes?

A

+++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would you note a normal reflex in case notes?

A

++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you note a diminished reflex in case notes?

A

+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you note an absent reflex in case notes?

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If assessing plantar response, what would be a positive babinski’s sign?

A

Large to extends and other toes abduct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If assessing plantar response, what would be an abnormal plantar response?

A

Only large to extends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If assessing plantar response, what would be an abnormal plantar response?

A

Only large to extends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If assessing plantar response, what would be classed as no response?

A

No movement of large toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If assessing plantar response, what would be a withdrawal response?

A

Large toe and other toe extends, ankle dorsiflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is grade 0 of the MRC power grading scale?

A

No muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is grade 1 of the MRC power grading scale?

A

Filcker of contraction but no movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is grade 2 of the MRC power grading scale?

A

Joint movement when effect of gravity eliminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is grade 3 of the MRC power grading scale?

A

Movement against gravity but not against examiner’s resistance

17
Q

What is grade 4 of the MRC power grading scale?

A

Movement against resistance but weaker than normal

18
Q

What is grade 5 of the MRC power grading scale?

A

Normal power

19
Q

What are the components to decroticate posturing?

A
  1. Facilitation of the rubrospinal tract and medullary reticulospinal tracts - disinhibition of red nucleus due to disconnection from cortex leads to biased flexion of upper extremities as tone from these tracts outweighs the medial and lateral vestibulospinal and pontine reticulospinal tract which facilitates extension in the upper extremities.
  2. Disruption of lateral corticospinal tract - reduces motor neuron activity in the lower spinal cord supplying flexor muscles of the lower extremities. The pontine reticulospinal and the medial and lateral vestibulospinal biased extension tracts greatly overwhelm the medullary reticulospinal biased flexion tract.

The effects on these two tracts (disruption of corticospinal and facilitation of rubrospinal) by lesions above the red nucleus is what leads to the characteristic flexion posturing of the upper extremities and extensor posturing of the lower extremities.

20
Q

Why does decerebrate posturing occur?

A

Lesions below the red nucleus cause disruption of supply to flexors. However, vestibulospinal tracts are unaffected, meaning that extensors predominate. This leads to the arms and legs being extended and rotated internally. The patient is rigid, with the teeth clenched.

21
Q

What does decorticate posturing indicate?

A

There may be damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus. It may also indicate damage to the midbrain

22
Q

What does decerebrate postuing indicate?

A

Indicates brain stem damage, specifically damage below the level of the red nucleus (e.g. mid-collicular lesion). It is exhibited by people with lesions or compression in the midbrain and lesions in the cerebellum, and is commonly seen in pontine strokes

23
Q

What does progression from decorticate to decrerebrate posturing indicate?

A

Progression from decorticate to decerebrate posturing is often indicative of uncal (transtentorial) or tonsilar brain herniation

24
Q

Where is the red nucleus?

A

Located in the tegmentum of the midbrain next to the substantia nigra and comprises caudal magnocellular and rostral parvocellular components

25
Q

What is the function of the rubrospinal tract?

A

The tract is responsible for large muscle movement as well as fine motor control, and it terminates primarily in the cervical spinal cord, suggesting that it functions in upper limb but not in lower limb control. It primarily facilitates flexion in the upper extremities

26
Q

What is the function of the vestibulospinal tract?

A

The Vestibulospinal tract is infact made of two tracts, the lateral and medial. Each tract is responsible for increasing antigravity muscle tone in response to the head being tilted to one side [1] Fibres of the vestibulospinal tracts, the vestibular neuclei, are associated with the cerebellum, which therefore can subsequently result in the cerebellum indirectly influencing control on the spinal control [2]In addition these pathways recieve information from the labyrinthine system

27
Q
A