basic neuro exam Flashcards
anosmia
olfactory (cn1): loss of sensory of smell
pupils assymeticral/uneven
aniscoria
parasympathetic stimulation, light, looking at a near object
miosis
direct pupillary rxn to light
light show on the retina (afferent CNII) results in constriction of the ipsilateral pupil (efferent CNIII)
indirect pupillary rxn to light
light show on the retina (afferent CNII) results in constriction of the contralateral pupil (efferent CNIII)
pupillary rxn to accomodation***
pupils constrict when focused on a near object
what causes relative afferent pupillary defect? (aka marcus gunn pupil) characteristic?
due to optic nerve or severe retinal disease
direct pupillary resposne to light absent, but indirect response is intact because CNII is intact
whats the hallmark of neurosyphilis**
intact to accommodation but not to light*
“prostitute pupil”
nonresponse to light but do constrict when looking at near object
Signs and symptoms of horner’s syndrome
loss of sympathetic tone, ptosis, miosis, anhydrosis
CN IV palsy
what does this lead to?
and how does it often develop?
inability to bring the eye in and down
often leads to vertical diplopia with reading or near vision
often develop head tilt AWAY from affeected eye
normal jumping movements of the eye with voluntary scanning (reading)
Saccades
involuntary movement of eye; slow drift away from the focus with fast beat correlation back to the focus.
nystagmus
named for the fast phase twitching back
what CN is hypersensitivity to sound
CNVII
bells palsy characteristic
LMN lesion: cause facial drooping involving forehead (forehead has unilateral LMN involvement–therefore it involves the forehead)
One sided face droop
if patient had a stroke, how would the patient look
UMN lesion will cause facial drooping but spare the forehead because the forehead has BILATERAL UMN involvement (and stroke only involves one side)
hearing loss is due to inefficient conduction from the outer ear to the ear drum to ossicles from fluid in middle ear, perforated ear drum cerumen, foreign body
conductive hearing loss
damage to the inner ear apparatus or CN VIII
sensorineural hearing loss
what should the normal rxn of Rinne test should be
Normal rinne test is positive or negative? abnormal?
the sound should be louder on air conduction than bone conduction
positive ; negative
what is abnormal for webber test vs normal response?
normal: sound heard equally in both ears
abnormal: loud in one ear is considered lateralising to that side
spinal level: back of the head dermatome
C2
spinal level: nipple line dermatome (derm)
T4
spinal level: anterior axilla (derm)
T1
spinal level: thumb (dermatome)
C6
spinal level: index and middle finger
C7
spinal level: medial knee
L3
spinal level: medial malleolous
L4
spinal level: dorsum 3rd MTP joint
L5
spinal level: lateral heel
S1
spinal level: popliteal fossa
S2
spinal level: ring and little fingers
C8
spinal level: ischial tuberosity
S3
Perianal area
S5
identification of objects by touch; which lobe does this function?
sterognosis; parietal lobe
inability to identify objects by touch
tactile agnosia
write letter/number on patients palm
Graphthesthesia
loss of two point discrimination with maintenance of other sensory function (intact) indicates what type of injury?
parietal lobe injury
what are the spinal levels for:
biceps
C5-C6
what are the spinal levels for:
brachioradial
C5-C6
what are the spinal levels DTR for: triceps
C6, C7, C8
what are the spinal levels DTR for: Patellar
L2, L3, L4
what are the spinal levels DTR: Achilles
S1 & S2
What are the grades for assessing strength from Grade 0-5*****
0: no evidence of movement
1: trace movement
2: full ROM w/o gravity
3: full ROM against gravity
4: full ROM against gravity with some resistance
5: normal
able to go against gravity but when someone pushes on you, you cant resist against it, is what muscle function level?
grade 3
muscle can twitch–otherwise no more strength
Grade 1
damage in the C-spine or higher
upper extremity weakness
damage in the Lspine/sacrum or higher
lower extremity weakness
umbilicus dermatome
T10
