Basic Neuro Exam Flashcards
Cranial Nerve Functions
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Cranial Nerves with Parasympathetic function
Optic - pupillary constriction
Facial - tears/saliva
Glossopharyngeal - saliva, carotid reflex
Vagus - secretion of digestive enzymes, carotid reflex, involuntary action of heart, lungs, digestive tract
CN I: Olfactory
Anosmia - loss of smell
Test - whatever is on hand
“CN I grossly intact; detect smell”
Aniscoria
Pupil asymmetry - present in up to 20% of population
Consistent in varying light = normal
Miosis
pupil constriction
Parasympathetic stimulation, light, looking at near object
Mydriasis
Pupil dilation
Sympathetic stimulation, dark, looking at far object
Pupillary reaction
Direct - light on retina (afferent CN II) = constriction of ipsilateral pupil (efferent CN III)
Indirect - light on retina (afferent CN II) = constriction of contralateral pupil (efferent CN III)
Pupillary reaction to accommodation
Pupils constrict when focused on near object
Relative afferent pupillary defect
Marcus Gunn pupil
due to optic nerve or severe retinal disease
Direct response absent, indirect response intact (CN III)
DDx - optic neuritis, severe glaucoma, retinal detachment, retinal infection
Intact to accommodation by not light
Argyll Robertson - Prostitute Pupil
Hallmark of neurosyphilis
Pupils typically small at baseline, nonresponsive to light, constrict for accommodation
Horner’s syndrome
Oculosympathetic paresis
Ptosis - droopy eyelid
Miosis - pupil constricted
Anhydrosis - no sweat on that side of face
DDx - carotid a. dissection, pancoast tumor, nasopharyngeal tumor, brachial plexus injury
CN IV palsy
Inability to bring eye in and down
Leads to vertical diplopia with reading/near vision
Tilt head AWAY from affected eye
Saccades
Normal jumping movements of eye with voluntary scanning
Nystagmus
Slow drift away from focus with FAST* beat correction back to focus
Cerebellar - lateral; fast phase toward lesion side
Vertical - lesion of midbrain
Hypersensitivity to sound
CN VII innervates stapedius
UMN lesion to face
facial drooping sparing forehead
LMN Lesion to face
facial drooping including forehead