CH 24 Neuro Flashcards
Structure/Function: CNS
central nervous system
contains: brain and spinal cord
Structure/Function: PNS
peripheral nervous system
12 cranial nerves
31 pairs of spinal nerves
autonomic nervous system (ANS) - automatic
somatic nervous system (SNS) - controlled
CNS 4 lobes (functions)
frontal - personality, emotion, behavior, intellectual function, skilled movement
- Broca’s area injury = expressive aphasia (able to understand but cannot verbally communicate)
parietal - main processing center for sensory information
occipital - vision and interpretation of visual data
temporal - perception/interpretation of sounds and smell
- Wernicke’s area injury = receptive aphasia (cannot interpret/understand what is being said)
CNS (parts of brain and their function) Basal Ganglia Thalamus Hypothalamus Cerebellum Brainstem
Basal ganglia - important for initiating movement and maintaining automatic coordination (large bands of gray matter)
Thalamus - relay station//emotion and creativity
Hypothalamus - maintains homeostasis and basic vital signs
Cerebellum - for coordination of voluntary movement/ does not initiate movement
Brainstem - regulates HR, breathing, and swallowing
- contains: midbrain, pons, medulla
CNS Pathway
crossover representation
- right cerebrum controls left sided motor function and vice versa
PNS Spinal Nerves
cervical (8) thoracic (12) lumbar (5) sacral (5) coccyygeal (1)
How messages travel in PNS
sensory (afferent) goes FROM sensory receptors TO CNS
motor (efferent) goes FROM CNS TO muscles and glands
PNS sends automatic messages TO internal organs and blood vessels
Autonomic Nervous System (ANS) Components
innervates smooth muscle
Parasympathetic NS - rest and digest
Sympathetic NS - fight or flight
Reflex Arc (3 types)
Deep tendon reflex
LE: patellar, achilles, hamstring
UE: triceps, biceps, brachioradialis
Superficial reflexes
visceral reflexes - pupillary response to light and accommodation
Pathologic Reflexes
Plantar reflex - Babinski Sign
- positive finding after 24 months (abnormal)
Mental Status Assessment (4 things)
judgment
abstraction
memory
LOC
LOC (5 different levels)
alert - pt able to look at you and fully respond to stimuli
lethargy - drowsy but eyes open; responds to questions then falls asleep
obtunded - opens eyes, responds slowly, somewhat confused; may need repeated stimuli
stuporous - arouses from sleep after painful stimuli; verbal responses are slow or no response at all
comatose - verbal and tactile stimuli do not arouse
them
CN I
olfactory
normal if patient identifies common odors accurately
test if reports of loss of smell or head injury
CN II
optic
visual acuity and visual fields
color - ishihara plates
visual field - peripheral vision test
pupillary reflex - carries sensory information (sends to CNS)
- CN III deals with actual movement (motor function)
CN III, IV, VI
CN III (oculomotor) CN IV (trochlear) CN VI (abducens)
Cardinal Field of Gaze
- all tested together for conjugate movement
CN V
trigeminal
3 branches
- ophthalmic
- maxillary
- mandibular
assess:
- sensory supply to face (tests all three branches) with light touch in each area
- sensory reflex (corneal reflex)
- motor supply to muscles of mastication (maxillary and mandibular)
- palpate jaw and temple and ask patient to clench teeth
CN VII
Facial
innervates muscles for facial expression
- tell patient to raise eyebrows, clench eyes, puff out cheeks, and smile
CN VIII
vestibulocochlear
innervates hearing apparatus of the ear
auditory acuity - whisper test (detects high-pitch hearing loss)
conductive vs sensorinueral
air conduction vs bone conduction
vestibulo (balance) /// cochlear (hearing)
CN IX, CN X
CN IX (glossopharyngeal) CN X (vagus)
tested together with tongue depressor and pt saying “ahh”
CN IX - sensory supply to soft palate (gag reflex)
CN X - motor supply to pharynx (uvula and soft palate rise to midline)
CN XI
spinal accessory
tests strength of sternocleidomastoid (SCM) and trapezius muscle
have pt turn head against resistance (SCM)
have pt shrug shoulders against resistance (trap)
CN XII
hypoglossal
tongue strength
Cerebellar Function Assessments (4)
Rapid rhythmic alternating movements
- alternate patting knees with both hands
- airplay piano
- touch thumb to finger tips on both hands
Accuracy of movements
- finger to nose
Balance
- very light sternal nudge
- Romberg Test (stand with feet together, eyes closed)
- swaying = positive
Gait
- tandem walking (heel-to-toe)
Muscular (contraction) Grade Scale
(higher number = better response)
0 = no contraction detected 1 = barely detectable contraction 2 = active movement with gravity eliminated 3 = active movement against gravity 4 = active movement against gravity and some resistance 5 = active movement against resistance w/o evident fatigue (NORMAL)
Glascow Coma Scale
objective assessment for LOC
3 categories:
eye opening response
verbal response
motor response
15-13 = mild (15 being the best response) 12-9 = moderate 8-3 = severe - 8 or less = compatose - 3 = unresponsive
Glascow (eye opening response)
- Spontaneously: 4
- to speech: 3
- to pain: 2
- no response: 1
