Chapter 17 Neuro Flashcards
5 categories of Neurological Exam
Mental status (speech & language), cranial nerves, motor system, sensory system, and reflexes
LOC
Alertness (responds fully), lethargy (appears drowsy), obtundation (responds slowly/confused), stupor (minimal awareness), coma (no evident awareness)
Speech
Look for underlying abnormalites; is there evidence of dysarthria, aphasia, or other psychological problems?
Thought processes
Logical, Relevant, Organized, Coherent
CN I
Olfactory: smell
CN II
Optic: Visual acuity, visual fields, ocular fundi, and pupillary reactions
CN III
Oculomotor: Pupillary reactions, extraocular movements
CN IV, VI
Trochlear (IV) Abducens (VI): Extraocular movements
CN V
Trigeminal: Corneal reflexes, facial sensation, voice and speech, and jaw movements
CN VII
Facial: facial movements and voice and speech
CN VIII
Acoustic: Hearing
CN IX & X
Glossopharyngeal: swallowing and rise of the palate, gag reflex
voice and speech (X)
CN XI
Spinal Accessory nerve: shoulder and neck movements
CNXII
Hypoglossal: Tongue symmetry and position, and voice and speech
Muscular atrophy
fasciculations, hyporeflexia (lower motor nerver lesion)wasting away/ loss of muscle bulk. Seen in diabetic neuropathy and flattening of thenar and hypothenar eminences
Muscle tone
look for hyperreflexia, clonus, spasticity, and barbinski’s sign (upper motor neuron lesion) versus atrophy
Muscle strength
impaired strength (paresis), absence of strength (plegia),
Weakness of extension at elblow
CNS disease producing hemiplegia- stroke, MS
Weak grip
de Quervain’s tenosynovitis, CTS, arthritis
Rapid alternating movements
Dysdiadochokinesis: one movement cannot be followed quickly by its opposite and movement are slow
Positive Romberg sign
Ataxia from dorsal column disease and loss of position sense
Patient stands fairly well with eyes open but loses balance when they are closed.
Pronator drift test
A sideward or upward drift, sometimes with searching, writhing movements of hand suggest loss of position sense.
Cerebellar incoordination- arms returns to original positiion but overshoots and bounces
Gait
Ataxia (cerebellar disease) lacks coordination with reeling and instability
Muscle atrophy
loss of muscle bulk wasting; results from diseases such as diabetic neuropathy
Hypertrophy
increase in bulk with proportionate strength;
Pseudohypertrophy
Increase in bulk with diminished strength (seen in the Duchenne form of muscular dystrophy)
flaccidity
marked floppines that indicates hypotonia
Spasticity
increased resistance that worsens at the extreme range (seen in central corticospinal tract diseases
Rigidity
increased resistance throughout rangle of movement in both directions
upper motor neuron lesion
hyperreflexia, clonus, spasticity, and barbinski’s sign
Clonus
a hyperactive response required for assigning a reflex grade of 4, usually elicited at the ankle. The ankle plantar flexes and dorsiflexes repetitively and rhythmically
caused by CNS disease
lower motor neuron lesion
atrophy, fasciculation, hyporeflexia
hyperthesia
decrease sensitivity
Anesthesia
absence of touch sensitivity
Loss of position sense
tabes dorsalis, MS, B12 deficiency
Astereognosis
inability to recognize objects place in hand
Lesion in sensory cortex
inability to recognize numbers
Graphesthesia
tests the individual’s ability to use sensory input to identify a number or letter drawn onto his/her hand while visually occluded.
Positive Barbinski’s reflex
dorsiflexion of big toe
0 (grading reflexes 0-4 scale)
no reponse
1+ (grading reflexes 0-4 scale)
somewhat diminished; low normal
2+ (grading reflexes 0-4 scale)
Average; normal
3+ (grading reflexes 0-4 scale)
Brisker than average; possible not necessarily indicative of disease
MMSE
Date, Place, Object, Serial sevens, Naming, Recall, Repeat, Verbal commands, written command, writing, drawing
4+ (grading flexes 0-4 scale)
very brisk; hyperactive, with clonus (rhythmic oscillations between flexion and extension)
Symmetric weakness of proximal muscles suggests:
a myopathy or muscle disorder
Symmetric weakness of distal muscles suggests:
polyneuropathy or disorder of peripheral nerves
Dysdiadochokinesis
In cerebellar disease, when one movement cannot be followed quickly by its opposite movement
Cerebellar Ataxia
patient has difficulty standing with feet together whether they eyes are open or closed.
First sensation to be lost in a peripheral neuropathy
vibration sense
Causes of peripheral neuropathy:
Diabetes, alcoholism, vit. B12 deficiency, and tertiary syphilis
Causes of loss of position sense:
tabes dorsalis, MS, B12 deficiency, diabetes
Astereognosis and the inability to recognize numbers both suggest a lesion of:
the sensory cortex
Causes of hyperreflexia
CNS lesions along the descending corticospinal tract
Associated findings of weakness, spasticity, or positive Babinski’s sign.
Causes of hyporeflexia
Diseases of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves.
Associated findings of weakness, atrophy and fasciculations
Kernig’s Sign
Pain and increased resistance to extending the knee
Suggests meningeal irritation
