Chapter 23: Neuro Flashcards
Cranial nerve I test
Olfactory nerve,
test smelling
Cranial nerve II test
Optic nerve:
Test visual acuity and visual fields via the confrontation test, examine ocular fundus
Cranial nerve III, IV, VI test
Oculomotor, Trochlear, Abducens nerves;
check pupil size, extraocular movements via cardinal signs, Checking for nystagmus
Cranial nerve V motor test
Motor function: Trigeminal nerve; muscles of mastication by palpating the temporal and masseter muscles as person clenches teeth, muscles should feel equal and strong
Sensory:
Cranial nerve VII test
Facial nerve;
mobility and facial symmetry, smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks (air should exit from both sides equally)
Cranial nerve VIII test
Acoustic (Vestibulocochlear); test hearing acuity through normal conversation and whisper test, tuning fork, Balance (Romberg)
Cranial nerve IX and X test
Glossopharyngeal and Vagus nerve;
Motor function: depress the tongue and note pharyngeal movement as they say “ahhh”
Note gag reflex
Cranial nerve XI test
Spinal accessory:
examine sternomastoid and trapezius for equal size and check the strength
Cerebellar function
Have person move face laterally against your hand on their chin
Put hands on their shoulder and have them push up against
Cranial nerve XII test
Hypoglossal; have them move their tongue and have them say “light, tight, dynamite” making sure the l,t and d are said clearly
Cerebellar function: Coordination of movements
Cranial nerve V sensory test
Sensory: With persons eyes closed, test light touch sensation by touching cotton wisp to forehead, cheeks and chin and have person say “now” when they feel the cotton (tests ophthalmic, maxillary, mandibular)
Cerebellar function
Coordination of movements
Rapid alternating movements “RAM”
Tests cerebellar function
Have person pat knees with both hands, lift up, turn hands over and then pat knees with back of hand and have patient do it faster in a coordinated rhythmic pace
Finger to Finger test
Tests cerebellar function
Have patient touch thumb to each finger
Finger to nose test
Tests cerebellar function
Have patient close eyes and reach out and then touch tip of nose with each index finger separately
Heel to shin test
Tests cerebellar function
Tests lower extremities; supine position place heel on opposite knee (normally person move their knee in a straight line down the shin)
Balance test
Observe gait, have person walk 10-20 ft in a straight lint and turn around and walk back
Romberg Test
Ask person to stand up with feet together and arms at sides and then close eyes and balance for 20 seconds
What is a positive Romberg test?
If the person falls
What is a negative Romberg test?
If the person doesn’t fall
Spinothalamic tract test for pain
Pain: tested by person’s ability to feel a pinprick, break stick in half and then have patient if they feel the sharp or dull side when you lightly apply point to their skin
Spinothalamic tract test for light touch
Light touch: Apply wisp of cotton (stretched out cotton ball) to the skin and brush it over the skin randomly on arms, forearms, hands, chest, thighs and legs and have them say “now” when they feel it
Posterior dorsal column test for vibration
using low pitch tuning fork you test the ability to feel vibrations on bony surfaces like on the surfaces of the fingers and great toe
Posterior dorsal column test for position (Kinesthesia)
Move a finger or toe and with the patients eyes closed ask them which direction it moved
Posterior Dorsal Column for two point discrimination
Apply the two points of an opened paper clip lightly to the skin in a close distance and see if they can feel both
Posterior Dorsal Column stereognosis test
Ability to recognize objects in their hand with eyes closed, put key in their hand and see if they know what it is
Posterior Dorsal Column graphesthesia test
ability to “read” a number by having it traced on the skin
Posterior Dorsal Column Extinction test
Simultaneously touch both sides of the body at the same point. Ask the person to state how many sensations they felt and where
Posterior dorsal column point location test
Touch the skin and withdraw promptly, tell the person “put your finger where I touched you”
Reflex ratings
4+ = hyperactive, brisk, indicative of disease 3+ = brisker than average, possibly indicative of disease 2+ = Average normal 1+ = Diminished, low, occurs only with reinforcement 0 = no response
6 reflex points
Patellar (right under knee cap), Biceps (use the thumb and apply pressure), Triceps, Brachioradialis (2 cm above where you palpate for radial artery), Quadriceps, Achilles, Clonus (only when reflexes are hyperactive, it’s a repeated reflex muscular movement)
What does the CNS include?
Brain and spinal cord
What does the PNS include?
All nerve fibers outside the brain and spinal cord
What does the PNS do
- Carries sensory (afferent) messages to CNS from sensory receptors
- Motor (efferent) messages from CNS to muscles and glands, as well as autonomic messages that govern internal organs and blood vessels
What is the Cerebral cortex
It is the outer layer of nerve cells and the center of functions governing though, memory, reasoning, sensation and voluntary movement
4 lobes of the cerebral cortex
frontal, parietal, temporal, and occipital
Frontal lobe function
concerned with personality, behavior, emotions, and intellectual function
-Pre-central gyrus of frontal lobe initiates voluntary movement
Parietal lobe
Primary center for sensation
Occipital lobe
Visual receptor center
Temporal Lobe
Behind ears, has primarily auditory reception center, taste and smell
Wernickes area
language comprehension
Result of damage to Wernickes
When damaged in the person’s dominant hemisphere, receptive aphasia results; person hears sound, but it has no meaning, like hearing a foreign language
Brocas area function
Motor speech
Result of damage to Brocas
When injured in dominant hemisphere, expressive aphasia results; person cannot talk; person can understand language and knows what they want to say, but can produce only garbled sound
Damage to cerebral cortex can cause what damage?
Motor weakness
Paralysis
Loss of sensation
Impaired ability to understand and process language
When does damage to cerebral cortex usually occur?
When neurological cells are deprived of blood like when cerebral artery is occluded
Basal Ganglia
Initiate and coordinate movement and control automatic associated movements of body
Thalmus
Main relay station where sensory pathways of spinal cord, cerebellum, and brain stem form synapses
Hypothalamus purpose
Major respiratory center with basic functions such as
**controls hormones by the pituitary gland
controls body **temperature
**control of food and water intake, hunger and thirst
**control of sexual behavior and reproduction
**circadian rhythm
**emotional responses
Cerebellum location and function
under occipital lobe concerned with coordination of voluntary movements, equilibrium, and muscle tone
**Does not initiate, but coordinates and smoothes movements
What cranial nerves originate in the nuclei in the Brain stem
Cranial nerve (CN) III through XII originate from nuclei in brain stem
Midbrain
most anterior part of brain stem with tubular structure of spinal cord; contains many motor neurons and tracts
Pons
enlarged area containing ascending sensory and descending motor tracts
Medulla
continuation of spinal cord in brain; contains all fiber tracts connecting brain and spinal cord
Spinal cord location
Long cylindrical structure of nervous tissue that occupies upper two thirds of vertebral canal from medulla to lumbar vertebrae L1 to L2
Where would you find Nerve cell bodies, or gray matter, arranged in butterfly shape with anterior and posterior “horns”
Spinal cord
Pathways of CNS; what does the “crossed representation” mean
Left cerebral cortex receives sensory information from and controls motor function to right side of the body; vice versa
Left damage of the brain causes what?
Paralyzed right side, speech and language deficit, Behavioral style is slow and cautious and memory deficit in language
Right side brain damage causes what?
Left sided paralysis, Spatial perceptual deficits, Behavior becomes quick and impulsive, Memory deficit in performance
4 types of reflexes
Deep tendon reflexes=patellar
Superficial=corneal reflex
Visceral= pupillary response to light
Pathologic=Babinski’s reflex
What is an involuntary reflex?
below level of conscious control permitting quick reaction to potentially painful or damaging situations
What does it mean if an infant has prolonged primitive reflexes?
CNS dysfunction
What is Gower’s sign?
Indicates weakness of proximal muscles, mainly of the lower limbs. Patient uses hands on knees to stand up
Primitive reflexes (examples)
Rooting , Sucking, Palmar grasp, Plantar grasp, Babinski , Tonic-neck, Moro, Stepping
Developmental competence in Aging Adult
Senile tremors, loss of muscle bulk, decreased muscle strength, impaired fine coordination, decreased pupillary reflex, decreased or absent reflex, reaction time slows down, slow movement, dizziness, loss of balance because decrease in cerebral blood flow, diminished sensation of touch, pain, taste and smell, Gait is unsteady
Developmental competence in pregnant women
Hyperactive reflexes (hyperreflexia) and preeclampsia **Mag sulfate (used to treat preeclampsia)if their reflex is a 0, they are receiving too much Mag and Preeclamptic women are at risk of seizures, if their reflex is a 4+ you are concerned
Strokes are high in which population
Higher for African Americans and Hispanic populations
What is the “stroke belt”
11 states with increased stroke mortality
Seizures postictal phase questions
After having a seizure, do you sleep? Do you have confusion, weakness, headache, or muscle ache? Are you on any medication?
Tremor questions
Any shakes or tremors in hands or face? When did these start?
Do they seem to grow worse with anxiety, intention, or rest? Do they affect daily activities?
What would you know about an infant regarding the evaluation of their neuro system
If there were birth traumas, reflexes, seizures, balance problems, milestones, family medical history, premature or full term, Apgar score, does infant startle
What is a good sequence for doing a neurologic examination
Mental status Cranial nerves Motor system Sensory system Reflexes
How do you observe mental status, speech and language
- LOC, appropriateness of responses, orientation
* Ask Name, Date (day of the week) and Time
Olfactory (Sensory, motor or both)
Sensory
Optic (Sensory, motor or both)
Sensory
Oculomotor ((Sensory, motor or both)
Motor
Trochlear (Sensory, motor or both)
Motor
Trigeminal (Sensory, motor or both)
Both
Abducens (Sensory, motor or both)
Motor
Facial (Sensory, motor or both)
Both
Acoustic (Sensory, motor or both)
Sensory
Glossopharyngeal (Sensory, motor or both)
Both
Vagus (Sensory, motor or both)
Both
Spinal (Sensory, motor or both)
Motor
Hypoglossal (Sensory, motor or both)
Motor
Balance tests
Gait and Rombergs test
Biceps reflex normal response
Normal response is contraction of biceps muscle and flexion of forearm
Triceps reflex normal response
Normal response is extension of forearm
Quadriceps reflex normal response
Normal response is extension of lower leg
Achilles reflex normal response
Normal response is foot plantar flexes against your hand
Sensory receptor location vs Motor response receptor location
Sensory: skin
Motor: muscle
Abdominal reflexes (T8 - T10)
Supine, knees bent using handle end of the reflex hammer to stroke skin
Normal response is ipsilateral contraction of abdominal muscle with observed deviation of umbilicus toward stroke
Go from each corner to midline
Cremasteric reflex (L1 - L2)
On male, lightly stroke inner aspect of thigh with reflex hammer or tongue blade
Note the elevation of ipsilateral testicle
Plantar reflex
With reflex hammer, draw a light stroke up lateral side of sole of foot and inward across ball of foot, like an upside-down “J”
Normal response is plantar flexion of toes and inversion and flexion of forefoot
Glascow coma scale
15 is intact
3 means the person is on a vent in a comatose state
Anosmia
damage to cranial nerve I
Absent central vision and peripheral vision with absent light relfex
damage to Cranial nerve II
Dilated pupil, ptosis, eye turns out, eyes cant move up or down
Damage to cranial nerve III
Failure to turn eye down or out
Damage to cranial nerve IV
Absent touch and pain, paresthesias, No blink, weakness of masseter or temporalis muscle
Damage to cranial nerve V
Failure to move laterally, diplopia on lateral gaze
Damage to cranial nerve VI
Absent or asymmetric facial movement, Loss of taste s damage to what nerve?
Damage to cranial nerve VII
Decrease or loss of hearing is damage to what nerve?
Damage to cranial nerve VIII
No Gag Reflex is damage to what cranial nerve?
Damage to cranial nerve IX
Uvula deviates to side No gag reflex Voice quality: Hoarse or brassy, nasal twang or husky Dysphagia, fluids regurgitate through nose
Damage to cranial nerve X
Absent movement of sternomastoid or trapezius muscles
Damage to cranial nerve XI
Tongue deviates to side, Slowed rate of tongue movement
Damage to cranial nerve XII
Ischemic stroke
Brain deprived of blood
Hemorrhagic stroke
Brain bleed
4 things to check if someone is having a stroke
Face, Arm, Speech, Time
Vertigo
a sensation of spinning dizziness, problem of inner ear or brain
Tinnitus
is the perception of noise or ringing in the ears
Anosmia
the loss of the sense of smell, either total or partial. It may be caused by head injury, infection, or blockage of the nose.
Nystagmus
is a vision condition in which the eyes make repetitive, uncontrolled movements
Diplopia
technical term for double vision, seeing two images instead of one
Analgesia
the inability to feel pain
Kinesthesia
awareness of the position and movement of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints.
Clonus
muscular spasm involving repeated, often rhythmic, contractions
Syncope
temporary loss of consciousness caused by a fall in blood pressure
Parasthesia
refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body
Flaccidity
an illness characterized by weakness or paralysis and reduced muscle tone without other obvious cause
Spasticity
condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles
Paralysis
the loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of illness, poison, or injury.
Hypoalgesia
decreased sensitivity to painful stimuli.
Hyperalgesia
abnormally heightened sensitivity to pain
Anesthesia
a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes.
Rigidity
in which passive movement of the limbs elicits ratchet-like start-and stop movements through the range of motion of a joint and that occurs especially in individuals affected with Parkinson’s disease
NIH stroke scale
National Institutes of Health Stroke Scale, or NIH Stroke Scale is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4
FAST
16-item scale designed to parallel the progressive activity limitations associated with Alzheimer’s disease.
Stage 7 identifies the threshold of activity limitation that would support six-month prognosis
Neurologic exam
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired.
Cogwheel rigidity
Type of rigidity in which the increased tone is released by degrees during passive range of motion so it feels like small, regular jerks
Fasiculation
Rapid, continuous twitching of resting muscle or part of muscle without movement of limb
Myoclonus
Rapid, sudden jerk or a short series of jerks are fairly regular intervals. A hiccup is a myoclonus of the diaphragm
Myoclonus jerks are severe with grand mal seizures
Paralysis
Decrease or loss of motor power caused by problem with motor nerve or muscle fibers
Tic
Involuntary, compulsive, repetitive twitching of a muscle group; due to neurologic cause or a psychogenic cause
Chorea
Sudden, rapid, jerk, purposeless movement involving limbs, trunk, or face. Irregular intervals. Disappears with sleep
Common with Sydenham chorea and Huntington disease
Athetosis
Slow twisting, writhing, continuous movement, resembling a snake or worm
Disappears with sleep
Occurs with cerebral palsy
Seizure disorder
1) loss of consciousness 2) tonic phase with muscular rigidity, opening of mouth and eyes, tongue biting, high pitched cry 3) clonic phase with violent muscular contractions 4) postictal phase with deep sleep, disorientation and confusion
Rest tremor
It occurs when muscles are quiet and supported against gravity (hand in lap). Coarse and slow; partly or completely disappears with voluntary movement
Intention tremor
Worse with voluntary movement towards a visually guided target.
Occurs with cerebellar disease and multiple sclerosis
