Chapter 23: Neurologic System Flashcards
What are the two main divisions of the Nervous System
Central Nervous System: Brain and spinal cord
Peripheral Nervous System: All nerve fibers outside the brain and spinal cord: 12 pairs of cranial nerves and 31 pairs of spinal nerves.
What is the difference between afferent and efferent messages?
Afferent signals: Sensory signals that are carried TO CNS from sensory receptors.
Efferent signals: Motor signals that are carried FROM the CNS out to muscles and glands, and autonomic messages that govern the internal organs and blood vessels.
What is the cerebral cortex?
the outer layer of the brain, gray matter, center for highest functions (memory, cognition, governing thought, sensation, reasoning and voluntary movement)
What are the four lobes of the cerebrum and their functions?
Frontal Lobes: personality, behavior, emotions, and intellectual function. Precentral gyrus: initiates vol. mvmt.
Parietal Lobes: postcentral gyrus is the primary center for sensation.
Occipital Lobes: Primary visual receptor center
Temporal Lobes: Primary auditory center with functions of hearing, taste, and smell
what is the Wernicke’s area?
An area in the temporal lobe responsible for language comprehension.
What is receptive aphasia?
A person’s inability to interpret speech. This occurs when damage occurs to Wernicke’s area.
What is Broca’s Area? What is the result if this is injured?
located in the frontal lobe, this mediates motor speech. If this area is injured, expressive aphasia results.
what are the basal ganglia?
large bands of gray matter buried deep within the two hemispheres that form the extrapyramidal system (subcortical associated motor system). This is responsible for initiating and coordinating movement.
what is the thalamus?
main relay station where the sensory pathways of spinal cord, cerebellum, basal ganglia, and brainstem form synapses on their way to the cerebral cortex. It is an integrating center that is crucial for emotion and creativity.
what is a synapse?
sites of contact between two neurons
what is the hypothalamus?
Major respiratory center with basic vital functions: temperature, appetite, sex drive, heart rate, BP, sleep center, ant/post pituitary gland regulator, and coord of ANS and stress response.
Damage to the cerebral cortex might cause?
loss of function, motor weakness, paralysis, loss of sensation, impaired ability to understand/process language.
What is paresthesia?
loss of sensation
what is the cerebellum?
coiled structure located under the occipital lobe that is responsible for motor coordination of muscle movements. Equilibrium and muscle tone important here.
what does crossed representation mean?
A notable feature of nerve tracts in CNS. The left cerebral cortex receives info and controls the RIGHT side of the cerebral cortex. The right cerebral cortex receives info and controls the LEFT side of the cerebral cortex.
which cranial nerves originate in the brainstem?
Cranial nerves III-XII
What are the sensory pathways?
sensory fibers that transmit and conduct sensations of pain, temperature, crude or light touch, position, vibration, finely localized touch.
what are the motor pathways?
pyramidal tract: skilled and purposeful movement, extrapyramidal tract, more primitive motor system-maintains muscle tone, controls body movement such as walking.
What are upper motor neurons? diseases associated with?
within CNS. diseases associated with stroke, CP, MS
What are LMNs? What are some examples? What are some diseases associated with LMNs?
Lower Motor Neurons: located in PNS; final direct contact with muscles. movement translated into action by LMNs.
Examples: cranial nerves, spinal nerves.
Diseases assoc. with: spinal cord lesions, poliomyelitis, amyotrophic lateral sclerosis (ALS).
What are the 5 components of deep tendon reflexes?
- intact sensory nerve-afferent
- A functional synapse at the cord
- An intact motor nerve-efferent
- The neuromuscular junction
- A competent muscle
What are cranial nerves I-VI and their functions
CN I-Olfactory-sense of smell
CN II-Optic-sense of vision
CN III-Oculomotor-most EOM of the eye, opening of eyelid, and pupil constriction, lens shape
CN IV-Trochlear-Down and inward movement of the eye
CN V-Trigeminal-Chewing, sensation of scalp, face, cornea, mucous membranes of mouth and nose.
CN VI-Abducens-lateral movement of the eye
What is the PNS comprised of and what are the functions?
Cranial and spinal nerves
Function: Somatic and autonomic
Somatic: innervate the skeletal (voluntary) muscles
Autonomic: innervate smooth (involuntary) muscles, cardiac, and glands; mediates unconscious activity.
How many spinal nerves are there? What do they contain, where do the nerves exit? Sensory and Motor signals go through what roots?:
31 pairs: 8 Cervical, 12 Thoracic, 5 Lumbar, 2 Sacral, and 1 coccygeal.
They contain both sensory and motor fibers
Nerves exit through roots
Sensory nerves: posterior (dorsal) roots
Motor nerves: anterior (ventral) roots
What are dermatomes?
circumscribed skin area supplied from the spinal cord segment through a particular spinal nerve.
What is movement directed by primarily in infants
primitive reflexes, these disappear with age.
What process results in increased motor control in infants
Increase in myelination
what are changes in the neurologic system of the aging adult
loss of neuron structure in the brain and spinal cord, general loss of muscle bulk, decreased muscle strength, impaired fine coordination and agility, loss of sensation, pupillary changes, reaction time slows, touch, pain, taste, and smell may diminish.
What may cause dizziness and loss of balance with position changes?
decreased cerebral blood flow and oxygen consumption
what is the Stroke belt of the US?
US Southeast: stroke belt, buckle coastal plain of NC, SC, and GA stroke mortality 20% higher than in belt and 40% higher than rest of US.
What is the subjective data that should be assessed in a neuro assessment?
Headache, Head injury, dizziness, vertigo, seizure, tremors, weakness, incoordination, numbness, tingling, difficulty swallowing, difficulty speaking, past neuro history, environmental hazards, medications
what questions might you ask with a seizure history?
Aura, motor activity, associated signs others have noted, post-ictal period: sleepy, confused, weakness, headache. Medications, effect on daily life/quality of life.
what is dysarthria
difficulty forming words
what is dysphagia
difficulty with language comprehension or expression.
What things might a past neuro history include?
stroke, meningitis, spinal cord injury, congenital defect, alcohol use.
What might increase a fall risk for an aging adult?
increased with diagnosis of stroke or dementia, gait and balance disorders, use of assistive devices, history of recent falls.
What is micturition syncope?
Feeling faint when standing to urinate.
What are symptoms of a stroke?
- weakness in the face, arms, or legs, especially when it is on one side of the body.
- confusion, trouble speaking, or understanding,
- changes in vision: blurry vision, partial/complete loss of vision in one or both eyes.
- trouble walking, dizziness, loss of balance, or coordination
- severe headache with no reason or explanation
What is the objective data for a neurological exam?
CN testing, inspect and palpate muscles: size, symmetry, tone, and strength.
What does paresis mean?
partial or incomplete paralysis
How do you test for muscle tone?
passive ROM,
What is flaccidity?
decreased muscle tone or hypotonia with peripheral weakness
What is spasticity
Increased tone or hypertonia; with central weakness
What is rigidity?
constant state of resistance. central weakness
What are some involuntary muscle movements
fasciculations: rapid; continuous twitching of resting muscle.
Myoclonus: rapid, sudden jerk or short series of jerks
Tic: involuntary, compulsive, repetitive twitching
Chorea: sudden, rapid, jerky purposeless movement, involving head, neck, or face.
Athetosis: slow, twisting, writhing, continuous movement occurs with CP
What are some tests for coordination and skilled movements?
Rapid Alternating Movements (RAM)
Finger to Finger Test
Finger to Nose Test
Heel to Shin Test
What are the characteristics of a normal gait
smooth, rhythmic, free-flowing, effortless, 15” step length from heel to heel
what is the Romberg test
standing with arms at sides with eyes closed.
What is stereognosis
the ability of a person to identify an object by recognizing its form, shape, weight, and size.
What is graphesthesia?
Ability to read a number by having it traced on the skin.
what is 2 point discrimination?
distinguishing between two separate; simultaneous pin points on the skin.
what is the extinction test?
simultaneous touching of both sides of the body at the same point.
what is hyperreflexia
exaggerated reflex seen when monosynaptic reflex arc is released from the usually inhib influence of higher corticol levels
what is hyporeflexia
absence of reflex interruption of sensory afferents or destruction of motor efferents and anterior horn cells
What is clonus?
a set of rapid, rhythmic contractions of the same muscle
How is the Babinski reflex tested
Stroke finger up the lateral edge and across the ball of the foot. fanning of toes is positive. Present at birth and disappears by age 2.
Negative Babinski: dorsiflexion of toes,UMN disease
what are the three areas the Glasgow Coma Scale rates?
Eye opening, Verbal, and Motor responses
what do you assess in a neuro recheck?
level of consciousness, motor coordination, pupillary response, and vital signs
What is rest tremor, intention tremor, and tremor?
rest tremor: occurs when muscles are quiet and supported in gravity.
intention tremor: Rate varies, worse with vol movement occurs with MS and Cerebellar disease.
Tremor: involuntary contraction of opposing muscle groups, results in rhythmic back and forth motions of joints.
What are the ten signs of Alzheimer’s Disease
Memory loss, losing track, forgetting words, getting lost, poor judgment, abstract failing, losing things, mood swings, personality change, growing passive
afferent nerve deficits show up where?
legs, thorax, 1/2 way between nipple and clavicle, back, and perineum
Efferent nerve deficits show up where
legs, spine, paraspinal muscles, thorax, diaphragm, intercostal muscles, abd. muscles, bladder, and loss of sphincter control
What is the CSM assessment? when should these be reassessed?
Circulation, movement, and sensation.
Recheck CSMs each time a person is transferred/moved
What are CN I-IV tests, and abnormal findings
CN I- Olfactory, identify familiar odors, anosmia
CN II: Optic, visual acuity, visual fields, light shine in eye, inspection: Papilledema, defects in vision, retinal lesions, optic atrophy absent light reflex
CN III: Oculomotor: Inspection, light shine, EOM; dilated pupil, ptosis, eye turns out and down, can’t move eye up, in or down. absent light reflex
CN IV: Trochlear-EOM movement; failure to turn eye down or out
What are CN V-VIII tests and abnormal findings
CN V-Trigeminal, superficial touch (three divisions), corneal reflex, clench teeth: absent touch/pain, paresthesias, no blink, weak masseter or temporalis muscles
CN VI- Abducens, EOM left and right: failure to move laterally, diplopia on lateral gaze.
CN VII- Facial, wrinkle forehead, close eyes tightly, smile, puff cheeks, id tastes: absent or asymmetric facial movement, loss of taste
CN VIII- Acoustic, hearing acuity: hearing loss
What are CN IX-XII tests and abnormal findings
CN IX-Glossopharyngeal, gag reflex: No gag, uvula deviation, dysphagia.
CN X- Vagus, phonates ahh, gag reflex: hoarse voice, absent gag, deviated uvula, nasal twang, husky, dysphagia
CN XI- Spinal Accessory, turn head, shrug shoulders against resistance: absent movement of trapezius and sternomastoid
CN XII- Hypoglossal, protrude tongue, move tongue side to side: deviates to side, slowed rate of movement
what is the leading cause of long term disability and 4th leading cause of death after heart disease and cancer
stroke
nearly 75% of strokes occur after what age
over age 65
what is the difference between ischemic and hemorrhagic stroke
ischemic: blood clot blocking blood vessel
hemorrhagic: blood vessel in brain ruptures and causes bleeding
