Clin Assess-Neuro Flashcards
Reflects pts capacity for arousal or wakefulness; determined by level of activity that pt can be aroused to performing the response to stimuli from examiner
Level of consciousness
Using normal tone of voice, pts arousal intact; responds fully and appropriately
alert
Using loud tone of voice, pt appears drowsy but opens eyes and responds then falls asleep
lethargic
Shake pt gently; pt opens eyes but resounds slowly, somewhat confused
obtunded
Apply painful stimulus to arouse pt from sleep, verbal responses slow/absent, unresponsive when stimulus ceases
Stuporous
Unarousable w/ eyes closed after repeated painful stimuli, no response to environment
comatose
Pts with a GCS of ____ are usually considered to be in a coma:
3-8
Suggests damage to the sympathetic pathways in hypothalamus, or metabolic encephalopathy, a diffuse failure of cerebral function that has many causes, including drugs; light rxns usually normal.
Bilaterally small pupils (1-2.5mm)
Suggests a hemorrhage in the pons or the effects of narcotics; light rxn may be seen with a magnifying glass
Pinpoint pupils (
Bilaterally dilated and fixed pupils may be d/t severe anoxia and its sympathetic effects, as seen after cardiac arrest. They may also result from atropine-like agents- phenothiazines or tricyclics
Large pupils
Testing for meningeal signs: positive if flexion of both hips and knees is noted when neck is flexed
Brudzinski’s sign
Testing for meningeal signs: positive if pain & increased resistance is noted to straightening the knee after hip and knees are flexed
Kernig’s sign
Test if mental function is impaired; may indicated METABOLIC ENCEPHALOPATHY; have pt “stop traffic” by extending both areas w/ hands cocked up-watch 1-2min; positive if sudden, brief, non-rhythmic flexion of hands and fingers
Asterixis
Ex- pill-rolling tremor of parkinsonism
Resting tremor
Ex-benign essential/familial tremor
Postural tremor
Ex- cerebellar disease, MS
Intention tremor
Ex- Tardive dyskinesia
Oral-facial dyskinesias
Ex- tourette’s syndrome
Tics
Ex- torticollis (neck muscles twitch and cause head to twist to one side)
Dystonia (Involuntary muscle contractions that cause repetitive or twisting movement)
Ex- Cerebral palsy
Athetosis (a condition in which abnormal muscle contractions cause involuntary writhing movements. It affects some people with cerebral palsy, impairing speech and use of the hands)
Ex- Huntington’s disease
Chorea
Increased tone; rate-dependent, increasing w/ rapid movement (eg, stroke)
Spasticity
Increased resistance throughout ROM; it is NOT rate-dependent
Rigidity
Marked floppiness (eg Guillain-Barre & spinal shock)
Flaccidity
Sudden changes in tone w/ passive ROM (eg dementia)
Paratonia
Normal muscle strength = ?
5
Motor function of cervical spine: Deltoid and biceps (shoulder abduction and elbow flexion)
C5
Motor function of cervical spine: Biceps flexion and wrist extensors
C6
Motor function of cervical spine: Triceps, wrist flexors and finger extensors
C7
Motor function of cervical spine: Finger flexors and interossei muscles (abduction and adduction of the fingers)
C8
Motor function: Interossei muscles ONLY!
T1
Motor function of cervical spine: Head
C1-C2
Motor function of cervical spine: diaphragm, breathing
C3-C4
Motor function of lumbar spine: Hip flexion
L2
Motor function of lumbar spine: Knee extension
L3
Motor function of lumbar spine: Ankle dorsiflexion
L4
Motor function of lumbar spine: Great toe extension
L5
Motor function: ankle plantar flexion, ankle eversion, hip extension
S1
Motor function: Knee flexion
S2
Test if pt has low back pain w/ lumbosacral radiculopathy (sciatica if in S1 distribution); Positive for lumbosacral radiculopathy if pain radiates into ipsilateral leg (foot dorsiflexion can further increase pain)
straight leg raise
Tests for cerebellar function=
Rapid alternating movements, point-to-point movements, and Gait
Stand w/ feet together and eyes open, then close eyes for 30-60 seconds, only minimal sway should occur (+ if pt almost falls)
Romberg test
Stand for 30 seconds w/ arms straight forward, palms up and eyes closed, then tap arms briskly downward
Pronator drift test
Wide, unsteady gait
Cerebellar ataxia
Wide, unsteady gait AND heel strikes first
Sensory ataxia
Seen in spinal cord disease, causing bilateral lower extremity spasticity; Gait is stiff; pts advance each leg slowly and thighs tend to cross forward on each other at each step (MC in cerebral palsy)
Scissor gait
Seen in foot drop, usually secondary to peripheral motor unit disease; Pts either drag feet or lift them high, with knees flexed, and bring them down with a slap on the floor
Steppage gait
The ability to perceive the form of a solid object by touch
Stereognosis
Ability to detect writing on the skin purely by the sensation of touch
Graphesthesia
DTRs: ankle reflexes
Primarily S1 (some S2)
DTR: knee reflex
L2, L3, L4
DTR: Brachioradialis reflex
C5, C6
DTR: Biceps reflex
C5, C6
DTR: Triceps reflex
C6, C7
If DTRs seem HYPERACTIVE (4+), test for this; Dorsiflex and plantar flex foot a few times then sharply dorsiflex foot and hold-look/feel for rhythmic oscillations between dorsiflexion and plantar flexion; If present, may indicate CNS disease
Clonus
Stroke lateral aspect of sole from heel to ball of foot, curving medically across the ball-not movement of the great toe; + if dorsiflexion of great toe-may indicate CNS lesion in corticospinal tract, unconscious states from drugs/alcohol intoxication, postictal period after seziure
Babinski Response (L5, S1)
Used to dx stroke, determine location/size or tumor, aneurysm, or vascular formation; Dye injected via capsule placed via catheter and serial X-rays taken
Cerebral angiogram
Noninvasive; painless; detect bone and vascular, certain brain tumors, cysts, herniated discs, spinal stenosis, encephalitis, blood accumulation, intracranial bleeding in stroke, tissue damage in trauma; A lot of radiation
CT scan
Small amounts of dye injected via x-ray guidance into the spinal disc (nucleus propulsus), CT then completed; may cause some residual discomfort requiring short term pain meds
Discography
Used to detect problems with spinal and spinal nerve toots; Lumbar puncture- fluid is mixed with contrast dye and injected into spinal sac; allows or clearer image of spinal canal and nerve roots
Cisternography
Monitors brain activity through the skull; assists in dx of seizure disorders, tumor, tissue damage post TBI, inflammation of the brain/spinal cord, psychiatric disorders, sleep disorders; Pre procedure-pts should avoid caffeine and rx/non rx drugs that impact nervous system
EEG
Diagnoses nerve and muscle dysfunction and spinal cord disease; measures electrical activity from brain and/or spinal cord to a peripheral nerve root; usually completed in conjunction with a Nerve conduction velocity test (NCV) which measures electrical energy by assessing the nerves ability to send a signal
EMG
Group of tests used to dx disorders such as involuntary eye movement, dizziness and balance disorders; involved electrode taped around eyes to record eye movements; infrared photography may also be used to evaluate eye movements
ENG
Measures the electoral signals to the brain generated by hearing, touch, and sight; used to evaluate sensory nerve problems, confirm MS, brain tumor, acoustic neuroma, spinal cord injury
Evoked potentials
Injection of water or oil based contrast dye into the spinal cord to enhance x-ray imaging of the spine; used to dx spinal nerve injury, herniated discs, fx, back or leg pain, and spinal tumors
Myelograpy
Provides 2D and 3D pictures of brain activity by measuring radioactive isotopes that are injected into bloodstream; used to detect or highlight tumors, diseased tissue, measure cellular and/or tissue metabolism, monitor blood flow, determine brain injury post trauma, substance abuse
PET scan
Measures brain and body activity during sleep; used to detect sleep disorders, restless leg syndrome, insomnia, OSA; painless, non-invasive, risk-free
Polysomnogram
Evaluates blood flow to tissue; f/u test to MRI to dx tumors, infections, degenerative spinal disorders, stress fractures; uses radioactive isotope, a rotating camera and production of a detailed 3D image of blood flow and activity in brain
SPECT
Ultrasound of brain and spinal cord; analysis of blood flow to the brain and can dx stroke, brain tumors, hydrocephalus and vascular problems
Neurosonography
Uses infrared sensing devices to measure small temp changes between the 2 sides of the body or within a certain organ; used to detect vascular disease of head and neck, soft tissue injury, nerve root compression, and some degenerative disorders; 2D pic
thermography
