Clin Assess-Neuro Flashcards by Casey Emge

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

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Using normal tone of voice, pts arousal intact; responds fully and appropriately

alert

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Using loud tone of voice, pt appears drowsy but opens eyes and responds then falls asleep

lethargic

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Shake pt gently; pt opens eyes but resounds slowly, somewhat confused

obtunded

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Apply painful stimulus to arouse pt from sleep, verbal responses slow/absent, unresponsive when stimulus ceases

Stuporous

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Unarousable w/ eyes closed after repeated painful stimuli, no response to environment

comatose

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Pts with a GCS of ____ are usually considered to be in a coma:

3-8

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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)

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Suggests a hemorrhage in the pons or the effects of narcotics; light rxn may be seen with a magnifying glass

Pinpoint pupils (

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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

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Testing for meningeal signs: positive if flexion of both hips and knees is noted when neck is flexed

Brudzinski’s sign

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Testing for meningeal signs: positive if pain & increased resistance is noted to straightening the knee after hip and knees are flexed

Kernig’s sign

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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

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Ex- pill-rolling tremor of parkinsonism

Resting tremor

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Ex-benign essential/familial tremor

Postural tremor

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Ex- cerebellar disease, MS

Intention tremor

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Ex- Tardive dyskinesia

Oral-facial dyskinesias

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Ex- tourette’s syndrome

Tics

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Ex- torticollis (neck muscles twitch and cause head to twist to one side)

Dystonia (Involuntary muscle contractions that cause repetitive or twisting movement)

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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)

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Ex- Huntington’s disease

Chorea

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Increased tone; rate-dependent, increasing w/ rapid movement (eg, stroke)

Spasticity

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Increased resistance throughout ROM; it is NOT rate-dependent

Rigidity

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Marked floppiness (eg Guillain-Barre & spinal shock)

Flaccidity

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Sudden changes in tone w/ passive ROM (eg dementia)

Paratonia

Normal muscle strength = ?

Motor function of cervical spine: Deltoid and biceps (shoulder abduction and elbow flexion)

Motor function of cervical spine: Biceps flexion and wrist extensors

Motor function of cervical spine: Triceps, wrist flexors and finger extensors

Motor function of cervical spine: Finger flexors and interossei muscles (abduction and adduction of the fingers)

Motor function: Interossei muscles ONLY!

Motor function of cervical spine: Head

C1-C2

Motor function of cervical spine: diaphragm, breathing

C3-C4

Motor function of lumbar spine: Hip flexion

Motor function of lumbar spine: Knee extension

Motor function of lumbar spine: Ankle dorsiflexion

Motor function of lumbar spine: Great toe extension

Motor function: ankle plantar flexion, ankle eversion, hip extension

Motor function: Knee flexion

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