Clinical and Research techniques for investigating the human Nervous system Flashcards
who pioneered the standardized exam?
charcot
what are 2 clinical methods of assessment?
- clinical history of patient (i.e their lifestyle, any recent changes…etc..)
- clinical examination (measuring BP, heart rate..etc..)
What is a neurological exam?
it is a baseline assessment of overall neurological function (brain, spinal cord, and pathways) and if they’re working as they should be (broad examination)
What are 6 types of neurological exams?
- Mental Status –> i.e. whats ur name, whens ur birthday… questions that test general awareness
- cranial nerves –> assessment to see if cranial nerves are damaged like for oculomotor pathway damage, the test would be to shine a light in the eyes to see if pupils would contract
- motor examination
- sensory examination
- cerebellar function
- deep tendon reflexes (assesses lower motor neuron function like muscles in afferent pathways in PNS and CNS)
What is a commonly used test to check deep tendon reflexes?
the patellar tendon reflex (tapping knee and seeing if it will jerk upwards)
What is the common test for cranial nerves?
test on the CN 2-3 (cranial nerves 2 and 3) involves the oculomotor pathway, shining a light on the patients pupil and seeing if it contracts
What is impaired upper motor neurons?
upper motor neurons are in the cortex and brain stem while the lower motor neurons are in the spinal cord and cranial nerves. Upper motor neuron impairment is related to some type of impairment in the cortex and brain stem areas instead of the spinal cord and cranial nerve damage areas
What 2 tests to assess upper motor neuron impairment?
- Babinski sign –> stroking bottom of foot to see if it curls inwards (if it flares upwards then its a + Babinski, and it shows damaged o upper motor neurons, usually from people who have MS and strokes)
- Clonus: when holding foot down normally, it should not be shaking at the bottom, but for people who have clonus, it shakes indicating problem with the pathway between motor neurons and the brainstem area
What were the initial clincal methods used?
anatomical examination of the brain after death called post-mortem examination
What does the neurological examination and history for progression of symptoms indicate about the disease and lesion?
the neurological examination can indicate where the lesion would be, the history of the progression of symptoms can indicate what the disease could be (but cant confirm)
What are some examples of pathological clinical methods?
- Broca’s area (identified damage in the orbitofrontal cortex of patient after death) and linked the symptoms of difficulty speaking with that pathology in their brain. Looked at lateralization of the linguistic function and how its more left brained than right for right handed individuals
- phineas gage and his rod through the head –> he used to have a normal personality but then it changed after his incident via damage to the frontal lobe
- Chronic traumatic encephalopathy –> sings of severe neurodegeneration due to too much head trauma in life due to accumulation of Tau proteins
What are some downfalls of pathology based clinical methods? how can we prevent this
pathology requires sample of brain which is really hard to get in most people unless they die, so now neuroimaging techniques are used to preserve tissue
What are some advantages and disadvantages to MRI imaging clinical methods?
advantages:
- MRI provides fine details of the anatomy
- multiple sequences used to detect specific problems (sequences are different magnetic strengths and pulses which can generate different outputs and areas of the brain) like inflammation, stroke, infection..etc..
Disadvantages
- takes 1 hr (3 min for CT scan)
- children require sedation and special care
- mri and stuff are rly costly
- availability is limited (used in labs only)
What is MRI Pulse sequencing?
programmed set of changing magnetic gradients which allow for the radiologist to look at the same tissue in various ways
- combining various sequences is important to reveal diagnostic information about the tissue under question
What is a computerized tomography -CT scan? what are some advantages and disadvantages?
method of obtaining image x-ray slices
advantage: - cheap and fast, mostly used in hospitals, and very good at detecting blood and strokes
disadvantages: - image resolution is poor, and can miss rly small blood clots (hard to pinpoint)