Clinical Assessment of the Neurosurgical Patient

Question 1

Which two examination aspects could be carried out in an unconscious patient?

Answer 1

GCS
Pupillary reflex

Question 2

Which nerve is responsible for the afferent pathway of the light reflex?

Answer 2

Optic nerve

Question 3

Which nerve is responsible for the efferent pathway of the light reflex?

Answer 3

Oculomotor nerve

Question 4

When assessing pupillary reflex, which nerve is being tested to see if there is any compression?

Answer 4

Oculomotor nerve

Question 5

Name the triad of clinical signs which make up Cushing’s response.

Answer 5

Increased systolic bp
Bradycardia
Respiratory irregularity

Question 6

What is functional MRI used for?

Answer 6

Used to see which parts of the brain become activated during certain movements or talking, etc.

Question 7

RECAP- which sulcus divides frontal and parietal lobe?

Answer 7

Central sulcus

Question 8

What is controlled in the precentral gyrus?

Answer 8

Voluntary movement

Question 9

Is pronator drift seen in UMNL or LMNL?

Answer 9

UMNL

Question 10

List some of the functions of the frontal lobe.

Answer 10

Voluntary movement (precentral gyrus)
Speech
Initiative
Order
Restraint

Question 11

If a patient is muddling up words, stumbling over words, or having general speech issues, which lobe of the brain is likely to be affected?

Answer 11

Frontal lobe, specifically Broca’s area

Question 12

List the functions of the parietal lobe.

Answer 12

Primary somatosensory area
Visuospatial coordination
Language
Numeracy

Question 13

List the functions of the temporal lobe.

Answer 13

Processes auditory input
Language
Emotion
Visual field
Encoding declarative long term memory- hippocampus

Question 14

List the functions of the cerebellum using the acronym DANISH P to help.

Answer 14

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
Past pointing

Question 15

If there is a lesion in the spinal cord, will there usually be unilateral or bilateral symptoms?

Answer 15

Bilateral

->spinal cord is thin so lesions often cross it all

Question 16

If there is a lesion or issue with a nerve root, will symptoms be unilateral or bilateral?

Answer 16

Unilateral

Question 17

If there is a lesion or issue with a peripheral nerve, will symptoms be unilateral or bilateral?

Answer 17

Unilateral

Question 18

If there is a lesion or issue with a nerve root, will symptoms be LMN or UMN?

Answer 18

LMN

Question 19

If there is a lesion or issue with a peripheral nerve, will symptoms be LMN or UMN?

Answer 19

LMN

Question 20

If there is a lesion or issue with the spinal cord, will symptoms be LMN or UMN?

Answer 20

UMN

Question 21

Which two areas of the spine does myelopathy usually affect?

Answer 21

Cervical or thoracic as spinal cord ends at L1-2

Question 22

In myelopathy (injury to spinal cord caused by decompression), will there be motor or sensory symptoms?

Answer 22

Both

Question 23

UMN signs in the context of a spinal tract problem can be known as long tract signs. List some long tract signs.

Answer 23

Clonus
Upgoing plantars
Increased tone
Hoffman sign
Brisk reflexes
Romberg’s test

Question 24

Hoffman sign is the upper limb equivalent of which lower limb sign?

Answer 24

Babinski sign

Question 25

Radiculopathy?

Answer 25

Injury or damage to nerve roots

Question 26

What will be experienced in a patient with radiculopathy?

Answer 26

Pain in single dermatome and weakness in associated myotome

Question 27

Would cauda equina syndrome have UMN or LMN signs? Why?

Answer 27

No
-> they have nerve roots and below the conus so cannot have UMN signs