Clinical Assessment of the Neurosurgical Patient Flashcards
Which two examination aspects could be carried out in an unconscious patient?
GCS
Pupillary reflex
Which nerve is responsible for the afferent pathway of the light reflex?
Optic nerve
Which nerve is responsible for the efferent pathway of the light reflex?
Oculomotor nerve
When assessing pupillary reflex, which nerve is being tested to see if there is any compression?
Oculomotor nerve
Name the triad of clinical signs which make up Cushing’s response.
Increased systolic bp
Bradycardia
Respiratory irregularity
What is functional MRI used for?
Used to see which parts of the brain become activated during certain movements or talking, etc.
RECAP- which sulcus divides frontal and parietal lobe?
Central sulcus
What is controlled in the precentral gyrus?
Voluntary movement
Is pronator drift seen in UMNL or LMNL?
UMNL
List some of the functions of the frontal lobe.
Voluntary movement (precentral gyrus)
Speech
Initiative
Order
Restraint
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?
Frontal lobe, specifically Broca’s area
List the functions of the parietal lobe.
Primary somatosensory area
Visuospatial coordination
Language
Numeracy
List the functions of the temporal lobe.
Processes auditory input
Language
Emotion
Visual field
Encoding declarative long term memory- hippocampus
List the functions of the cerebellum using the acronym DANISH P to help.
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
Past pointing
If there is a lesion in the spinal cord, will there usually be unilateral or bilateral symptoms?
Bilateral
->spinal cord is thin so lesions often cross it all
If there is a lesion or issue with a nerve root, will symptoms be unilateral or bilateral?
Unilateral
If there is a lesion or issue with a peripheral nerve, will symptoms be unilateral or bilateral?
Unilateral
If there is a lesion or issue with a nerve root, will symptoms be LMN or UMN?
LMN
If there is a lesion or issue with a peripheral nerve, will symptoms be LMN or UMN?
LMN
If there is a lesion or issue with the spinal cord, will symptoms be LMN or UMN?
UMN
Which two areas of the spine does myelopathy usually affect?
Cervical or thoracic as spinal cord ends at L1-2
In myelopathy (injury to spinal cord caused by decompression), will there be motor or sensory symptoms?
Both
UMN signs in the context of a spinal tract problem can be known as long tract signs. List some long tract signs.
Clonus
Upgoing plantars
Increased tone
Hoffman sign
Brisk reflexes
Romberg’s test
Hoffman sign is the upper limb equivalent of which lower limb sign?
Babinski sign
Radiculopathy?
Injury or damage to nerve roots
What will be experienced in a patient with radiculopathy?
Pain in single dermatome and weakness in associated myotome
Would cauda equina syndrome have UMN or LMN signs? Why?
No
-> they have nerve roots and below the conus so cannot have UMN signs
