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The Nervous System: Pathology > Clinical assessment of the neurosurgical patient > Flashcards

Clinical assessment of the neurosurgical patient Flashcards

1
Q

How do you asses an obtunded patient

A

ABS
Glasgow coma scale
Pupils

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2
Q

What does the Glasgow coma scale test

A

Conscious level

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3
Q

What problems does a decreases Glasgow coma scale highlight

A

Cerebral perfusion

Metabolic problems

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4
Q

What is cerebral perfusion pressure equal

A

Mean arterial pressure minus intra cranial pressure

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5
Q

How does cerebral perfusion pressure drop

A

If mean arterial pressure drops

If intra cranial pressure increases

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6
Q

What causes intra cranial pressure to rise

A

The brain of the skull has a fixed volume, add something else in e.g. tumour, the ICP rises has no more space can be created

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7
Q

What causes pupillary dilation in the obtund patient

A

Cerebral herniation

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8
Q

How does herniation in the brain cause pupillary dilation

A

Due to Uncal herniation, causes the template lobe over the edge of the tentorium squashing CNIII (oculomotor)

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9
Q

How do you asses the non communicative patient

A

Observation
(posture, focal lack of movement, neglect, eye movements)

Asses speech

Mini Mental score

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10
Q

What do you asses in the communicating patient

A

Cranial
Spinal
Peripheral nerve

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11
Q

What do you asses for in cranial

A

Which lobe - cerebellar localisation

If affects the cerebellar

In the central nervous system

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12
Q

How do you asses cerebral localisation

A

Functional MRI scan

Tractography (diffuse tensor imaging)

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13
Q

What is the exact location of the frontal lobe

A

Front of the cerebral hemisphere. It is separated from the parietal lobe by a groove between tissues called the central sulcus, and from the temporal lobe by a deeper groove called the lateral sulcus (Sylvian fissure)

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14
Q

What is the functions of the frontal lobe

A

Voluntary control of movement

Speech

Saccadic eye movements

Bladder control

Gait

Higher order (restraint, initiative and order -RIO)

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15
Q

What specific area in the frontal lobe has control over voluntary movement

A

Precentral gyrus

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16
Q

What specific area in the frontal lobe has control over speech

A

Broccas area

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17
Q

What is broccas area composed of

A

pars opercularis (45), pars triangularis (44)

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18
Q

What specific area of the frontal lobe has control over saccadic eye movements

A

Frontal eye fields

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19
Q

What specific area of the frontal lobe has control over bladder control

A

Paracentral lobule

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20
Q

What specific area of the frontal lobe has control over gait

A

Periventricular (around the ventricles)

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21
Q

What do you asses in frontal lobe examination

A

Inspection

  • decorticate posture
  • magnetic gait
  • urinary catheter
  • abulia (absence of willpower)

Pyrimidal weakness

saccadic eye movements

primitive reflexes

Speech

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22
Q

How can you detect pyramidal weakness in frontal lobe examination

A

UMN signs

  • weakness,
  • increased tone,
  • brisk reflexes,
  • up-going plantar

Pronator drift

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23
Q

What three areas in the frontal lobe that have functions of a high order

A

Orbitofrontal cortex (restraint)

Supplementary motor cortex/anterior cingulate (Initiative)

Dorsolateral prefrontal cortex (Order)

24
Q

What is the function of the orbitofrontal cortex

A

involved in the cognitive processing of decision-making

Mediating empathic, civil and socially appropriate behaviour

25
Q

How do you asses the neuropsychology of theorbitofrontal cortex

A

Is speech and behaviour socially appropriate?

Go/no-go tests

Stroop test

26
Q

How do you asses the neuropsychology of the Supplementary motor cortex/anterior cingulate

A

Lack of motivation

Apathy - lack of interest

Abulia - no will power

Depression

27
Q

What is the function of the dorsolateral prefrontal cortex

A

Executive function

28
Q

How do you asses the neuropsychology of the dorsolateral prefrontal cortex

A
  • Ability to make an appointment and keep to time
  • Ability to give coherent account of history
  • Spell WORLD backwards
  • Say as many words as possible with a particular letter
29
Q

How do you examine language in a patient

A

Ensure hearing is intact and patient’s first language is English

Handedness

Fluency

Nominal aphasia

Repetition

3 step command

‘Baby hippopotamus’

Orofacial movement (ppp, ttt, mmm)

Reading

Writing

30
Q

What area of the brain is responsible for language fluency

A

Broccas

31
Q

What area of the brain is responsible for repetition

A

arcuate fasciculus

32
Q

What area of the brain is responsible for understanding commands

A

Wernickes area

33
Q

Where doe the sensory and motor speech areas exist together

A

Only in one hemisphere

34
Q

How is the wernickes area connected to the broccas areas

A

Via a bundle of fibres caused the arcuate fasciculus

35
Q

What is the overall function of the arcuate fascicles

A

bidirectionally connects caudal temporal cortex and inferior parietal cortex to locations in the frontal lobe

36
Q

What is the functions of parietal lobe

A

Body image representation

Multimodality
assimilation

Visuospatial coordination

Language

Numeracy

37
Q

What specific area is responsible for body image representation in the parietal lobe

A

primary somatosensory area

38
Q

How do you examine for cortical sensory syndrome

A

Sensory inattention

Astereoagnosia - sensation of feeling something in your hands

Dysgraphasthesia - write numbers on hand

Two point discrimination

39
Q

How do we examine the dominant side of the parietal lobe

A

Dyscalculia - problem with maths

Finger anomia - cant recognise fingers

Left/right disorientation

Agraphia - problem with writing

40
Q

If there is brain damage in the dominant side of the partial lobe what is the name of this disorder

A

Gerstmans syndrome

41
Q

How do we examine the non dominant side of the parietal lobe

A

Ideomotor apraxia (cant mimic)

‘How to do’

Ideational apraxia (plan)

‘What to do’ – loss of understanding of the purpose of objects

Constructional apraxia (build)

Dressing apraxia

Hemineglect (forget one side exists)

Loss of spatial awareness

42
Q

What is the functions of the temple lobe

A

Processes auditory input

Language

Encoding declarative long-term memory (semantic/episodic)

Emotion

Visual fields

43
Q

What specific area of the temporal lobe is responsible for processing auditory input

A

Heschl gyrus

44
Q

What specific area of the temporal lobe is responsible for Encoding declarative long-term memory

A

Hippocampus

45
Q

What specific area of the temporal lobe is responsible for emotion

A

Amygdala

46
Q

What specific area of the temporal lobe is responsible for visual fields

A

Meyer’s loop

47
Q

What is the function of the occipital lobe

A

Visual processing center containing most of the anatomical region of the visual cortex.

48
Q

How does optic radiation travel to to the occipital lobe

A

Optic radiation goes through temporal lobe via the meter’s loop

49
Q

What do you examine for in the cerebellum

A

Dysdiadochokinesia (impaired ability to perform rapid)

Ataxia

Nystagmus

Intention tremor

Slurred Speech

Hypotonia - low muscle tone

Past pointing

(DANISH P)

50
Q

What is the presentation of radiculopathy

A

Unilateral,

Pain in single dermatome,

Dermatomal sensory disturbance

weakness in myotome

Loss of reflex

LMN

51
Q

What is the presentation with a peripheral nerve problem

A

unilateral,

motor and sensory deficit fits with PN,

LMN

52
Q

What is the presentation of myelopathy

A

Bilateral,

Motor and sensory level,

UMN below lesion

long tract signs

53
Q

What should be assessed in spinal examination

A

Level of lesion

Myelopathy or radiculopathy

54
Q

What are the two types if myelopathy pathology

A

Cervical or thoracic

not much cord in lumbar

55
Q

What is the long tract signs of myelopathy

A

Clonus,

Upgoing plantars,

Increased tone,

Hoffman sign,

Brisk reflexes,

Proprioception impairment

  • Romberg’ test,
  • Tandem walking
56
Q

What is the aetiologies of radiculopathy and myelopathy

A

My- hernatied disc

Ra- Slipped disc

57
Q

What occurs in cauda equna syndrome

A

something compresses on the spinal nerve roots causing incontinence and paralysis of the legs

The Nervous System: Pathology (25 decks)

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