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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
How do you asses the neuropsychology of theorbitofrontal cortex
Is speech and behaviour socially appropriate? Go/no-go tests Stroop test
26
How do you asses the neuropsychology of the Supplementary motor cortex/anterior cingulate
Lack of motivation Apathy - lack of interest Abulia - no will power Depression
27
What is the function of the dorsolateral prefrontal cortex
Executive function
28
How do you asses the neuropsychology of the dorsolateral prefrontal cortex
- 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
How do you examine language in a patient
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
What area of the brain is responsible for language fluency
Broccas
31
What area of the brain is responsible for repetition
arcuate fasciculus
32
What area of the brain is responsible for understanding commands
Wernickes area
33
Where doe the sensory and motor speech areas exist together
Only in one hemisphere
34
How is the wernickes area connected to the broccas areas
Via a bundle of fibres caused the arcuate fasciculus
35
What is the overall function of the arcuate fascicles
bidirectionally connects caudal temporal cortex and inferior parietal cortex to locations in the frontal lobe
36
What is the functions of parietal lobe
Body image representation Multimodality assimilation Visuospatial coordination Language Numeracy
37
What specific area is responsible for body image representation in the parietal lobe
primary somatosensory area
38
How do you examine for cortical sensory syndrome
Sensory inattention Astereoagnosia - sensation of feeling something in your hands Dysgraphasthesia - write numbers on hand Two point discrimination
39
How do we examine the dominant side of the parietal lobe
Dyscalculia - problem with maths Finger anomia - cant recognise fingers Left/right disorientation Agraphia - problem with writing
40
If there is brain damage in the dominant side of the partial lobe what is the name of this disorder
Gerstmans syndrome
41
How do we examine the non dominant side of the parietal lobe
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
What is the functions of the temple lobe
Processes auditory input Language Encoding declarative long-term memory (semantic/episodic) Emotion Visual fields
43
What specific area of the temporal lobe is responsible for processing auditory input
Heschl gyrus
44
What specific area of the temporal lobe is responsible for Encoding declarative long-term memory
Hippocampus
45
What specific area of the temporal lobe is responsible for emotion
Amygdala
46
What specific area of the temporal lobe is responsible for visual fields
Meyer's loop
47
What is the function of the occipital lobe
Visual processing center containing most of the anatomical region of the visual cortex.
48
How does optic radiation travel to to the occipital lobe
Optic radiation goes through temporal lobe via the meter's loop
49
What do you examine for in the cerebellum
Dysdiadochokinesia (impaired ability to perform rapid) Ataxia Nystagmus Intention tremor Slurred Speech Hypotonia - low muscle tone Past pointing (DANISH P)
50
What is the presentation of radiculopathy
Unilateral, Pain in single dermatome, Dermatomal sensory disturbance weakness in myotome Loss of reflex LMN
51
What is the presentation with a peripheral nerve problem
unilateral, motor and sensory deficit fits with PN, LMN
52
What is the presentation of myelopathy
Bilateral, Motor and sensory level, UMN below lesion long tract signs
53
What should be assessed in spinal examination
Level of lesion | Myelopathy or radiculopathy
54
What are the two types if myelopathy pathology
Cervical or thoracic | not much cord in lumbar
55
What is the long tract signs of myelopathy
Clonus, Upgoing plantars, Increased tone, Hoffman sign, Brisk reflexes, Proprioception impairment - Romberg’ test, - Tandem walking
56
What is the aetiologies of radiculopathy and myelopathy
My- hernatied disc Ra- Slipped disc
57
What occurs in cauda equna syndrome
something compresses on the spinal nerve roots causing incontinence and paralysis of the legs

The Nervous System: Pathology (25 decks)

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