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Systems: Neurology AB > Clinical Assessment of the Neurosurgical Patient > Flashcards

Clinical Assessment of the Neurosurgical Patient Flashcards

1
Q

What is the point of doing a history/examination?

A
  • Make a diagnosis
  • Determine anatomical location of pathology
  • Determine causative agent
  • Effect on daily life
  • Use SOCRATES and ICE
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2
Q

What type of neuro patients may you come across?

A
  • Obtunded patient (history from paramedics, bystanders etc.)
  • Confused/dysphasic/preverbal patient (History from notes and family)
  • Awake and alert patient (history from patient)
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3
Q

How should an obtunded patient be assessed?

A
  • ABC
  • GCS
  • Pupils
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4
Q

What pathology may there be in an obtunded patient?

A
  • Cerebral perfusion/metabolic issue

- Cerebral herniation

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5
Q

What are the components that make up the volume of intracranial space?

A
  • CSF volume
  • Blood volume
  • Brain volume
  • Other volume
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6
Q

What is the cerebral perfusion pressure equal to?

A

Mean arterial pressure - intracranial pressure

CPP=MAP-ICP

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7
Q

How can you assess if a patient has experienced brain herniation?

A
  • Pupillary response

- If herniated, fixed dilated pupils

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8
Q

How should the non-communicative patient be assessed?

A
  • Observation – posturing, focal lack of movement, neglect, eye movements
  • Assess speech
  • Mini-mental score
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9
Q

How should the communicating patient be assessed?

A
  • Cranial – which lobe, cerebellar, CN?
  • Spinal – which level, myelopathy, radiculopathy,
  • Peripheral nerve
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10
Q

What are the functions of the frontal lobe?

A
  • Voluntary control of movement
  • Speech
  • Saccadic eye movements
  • Bladder control
  • Gait
  • Higher order
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11
Q

What part of the frontal lobe is for voluntary control of movement?

A

Precentral gyrus

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12
Q

What part of the frontal lobe is responsible for speech?

A
  • Pars opercularis

- Pars triangularis

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13
Q

What part of the frontal lobe is responsible for saccadic eye movements?

A

Frontal eye field

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14
Q

What part of the frontal lobe is responsible for gait?

A

Periventricular

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15
Q

What part of the frontal lobe is responsible for bladder control?

A

Paracentral lobule

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16
Q

How should the frontal lobe be examined?

A

-Inspection (Decorticate posture, ‘Magnetic gait’, Urinary catheter, Abulia)
-Pyramidal weakness (UMN signs – weakness, increased tone, brisk reflexes, up-going plantar
Pronator drift)
-Saccadic eye movement
-Primitive reflexes
-Speech

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17
Q

What is the function of the orbitofrontal cortex?

A
  • Restraint

- Mediates empathic, civil and socially appropriate behaviour

18
Q

How can the orbitofrontal cortex be examined?

A
  • Is speech and behaviour socially appropriate?
  • Go/no-go tests
  • Stroop test
19
Q

What is the function of the supplementary motor cortex/anterior cingulate?

A

Initiative

20
Q

What may indicate a problem with initiative?

A
  • Lack of motivation
  • Apathy
  • Abulia
  • Depression
21
Q

What is the function of the dorsolateral prefrontal cortex?

A

Order

22
Q

Executive function

A

The integration of sensory information, the generation of a range of response alternatives to environmental challenges, the selection of the most appropriate response, maintenance of task set, sequential ordering of data, self-evaluation of performance and the selection of a replacement responses if the first applied response fails.

23
Q

How can the dorsolateral prefrontal cortex be tested?

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
24
Q

How can language be examined?

A
  • Fluency – Broca’s
  • Nominal aphasia
  • Repetition – arcuate fasciculus
  • 3 step command – Wernicke’s
  • ‘Baby hippopotamus’ – cerebellar speech
  • Orofacial movement – ppp, ttt, mmm
  • Reading
  • Writing
25
Q

What should you ensure before examining language ?

A
  • Hearing is intact
  • First language is English
  • Determine handedness
26
Q

What are the functions of the parietal lobe?

A
  • Body image representation – primary somatosensory area
  • Multimodality assimilation
  • Visuospatial coordination
  • Language
  • Numeracy
27
Q

What cortical sensory syndrome can occur as a result of parietal lobe pathology?

A
  • Sensory inattention
  • Astereoagnosia
  • Dysgraphasthesia
  • Two point discrimination
28
Q

What syndrome can affect the dominant parietal lobe?

A

Gerstman’s syndrome

29
Q

How can Gerstman’s syndrome present?

A
  • Dyscalculia
  • Finger anomia
  • Left/right disorientation
  • Agraphia
30
Q

How may pathology in the non-deominant parietal lobe present?

A

-Ideomotor apraxia
-‘How to do’ – light a match
-Ideational apraxia
‘What to do’ – loss of understanding of the purpose of objects – what is a comb for?
-Constructional apraxia
-Dressing apraxia
-Hemineglect
-Loss of spatial awareness

31
Q

What are the functions of the temporal lobe?

A
  • Processes auditory input (Heschl gyrus)
  • Language
  • Encoding declarative long-term memory (hippocampus) – semantic/episodic
  • Emotion (amygdala)
  • Visual fields (Meyer’s loop)
32
Q

How may pathology in the cerebellum present?

A

DANISH P

  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred Speech
  • Hypotonia
  • Past pointing
  • Lower CN signs
  • Hydrocephalus
33
Q

What types of pathology can occur in the spine?

A
  • Nerve root (radiculopathy)
  • Peripheral nerve
  • Cord (myelopathy)
  • Peripheral neuropathy
34
Q

What would suggest a radiculopathy (nerve root)?

A
  • Unilateral
  • Single myotome
  • Single dermatome, -(reflex),
  • LMN
35
Q

What would suggest pathology with a peripheral nerve?

A

-Unilateral
-Motor and sensory deficits
LMN

36
Q

What would suggest a myelopathy (cord)?

A
  • Bilateral
  • Motor and sensory level
  • UMN (long tract signs)
37
Q

What would suggest a peripheral neuropathy?

A

Glove and stocking

38
Q

What type of signs would occur with a myelopathy?

A

Long tract signs

  • Clonus
  • Upgoing plantars
  • increased tone
  • Hoffman sign
  • brisk reflexes
  • Proprioception impairment Romberg’s test
  • Tandem walking
39
Q

Where is the pathology in myelopathy?

A

Cervical or thoracic

40
Q

What does the location of pathology in myelopathy determine?

A
  • UMN below the lesion

- Motor and sensory level

41
Q

What does radiculopathy present with?

A
  • Pain in single dermatome
  • Dermatomal sensory disturbance
  • Weakness in myotome
  • Loss of reflex

Systems: Neurology AB (51 decks)

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