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Nervous System > Clinical Assessment of the Neurosurgical Patient > Flashcards

Clinical Assessment of the Neurosurgical Patient Flashcards

1
Q

Name six function of the frontal lobe

A
  • Voluntary control of movement - precentral gyrus
  • Speech – pars opercularis, pars triangularis
  • Saccadic eye movements - frontal eye field
  • Bladder control – paracentral lobule
  • Gait – periventricular
  • Higher order - Restraint, Initiative, and Order (RIO)
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2
Q

What do you look for in the frontal lobe examination?

A
  • Inspection
  • Pyramidal weakness
  • Saccadic eye movement
  • Primitive reflexes
  • Speech
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3
Q

What do you look for in the inspection of the frontal lobe examination?

A
  • Decorticate posture
  • ‘Magnetic gait’
  • Urinary catheter
  • Abulia
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4
Q

What is decorticate posture?

A

Abnormal posture - stiff with bent arms, clenched fists, and legs held out straight

Indicative of brain damage

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5
Q

What is abulia?

A

A lack of will and initiative resulting in the inability to act or make decisions independently

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6
Q

What will pyramidal weakness present as in the frontal lobe examination?

A
  • UMN signs - weakness, increased tone, brisk reflexes, up-going plantar
  • Pronator drift
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7
Q

What is the orbitofrontal cortex (restraint) of the frontal lobe?

A

It is a prefrontal cortex region in the frontal lobes which is involved in the cognitive processing of decision-making.

Mediate empathic, civil and socially appropriate behaviour.

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8
Q

How do you examine the orbitofrontal cortex (restraint) of the frontal lobe?

A
  • Is speech and behaviour socially acceptable?
  • Go/no-go tests
  • Stroop test - measures a person’s selective attention capacity and skills, as well as their processing speed ability
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9
Q

What is the supplementary motor cortex/anterior cingulate (Initiative) of the frontal lobe?

A

It is part of the premotor cortex and contributes for movement

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10
Q

What do you look for to examine the supplementary motor cortex/anterior cingulate (Initiative)?

A
  • Lack of motivation
  • Apathy
  • Abulia
  • Depression
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11
Q

What is the function of the dorsolateral prefrontal cortex of the frontal lobe?

A
  • Integration of sensory information
  • Generation of a range response alternatives
  • Selection of most appropriate response
  • Self-evaluation of performance and the selection of a replacement responses if first response fails
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12
Q

What do you look for to examine the dorsolateral prefrontal cortex (order) of the frontal lobe?

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
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13
Q

State 10 ways to examine language?

A
  • Ensure hearing is intact and patient’s first language is English
  • Handedness
  • Fluency – Broca’s
  • Nominal aphasia
  • Repetition – arcuate fasciculus
  • 3 step command – Wernicke’s
  • ‘Baby hippopotamus’ – cerebellar speech
  • Orofacial movement – ppp, ttt, mmm
  • Reading
  • Writing
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14
Q

What is handedness?

A

Dominance of one hand over the other, or the unequal distribution of fine motor skills between the left and right hands

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15
Q

Name five functions of the parietal lobe

A
  • Body image representation - primary somatosensory area
  • Multimodality assimilation
  • Visuospatial coordination
  • Language
  • Numeracy
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16
Q

State four cortical sensory syndromes of the parietal lobe

A
  • Sensory inattention
  • Astereoagnosia
  • Dysgraphasthesia
  • Two point discrimination
17
Q

What is astereoagnosia?

A

The inability to identify an object by active touch of the hands without other sensory input, such as visual or sensory information.

18
Q

What is dysgraphasthesia?

A

The inability to recognise writing on the skin purely by the sensation of touch

19
Q

What are the four symptoms of Gerstman’s syndrome of the dominant left parietal lobe?

A
  • Dyscalculia - difficulty in making decisions
  • Finger anomia - inability to distinguish the fingers on the hand
  • Left/right disorientation
  • Agraphia - inability to communicate through writing
20
Q

What can damage to the left (dominant) parietal lobe cause?

A

Gerstman’s syndrome

21
Q

What can damage to the right (non dominant) parietal lobe cause?

A

Neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.

22
Q

What do you look for when examining non-dominant parietal lobe?

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
23
Q

What is apraxia?

A

Difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and the individual is willing to perform the task

24
Q

Name five 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)
25
Q

What is the danish pneumonic for what you look in the cerebellar examination?

A

DANISH P

26
Q

What symptoms do you look for in the cerebellum examination?

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred Speech
  • Hypotonia
  • Past pointing
27
Q

Name four conditions that are found with spine examination

A
  • Nerve root (Radiculopathy)
  • Peripheral nerve
  • Cord (myelopathy)
  • Peripheral neuropathy
28
Q

Describe signs of radiculopathy (nerve root)

A

Unilateral, single myotome, single dermatome, (reflex), LMN

29
Q

Describe signs of peripheral nerve deficit

A

Unilateral, motor and sensory deficit fits with PN, LMN

30
Q

Describe signs of myelopathy (cord)

A

Bilateral, motor and sensory level, UMN (long tract signs)

31
Q

Describe signs of peripheral neuropathy

A

Glove and stocking pattern of pain

32
Q

What are the features of myelopathy?

A
  • Cervical or thoracic pathology
  • Motor and sensory level
  • UMN below lesion
  • Long tract signs – clonus, upgoing plantars, increased tone, Hoffman sign, brisk reflexes, proprioception impairment – Romberg’ test, tandem walking
33
Q

What are the features of radiculopathy?

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

Nervous System (47 decks)

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