Clinical Assessment of the Neurosurgical Patient Flashcards
Name six function of the frontal lobe
- 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)
What do you look for in the frontal lobe examination?
- Inspection
- Pyramidal weakness
- Saccadic eye movement
- Primitive reflexes
- Speech
What do you look for in the inspection of the frontal lobe examination?
- Decorticate posture
- ‘Magnetic gait’
- Urinary catheter
- Abulia
What is decorticate posture?
Abnormal posture - stiff with bent arms, clenched fists, and legs held out straight
Indicative of brain damage
What is abulia?
A lack of will and initiative resulting in the inability to act or make decisions independently
What will pyramidal weakness present as in the frontal lobe examination?
- UMN signs - weakness, increased tone, brisk reflexes, up-going plantar
- Pronator drift
What is the orbitofrontal cortex (restraint) of the frontal lobe?
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.
How do you examine the orbitofrontal cortex (restraint) of the frontal lobe?
- 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
What is the supplementary motor cortex/anterior cingulate (Initiative) of the frontal lobe?
It is part of the premotor cortex and contributes for movement
What do you look for to examine the supplementary motor cortex/anterior cingulate (Initiative)?
- Lack of motivation
- Apathy
- Abulia
- Depression
What is the function of the dorsolateral prefrontal cortex of the frontal lobe?
- 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
What do you look for to examine the dorsolateral prefrontal cortex (order) of the frontal lobe?
- 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
State 10 ways to examine language?
- 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
What is handedness?
Dominance of one hand over the other, or the unequal distribution of fine motor skills between the left and right hands
Name five functions of the parietal lobe
- Body image representation - primary somatosensory area
- Multimodality assimilation
- Visuospatial coordination
- Language
- Numeracy
State four cortical sensory syndromes of the parietal lobe
- Sensory inattention
- Astereoagnosia
- Dysgraphasthesia
- Two point discrimination
What is astereoagnosia?
The inability to identify an object by active touch of the hands without other sensory input, such as visual or sensory information.
What is dysgraphasthesia?
The inability to recognise writing on the skin purely by the sensation of touch
What are the four symptoms of Gerstman’s syndrome of the dominant left parietal lobe?
- Dyscalculia - difficulty in making decisions
- Finger anomia - inability to distinguish the fingers on the hand
- Left/right disorientation
- Agraphia - inability to communicate through writing
What can damage to the left (dominant) parietal lobe cause?
Gerstman’s syndrome
What can damage to the right (non dominant) parietal lobe cause?
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.
What do you look for when examining non-dominant parietal lobe?
• 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
What is apraxia?
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
Name five functions of the temporal lobe
- Processes auditory input (Heschl gyrus)
- Language
- Encoding declarative long-term memory (hippocampus) – semantic/episodic
- Emotion (amygdala)
- Visual fields (Meyer’s loop)
What is the danish pneumonic for what you look in the cerebellar examination?
DANISH P
What symptoms do you look for in the cerebellum examination?
- Dysdiadochokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred Speech
- Hypotonia
- Past pointing
Name four conditions that are found with spine examination
- Nerve root (Radiculopathy)
- Peripheral nerve
- Cord (myelopathy)
- Peripheral neuropathy
Describe signs of radiculopathy (nerve root)
Unilateral, single myotome, single dermatome, (reflex), LMN
Describe signs of peripheral nerve deficit
Unilateral, motor and sensory deficit fits with PN, LMN
Describe signs of myelopathy (cord)
Bilateral, motor and sensory level, UMN (long tract signs)
Describe signs of peripheral neuropathy
Glove and stocking pattern of pain
What are the features of myelopathy?
- 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
What are the features of radiculopathy?
- Pain in single dermatome
- Dermatomal sensory disturbance
- Weakness in myotome
- Loss of reflex
