Clinical Assessment of the Neurosurgical Patient Flashcards
What can dilated pupils be a sign of?
- Cerebral herniation
raised ICP
What does a low GCS usually indicate?
- Inadequate cerebral perfusion
- Metabolic issues
With regard to cerebral injuries, what can be particularly important before planning surgery?
- Localizing the injury, which lobe is it
Functions of the frontal lobe?
- Voluntary control of movement (precentral gyrus)
- Speech
- Saccadic eye movement
- Bladder control
- Gait
- Higher order functions
Steps in examination of the frontal lobe?
- Posture, gait, urinary incontinence
- Pyramidal weakness (UMN signs)
- Saccadic eye movement
- Primitive reflexes
- Speech
What behaviour abnormalities are often shown in a person with an injured frontal lobe?
- Lack of restraint (orbitofrontal cortex)
- Lack of initiative (no motivation / depression)
- Lack of order (ability to keep track of history / have a replacement response if first fails)
Functions of the parietal lobe?
- Body image representation (primary somatosensory cortex)
- Multimodality assimilation
- Visuospatial coordination
- Language
- Numeracy
What to examine for sensory parietal lobe function?
- Sensory inattention
- Astereoagnosia (can’t identify objects by touch alone)
- Dysgraphasthesia (can’t recognize writing on skin by touch alone)
- Two point discrimination
What to examine for dominant side (Gerstman’s syndrome) parietal lobe function?
- Dyscalculia
- Finger anomia (can’t recognize / name the different fingers)
- Left / right disorientation
- Agraphia (can’t communicate via writing)
What to examine for NON-dominant side parietal lobe function?
- Ideomotor apraxia (inability to perform pantomimes / communicative gestures)
- ideational apraxia (can’t plan movements)
- What to do “what is a comb for?”
- Hemineglect
- Loss of spatial awareness
Functions of the Temporal Lobe?
- Processes auditory input (Heschl gyrus)
- Language
- Encoding declarative long term memory
- Emotion (amygdala)
- Visual fields (meyer’s loop)
Signs of cerebellar dysfunction?
- Impaired ability to perform rapid alternating movements (dysdiadochokinesia)
- Ataxia
- Nystagmus
- Slurred speech
When a CNS injury is expected to be below the cerebrum, what should be tested?
- Is it within the nerve root (radiculopathy), within the peripheral nerve, or within the cord itself (myelopathy)
What are signs that below cerebrum injury is in the SC? (Myelopathy)
- Motor and sensory function impaired
- UMN signs below lesion
- Long tract signs
What are some common long tract (attributable to long fibres of SC) signs?
- Clonus
- Increased tone
- Hoffman sign
- Brisk reflexes
- Proprioception impairment
