Clinical Assessment of the Neurosurgical Patient’

Question 1

functions of frontal lobe

Answer 1

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)

Question 2

examining the frontal lobe?

Answer 2

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

Question 3

how do you examen language?

Answer 3

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

Question 4

functions of parietal lobe

Answer 4

Body image representation – primary somatosensory area
Multimodality assimilation
Visuospatial coordination
Language
Numeracy

Question 5

examening the parietal lobe?

Answer 5

Cortical Sensory Syndromes
Sensory inattention
Astereoagnosia
Dysgraphasthesia
Two point discrimination

Question 6

functions of temporal lobe

Answer 6

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

Question 7

what rae the questions you would ask in regards to spine?

Answer 7

Does it fit with nerve root (radiculopathy)? – unilateral, single myotome, single dermatome, (reflex), LMN

Does it fit with peripheral nerve? – unilateral, motor and sensory deficit fits with PN, LMN

Does it fit with cord (myelopathy)? – bilateral, motor and sensory level, UMN (long tract signs)

Does it fit with peripheral neuropathy? – glove and stocking
Is it actually higher? Brain stem/hemisphere

Question 8

what is myelopathy?

Answer 8

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

Question 9

what is radiculopathy?

Answer 9

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