Clinical Assessment of the Neurosurgical Patient Flashcards
What does CPP stand for?
Cerebral perfusion pressure
What is cerebral perfusion pressure (CPP)?
Net pressure gradient that drives oxygen delivery to cerebral tissue, measured in mmHg
What formula describes cerebral perfusion pressure?
CPP = MAP - ICP
What are some functions 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 parts of the examination are important for frontal lobe?
- Inspection
- Decorticate posture
- Magnetic gait
- Urinary catheter
- Abulia
- Pyramidal weakness
- UMN signs
- Weakness, increased tone, brisk reflexes, up-going planter
- Pronator drift
- UMN signs
- Saccadic eye movement
- Primitive reflexes
- Speech
What is the neurophychology of the frontal lobe?
- Orbitofrontal cortex (restraint)
- Mediates empathic, civil and socially appropriate behaviour
- Is speech and behaviour socially appropriate
- Go/no-go tests
- Stroop test
- Mediates empathic, civil and socially appropriate behaviour
- Supplementary motor cortex/anterior cingulate (initiative)
- Lack of motivation
- Apathy (lack of enthusiasm or concern)
- Abulia
- Depression
- Dorsolateral prefrontal cortex (order)
- Executive function
- The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
- 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
- The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
- Executive function
How does the orbitofrontal cortex control behaviour?
- Orbitofrontal cortex (restraint)
- Mediates empathic, civil and socially appropriate behaviour
- Is speech and behaviour socially appropriate
- Go/no-go tests
- Stroop test
- Mediates empathic, civil and socially appropriate behaviour
Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for restraint?
Oritofrontal cortex
Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for initiative?
Supplementary motor cortex/cingulate
Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for order?
Dorsolateral prefonrtal cortex
What is the clinical presentation of problems with supplementary motor cortex/anterior cingulate, in terms of psychology?
- Lack of motivation
- Apathy (lack of enthusiasm or concern)
- Abulia
- Depression
What is apathy?
Lack of enthusiasm or concern
What can be done to test the dorsolateral prefrontal cortex?
- Executive function
- The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
- 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
- The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
What is done to examine language?
- Ensure hearing is intact and patient’s first language is English
- Handedness
- Fluency (Broca’s)
- Nominal aphasia
- Repetition
- 3 step command
- Reading
- Writing
What are functions of the parietal lobe?
- Body image representation
- Primary somatosensory area
- Multimodality assimilation
- Visuospatial coordination
- Language
- Numeracy
What is looked for when examining the parietal lobe?
- Cortical sensory syndromes
- Sensory inattention
- Astereognosia
- Dysgraphasthesia
- Two point discriminiation
- Dominant side (Gerstman’s syndrome)
- Gyscalculia
- Finger anomia
- Left/right disorientation
- Agraphia
- Examining non-dominant
- Ideomotor apraxia
- ‘How to do’ light a match
- Ideational apraxia
- ‘What to do’, loss of understanding of the purpose of objects
- Constructional apraxia
- Dressing apraxia
- Hemineglect
- Loss of spatial awareness
What are functions of the temporal lobe?
- Processes auditory input (Heschl gyrus)
- Language
- Encoding declarative long term memory (hippocampus)
- Emotion (amygdala)
- Visual fields (Meyer’s loop)
What part of the temporal lobe is responsible for processing auditory input?
Heschl gyrus
What part of the temporal lobe is responsible for encoding declarative long term memory?
Hippocampus
What part of the temporal lobe is responsible for emotion?
Amygdala
What part of the temporal lobe is responsible for visual fields?
Meyer’s loop
What are signs/symptoms for pathology in the cerebellum?
- Dysdiadochokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
- Past pointing
What are different kinds of diseases of the spine?
- Nerve root (radiculopathy)
- Unilateral, single myotome, single dermatome, reflex, LMN
- Peripheral nerve
- Unilateral, motor and sensory deficit fits with PN, LMN
- Cord (myelopathy)
- Bilateral, motor, sensory level, UMN (long tract signs)
- Peripheral neuropathy
What are diseases of the nerve root called?
Radiculopathy
What are diseases of the spinal cord called?
Myelopathy
Describe the kinds of clinical presentations due to radiculopathy compared to peripheral nerve compared to myelopathy?
- Nerve root (radiculopathy)
- Unilateral, single myotome, single dermatome, reflex, LMN
- Peripheral nerve
- Unilateral, motor and sensory deficit fits with PN, LMN
- Cord (myelopathy)
- Bilateral, motor, sensory level, UMN (long tract signs)
What are some long tract signs (myelopathy)?
- Clonus, upgoing pantars, increased tone, Hoffman sign, brisk reflexes proprioception impairment, tandem walking
What is clonus?
Muscular spasm involving repeated, often rhythmic, contractions
