clinical correlates Flashcards
accommodation/conversion reflex
adaptation of the visual apparatus of the eye for near vision
- increase in curvature of lens (edinger-westphal nucleus)
- pupillary constriction (EW nuc)
- convergence of eyes (oculomotor nuc)
lower motor neuron lesion of oculomotor nerve (CN III)
ptosis - loss of levator palpebrae superioris
frontalis activated to compensate
dilated pupil (loss of parasympathetics)
downward and abducted eye - unopposed action of superior oblique and lateral rectus
pupillary light reflex is a good test for
optic nerve damage
oculomotor nerve damage
brain death
depressant drugs (barbiturates)
the optic nerve is responsible for the _____ limb of the pupillary reflex
afferent
senses incoming light
the oculomotor nerve is responsible for the _____ limb of the pupillary reflex
efferent
drives muscles that constrict pupil
symptoms of optic nerve damage on one side
ipsilateral direct reflex lost
contralateral reflex intact
ipsilateral consensual reflex intact (light shone onto opposite eye triggers constriction of both pupils)
contralateral consensual reflex lost (light shone into damaged eye cannot signal brain)
symptoms of oculomotor damage on oneside
ipsilateral direct reflex lost
contralateral direct reflex intact
ipsilateral consensual reflex lost (light shone onto oppposite eye should trigger both pupils to constrict, but doesn’t)
contralteral consensual reflex intact
touching the cornea with a cotton swab tests
blink reflex
occurs between V1 (nasociliary) and facial (to orbicularis oculi)
sensory testing of V1
nose/forehead/front of scalp
sensory testing v2
zygomatic area
sensory testing v3
chin, skin in front of ear
sensory testing transverse cervical nerve
front of neck
sensory testing great auricular nerve
skin under ear/back of jaw
sensory testing lesser occipital nerve
skin behind ear
sensory testing greater occipital nerve
back of head
testing muscles of face
have pt go through various facial exprssions and look for asymmetry
test motor component of V3
muscles of mastication
bite down on tongue depressor on one side and try to pull it out, repeat on other side
upper motor neuron lesion to facial nerve symptoms
paralysis of muscles iin the contralateral lower face
lower motor neuron lesion of facial nerve symptoms
paralysis of muscles in ipsilateral upper and lwoer face
weber test
hearing test
normal - mild sound in center
conductive loss (ossicles) - sound louder on affected side
sensorineural loss (nerve) sound absent on affected side
romberg test
balance test
pt asked to stand feet together, arms by side with eyes open
close eyes
positive = pt sways/falls when eyes closed
indicative of intracranial lesion affecting vestibular system
lesion to right accessory nerve
right shoulder may drop
test strength with resisted shrug
weakness in right scm
test by resisting motion of right SCM (sidebend right, rotate left)
torticollis
contraction/shortening of SCM
upper motor neuron lesion hypoglossal
tongue leans to opposite side of lesion
no atrophy in tongue muslces on affected side
lower motor neuron lesion hypoglossal
flaccid paralysis of tongue
atrophy of tongue muscles on affected side
tongue deviates to same side of lesion
