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CNS Flashcards

1
Q

How to measure bulk?

A

Arm - 10cm above the olecranon
Forearm - 10cm below olecranon
Thigh- 18cm from the superior border of patella
Leg- 10cm below the tibial tuberosity

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2
Q

Types of tone

A

Normal, hypotonic, hypertonic- spasticity and rigidity

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3
Q

Grading of power

A

0- complete paralysis
1-flicker of contraction
2-power detectable only when gravity is excluded
3- limb can be held against gravity but not against resistance
4- limb can be held against gravity and some resistance
5- normal power

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4
Q

Shoulder muscles and movements

A

Abduction - supraspinatus, deltoid, trapezius and serratus anterior

Adduction- Pectoralis major , latissimus dorsi, teres major

Flexion -biceps, deltoid,coracobrachialis

Extension - post. deltoid, teres major

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5
Q

Hip movements and muscles

A

Flexion - iliopsoas
Extension - Gluteus Maximus
Adduction- adductor longus, brevis and magnus
Abduction - gluteus medius, gluteus minimus

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6
Q

Superficial reflexes

A

•Corneal - CN V and VII
•Abdominal
Epigastric T6-T9
Mid-abdominal T9-T11
Hypogastric T11-L1
•Cremasteric L1, L2
•anal S1-S2
•plantar- afferent nerve- tibial nerve

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7
Q

Types of plantar reflex

A

•Chaddocks- lateral aspect of foot from below up
•Gordon’s -calf

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8
Q

Deep tendon reflexes

A

Jaw jerk - afferent and efferent both 5th nerve
Biceps- C5,C6
Triceps - C6C7C8
Knee jerk- L2, L3,L4
Ankle jerk- L5 S1 S2

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9
Q

Hoffmann’s sign

A

Also called finger flexor reflex, used to test peripheral nerve lesions

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10
Q

Grading of Reflex

A

0- no response
1- a slight but definitely present response
2- a brisk response, normal
3- a very brisk response
4- clonus

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11
Q

Primitive reflexes

A

Glabellar tap sign
Palmomental reflex
Sucking
Rooting
Pout and snout
Grasp

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12
Q

Cortical sensation ( can be tested only if primary sensations are intact)

A

Tactile localisation
Two point differentiation
Stereognosis
Graphesthesia

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13
Q

Cerebral signs - hand

A

Upper limb-
Limb ataxia: finger nose test, nose finger nose test
Didakokinesia: rapid hand tapping, pronation and supination
Pointing and past pointing
Macrographia
Rebound phenomenon
Intentional tremors

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14
Q

Cerebral tests for lower limb

A

Heel knee test
Pendular knee jerk

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15
Q

General cerebral signs

A

Titubation
Nystagmus
Tremors
Truncal ataxia
Tandem walking
Hypotonia

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16
Q

Signs of meningeal signs

A

Neck stiffness
Kernig’s sign
Brudzinski’s sign

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17
Q

What is pentaplegia?

A

Is a spinal cord injury at or above C4 level resulting in complete loss of motor functions below the injury level and paralysis of respiratory muscles

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18
Q

Patterned weakness

A

The pattern of pyramidal weakness is weakness of upper limb extensors and lower limb flexors

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19
Q

Cause of monoplegia

A

Stroke affecting ACA- ll
CV thrombosis
Head injury

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20
Q

Causes of quadriplegia

A

UMN causes
Cerebral palsy, MS, motor neuron disease, bilateral brainstem lesion

LMN causes
Anterior polyeomyelitis, GBS syndrome, peripheral neuropathy, MG

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21
Q

Ellsberg phenomenon

A

Compressive lesions near the high cervical cord produce weakness of ipsilateral shoulder followed by ipsilateral leg , then contralateral leg and finally the contralateral shoulder.
It is an anti clockwise phenomenon

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22
Q

Patterns of Sensory loss

A

Hemi sensory - internal capsule/ thalamus
Crossed sensory loss - lateral medulla
Ascending sensory loss - extramedullary compressive lesions
Descending sensory loss - intramedullary compressive lesions
Graded sensory loss- peripheral neuropathy

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23
Q

Neurofibromatosis

A

Type 1- von Recklinghausen disease
Ch.17 dominant
Criteria -
6 or more café au lait spots
Axillary or inguinal freckling
Two or more lisch nodules
Optic glioma

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24
Q

Tuberous sclerosis

A

Also called Bourneville disease
AD
Epilepsy, low intelligence and adenoma sebaceum ( EPI- LOI-A)

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25
Sturge weber's syndrome
From anomalous development of primordial vascular bed in early stages of cerebral vascularization Clinical features - port wine stain Bulophthalmus and glaucoma of ipsilateral eye
26
Von hipple lindau disease
AD, 3p Cerebral hemangioblastoma, retinal angioma, pheochromocytoma
27
Glascow coma scale
Eye opening, verbal response, motor response Total 15 , least 3 Eye - 4- opens spontaneously 3- opens to stimuli 2- opens only to pain 1-never opens Verbal 5- oriented 4- confused or disoriented 3- uses inappropriate words 2- makes incomprehensible sounds 1-no verbal response Motor response 6-obeys command 5- Localisation of pain 4- exhibits flexion withdrawal 3- decorticate rigidity 2- decerebrate rigidity 1- no motor response
28
Classification of memory
Explicit ( decelerative) and implicit memory Explicit - involves active recall and can be tested in bed side. Includes - immediate( prefrontal), recent ( medial temporal lobe), remote ( wide spread neocortical areas) Implicit - Doesn't involve active recall rather basal ganglia and cerebellum Cannot be tested in bedside Includes procedural memory ( basal ganglia), classical conditioning memory (cerebellum)
29
Examination of explicit memory
Immediate ( working memory)- repeat random numbers front and back Recent ( short term) - recall items in 5 minutes Remote- memory from childhood
30
Other types of memory
Episodic Semantic
31
Wernicke's encephalopathy and korsakoff 's psychosis
Global confusion, ophthalmoplegia and ataxia Recent memory loss and confabulation
32
Minimal mental state examination
ORARL Orientation - place and time Registeration - name three objects Attention and recall - serial 7 table or backwards Registeration recall Language - 3 stage command, name two object, draw a pentagon 21-24: mild cognitive dysfunction 10-20: moderate <10:severe
33
Aphasia vs Dysarthria
Aphasia is a disorder of language Dysarthria is a disorder of motor production or articulation of speech Caused due to cerebral dysfunction Due to defective articulation
34
What the area of speech in brain?
Wernicke's area- 22 - comprehension Arcuate fasciculus- needed for speech repetition Broca's area - 44 - for production
35
Types of aphasia
Fluent aphasia - repetitive aphasia: impairment mostly due to the input or reception in auditory verbal comprehension center( wernicke's) Non fluent aphasia - difficulties in articulation of words( broca's)
36
Domains of language
Spontaneous speech / fluency Compression Repetition Reading writing naming
37
CFR domains
C- comprehension requires- wernicke's and transcortical sensory area R- repetition- intact wernicke's, arcuate and broca's F- broca's and transcortical motor area
38
Hot potato voice
Also called spastic - strained, slurred UMN weakness - pseudobulbar palsy
39
Ataxic speech
Seen in cerebellar diseases Scanning speech- undue separation of syllables ( monosyllable ) Staccato speech- explosive type of speech with emphasis on syllables
40
Flaccid speech
Cerebrovascular diseases LMN palsy of facial, palatal and tongue
41
What is apraxia
It is the inability to perform skilled , complex and organised motor activities in the presence of normal basic motor, sensory and cerebellar functions.
42
Types of apraxia
Ideomotor- inability to perform a specific motor command Dressing apraxia - non dominant parietal lobe Constructional apraxia Ideational apraxia - deficit in execution of a goal directed sequence - often confused with dementia Gait apraxia- nph
43
Agnosia
Is the failure to recognise objects despite intact sensory system Lesion at the contralateral parietal lobe
44
What are hypnopompic and hypnagogic hallucinations?
Hypnopompic - when waking up Hypnagogic- when gng to sleep
45
Functions of frontal lobe
PSMILE Personality Social behaviour Micturation Intelligence Language Emotional response
46
Functions of parietal lobe
Dominant- language calculation Non Dominant- spatial orientation and construction
47
Functions of temporal lobe
Dominant side- auditory perception, language, verbal memory, smell, balance Non Dominant side- auditory perception, melody and pitch, non verbal memory , smell and balance
48
What is foster kennedy and psuedo foster kennedy syndrome?
Foster kennedy syndrome - anosmia, optic atrophy in one eye and papilledema in the contralateral eye due to tumor in the brain Similar symptoms in the absence of tumor
49
Optic nerve components
Visual acuity Visual field Colour vision Fundus examination
50
Extent of visual field
Normal extent of the visual field of the individual eye : Vertical upward - 60 Vertical downward -75 Medially - 60 Laterally - 100 In binocular vision Horizontal - 200 Vertical -140
51
Visual field defects
Optic nerve - total loss of vision in the affected eye Optic Chiasma- bitemporal hemianopia Optic tract - homonymous hemianopia Geniculocalcarine tract- upper and lower quadrantanopia Macula- homonymous hemianopia with macular sparing
52
Colour vision
Red green vision - chromosome X Blue vision - chromosome 7 Drugs like sildenalfil, ethambutol, chloroquine, divitalis
53
Causes of papilledema
Space occupying lesions - intracranial mass, abscess, haemorrhage Focal or diffuse edema- cytogenic and vasogenic edema
54
Psuedotumor cerebri
Hypercarbia, hypertension,hypercalcemia,hypoparathyroidism
55
Stages of hypertensive retinopathy
Keith Wagner barker classification Group 1- retinal arteriole constriction Group 2- group1+ focal narrowing retinal arteriole + AV nicking Group 3- group 2+ flame shaped+ cotton wool spots+ hard exudates and copper wiring Group 4- group 3 + optic disc swelling and silver wiring
56
Testing of CN III
eyelids Eyeballs at rest Extraocular muscles Pupils Nystagmus
57
Ptosis
Narrowing of palpebral fissure due to inability to open the upper eye lid Caused due to paralysis of levator palpebrae superioris and tarsal muscle Lps- supplied by CN III Tarsal muscle - sympathetic system Paralysis of lps- patient cannot volunteering lift the eyelid hence in long standing cases forehead wrinkling Paralysis of tarsal muscle - can be lifted volunteering
58
Causes of ptosis
Congenital ptosis Acquired ptosis- Neurogenic, neuromuscular, myogenic and mechanical ptosis
59
Causes of unilateral and bilateral ptosis
Unilateral - CN III lesion, horner's syndrome and upper eyelid lesion Bilateral ptosis - myopathies, myasthenia gravis, snake bite
60
What are saccades and pursuits?
Conjugate rapid eye movements - frontal lobe controls saccadic movements Pursuits - rapid and smooth
61
Pupillary abnormalities
1. Argyll Robertson pupil- seen in neurosyphilis - small irregular pupils having near light dissociation but present accommodation reflex 2. Reverse argyll Robertson pupil- accommodation reflex absent - doptheria and tumor at quadrigemina 3. Wernicke's hemianopia - lesions in optic tract 4. Adies tonic pupil- absence of light reflex, large pupil- anisocoria, unilateral seen in young women 5. Marcus Gunn pupil- swinging flash light test, optic nerve testing 6. Hutchison's pupil- seen in comatose patients - dilated poorly reactive pupil - due to expanding intracranial supratentorial mass causing uncal herniation and CN III
62
Horner's syndrome : oculosympathetic palsy
Ptosis Miosis Enophthalmos Anhydrosis Loss of ciliospinal reflex
63
Nystagmus
Involuntary, conjugate ,repetitive, rhythmic eye movements
64
Rule of 17
10+7- in facial nerve weakness and vagus involvement, the deviation will be towards the normal side- because levator anguli oris and palatopharyngeus are pulling muscles - hence the affected side is pulled towards normal side 12+5 - the deviation will be towards the affected side - later pterygoid and genioglossus are pushing muscles
65
Sensory involvement of CN V
Skin- balaclava helmet and dejerine onion skin distribution
66
Facial nerve motor testing
Frontal belly of occipitofrontalis Orbicularis oculi Orbicularis oris and buccinator Platysma
67
What is Bell's phenomenon?
Exaggerated palpebral oculogyric reflex- normally on closing the eye lids, the eyeballs deviate upwards
68
Signs in LMN fascial palsy
Bell's phenomenon - reflex upturning of eyeballs Levator sign of dutemps and cestan- patient looks down and slow closes eyes , there is incomplete closure orbicularis oculi Negro's sign - the eye on the paralysed side deviates outward and elevates more than the normal sign
69
Causes of LMN fascial palsy
•Congenital - mobius syndrome •Idiopathic - Bell's palsy •Infectious - ramsay hunt syndrome, otitis media, leprosy, lyme disease • neurological - mg , ms, GBS
70
Hemiplegia in UMN and LMN
UMN - contralateral LMN- ipsilateral
71
What is attitude?
It is the position of a limb when the patient is in the resting position
72
Erb's palsy attitude
Arm is adducted and internally rotated Forearm is Extended and pronated Wrist is flexed
73
Causes of muscle hypertrophy
True- excercise Psuedohypertrophy - duchene's muscular dystrophy , Becker 's muscular dystrophy and storage disorders
74
What muscle tone?
Tone is defined as partial state of contraction of the muscle at rest
75
Abnormalities of tone
Hypotonia - LMN, cerebellar diseases, hypothyroidism, chorea , down syndrome Hypertonia- Spasticity and rigidity - UMN, tetanus , strychnine poisoning, catatonia
76
Spasticity vs rigidity
Clasp knife Lead pipe/ cog wheel 🎡 Pyramidal and extra pyramidal Anti-gravity muscles ( flexors in upper limb and extensors in lower limb) , both muscle groups involved Velocity dependent Velocity independent
77
What is reflex?
It is an involuntary response to a sensory stimulus
78
Types of reflexes
Deep tendon reflexes ( monosynaptic) Superficial reflexes (polysynaptic reflexes) Plantar Latent Primitive reflexes
79
Reinforcement maneuvers
Distraction Clench teeth Jendrassik maneuver
80
What is a clonus?
It is a series of rhythmic involuntary muscular contractions induced by the sudden passive stretching of a muscle or tendon
81
Rhomberg's sign
It is a sign of posterior column dysfunction
82

Medicine Practicals (5 decks)

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