CNS 3 (Meningeal) Flashcards
Flexion of both the hips and knees is a positive
Brudzinski sign
Pain and increased resistance to knee extension are a
positive Kernig sign
If the patient has low back pain that radiates down the thigh and leg, commonly called __if in the sciatic nerve distribution
sciatica
Pain radiating into the ipsilateral leg is a positive straight leg test for
lumbosacral radiculopathy
Increased pain when the contralateral healthy leg is raised is a positive
crossed straight-leg raise sign
It suggests metabolic encephalopathy in patients whose mental functions are impaired. It is caused by abnormal function of the diencephalic motor centers that regulate agonist and antagonist muscle tone and maintain posture.
Asterixis
A state of impaired arousal and awareness, signals a potentially life-threatening event affecting the two hemispheres, the brainstem, or both
Coma
“Don’ts” When Assessing the Comatose Patient
● Don’t dilate the pupils, the single most important clue to the underlying cause
of coma (structural vs. metabolic).
● Don’t flex the neck if there is any question of trauma to the head or neck.
Immobilize the cervical spine and get an x-ray first to rule out fractures of the
cervical vertebrae that could compress and damage the spinal cord.
This patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases. There is minimal awareness of self or the environment.
Stupor
This patient opens the eyes, looks at you, and responds fully and appropriately to stimuli (arousal intact)
Alertness
This patient opens the eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.
Obtundation
The patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.
Lethargy
Patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Repeated painful stimuli needed.
Coma
In irritative lesions from epilepsy or a unilateral pontine lesion, the eyes ___ from the affected hemisphere.
“look away”
Pattern of movement:
The patient purposefully pushes the stimulus away or withdraws.
Normal–avoidant
Pattern of movement:
the stimulus evokes abnormal postural responses of the trunk and extremities.
Stereotypic
A flaccid arm drops ___, like a rock.
rapidly
In acute hemiplegia, the flaccid leg falls more ___.
rapidly
Reflex withdrawal of sympathetic tone and increased vagal tone causing drop in blood
pressure and heart rate but no vagal surge or drop in heart rate. Baroreflexes normal
Vasodepressor Syncope
The ability to focus or concentrate over time on a particular stimulus or activity—an inattentive person is easily distractible and may have difficulty giving a history or responding to questions.
Attention
The logic, coherence, and relevance of the patient’s thought as it leads to selected goals; how people .think
Thought processes
Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms
Judgment
The process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of information. Recent or short-term memory covers minutes, hours, or days; remote or long-term memory
refers to intervals of years.
Memory
Awareness of personal identity, place, and time; requires both memory and attention
Orientation
Awareness that symptoms or disturbed behaviors are normal or abnormal; for example, distinguishing between daydreams and hallucinations that seem real.
Insight
What the patient thinks about, including level of insight and judgment
Thought content
Sensory awareness of objects in the environment and their interrelationships (external stimuli); also refers to internal stimuli such as dreams or hallucinations.
Perceptions
A more pervasive and sustained emotion that colors the person’s perception of the world. (Affect is to mood as weather is to climate.) Mood may be euthymic (in the normal range), elevated, or dysphoric (unpleasant, possibly as sad, anxious, or
irritable), for example.
Mood
Assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions
Higher cognitive functions
A fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through tone of voice, facial expression, and demeanor. Disturbed affect may be flat, blunted, labile, or inappropriate.
Affect
A complex symbolic system for expressing, receiving, and comprehending words; as with consciousness, attention, and memory, language is essential for assessing other mental functions
Language
Characteristic Behavior Patterns
Odd or Eccentric Disorders
● Paranoid
● Schizoid
● Schizotypal
Odd or Eccentric Disorders
● Paranoid - Distrust and suspiciousness
● Schizoid - Detachment from social relations with a restricted emotional range
● Schizotypal - Eccentricities in behavior and cognitive distortions; acute discomfort
in close relationships
Characteristic Behavior Patterns
Characteristic Behavior Patterns
Dramatic, Emotional or Erratic Disorders ● Antisocial ● Borderline ● Histrionic ● Narcissistic
Dramatic, Emotional or Erratic Disorders
● Antisocial - Disregard for, and violation of, the rights of others
● Borderline - Instability in interpersonal relationships, self-image and affective regulation; impulsivity
● Histrionic - Excessive emotionality and attention seeking
● Narcissistic - Persisting grandiosity, need for admiration and lack of empathy
Characteristic Behavior Patterns
Anxious or Fearful Disorders
● Avoidant
● Dependent
● Obsessive–compulsive
Anxious or Fearful Disorders
● Avoidant - Social inhibition, feelings of inadequacy and hypersensitivity to negative
evaluation
● Dependent - Submissive and clinging behavior related to an excessive need to be
taken care of
● Obsessive–compulsive - Preoccupation with orderliness, perfectionism, and control
Two common kinds of aphasia—expressive (__) and receptive (___)
- Broca aphasia
- Wernicke aphasia
The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech
Circumstantiality
“Tangential” speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
Derailment (loosening of associations)
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected.
Flight of Ideas
Invented or distorted words, or words with new and highly idiosyncratic meanings.
Neologisms
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.
Incoherence
Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people.
Blocking
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory.
Confabulation
Persistent repetition of words or ideas.
Perseveration
Repetition of the words and phrases of others.
Echolalia
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
Clanging
