Cortical and Pediatric Exam (2) Flashcards
What are key principles of neurodevelopment
development of motor control proceeds in head to toe fashion, primitive reflexes normally present in term infant, diminish over 4-6 months, postural reflexes emerge at 3 to 8 months of age
What is the hallmark of an upper motor neuron abnormality in the infant
Persistence of primitive reflexes and the lack of development of the postural reflexes
What are the steps of the pediatric neuroexam?
1)stop, look, and listen; 2) hands-on part, further clarifies initial observations (game, non-threatening) 3) save all the threatening parts of examination until last
How is somatic growth examined and used in the pediatric exam?
measure height and weight and compare percentiles with head circumference
Why do we look for dysmorphic facial features in the pediatric exam?
anomalies of the midface are often associated with underlying brain malformations
Where and why is the head circumference measured?
largest from frontal to occipital; proportional to brain size, 80% of size by 2
What and why do we do an abdominal exam in the pediatric neuro exam?
palpate for visceromegaly which can indicate the presence of one of the
storage diseases
What are you looking for in the spine in pediatric exam?
look for scoliosis and any sacral anomalies
What is completed by 28 days of gestation?
Formation of the neural tube
What occurs 2 to 4 months gestation neuronally?
neuronal proliferation
What occurs 3 to 5 months gestation neuronally?
neuronal migration
What is responsible for most of the brain’s growth?
Growth of the individual neurons plus elaboration and proliferation of
dendritic and axonal processes and connections (increasing dendritic arborization, synaptogenesis, and axonal connections,)
How much bigger does a neuroblast get by maturity?
5-50 microns, 1000x
When does myelination start? Most rapid period? What parallels the time course and pattern?
3rd trimester, first two years of life, acquisition of neurodevelopmental milestones
Myelination occurs early for what structures? Why?
motor-sensory roots, special senses and the
brainstem; necessary for reflex behavior and survival
The corticospinal tract starts to myelinate when? complete when?
36 wks gestation, by second year of life, trunk and upper extremity to lower extremity, correlates to milestones
The areas of the cerebral hemispheres that are first to myelinate are what?
posterior portion of the frontal lobes, the parietal lobes and areas of the occipital lobes; followed by frontal and temproal
By the end of the second year, myelination of the cerebrum is what? What still needs myelination?
largely completed; interconnections of the association cortex are still being
myelinated into 2nd and 3rd decades of life
What primitive reflexes are tested in the pediatric exam?
suck, root, moro, gallant (trunk incurvation), grasp, and ATNR
What postural reflexes are tested in the pediatric exam?
positive support reflex, landau, lateral propping, and parachute
Independent walking is achieved between what ages? An infan is delayed when?
11-15 months; aren’t walking by 16 months
What are the charcteristics of the toddler’s gait?
wide-based, unsteady, Arms held at near shoulder level- high guard position, probably aids in balance
What cortical area is responsible for Attention?
dorsolateral frontal lobe/anterior cingulate gyrus
What cortical area is responsible for awareness?
Sensation-primary cortex, Perception- association cortex
What cortical area is responsible for motivation?
Executive-frontal lobe, Affective- amygdala,
hypothalamus, medial frontal lobes
What cortical area is responsible for memory?
hippocampus/limbic
What is orbitofrontal lobe function?
Personality, social judgment
What brodman’s areas correspond with Wernicke’s?
41,42
What brodman’s areas correspond with Broca’s?
44 and 45
How is the dorsolateral frontal lobe assessed?
conceptualization- similarities, working memory- digit span, spelling words backwards
What is the function of the frontal lobe?
executive function, judgment, volition and working memory
How is the Medial-frontal lobe assessed?
mental flexibility and verbal fluency set
generation (names as many words as you can in minute that begin with the letter “s”)
What is Korsakoff’s psychosis?
antegrade and retrograde memory loss. Patient makes up answers to questions (confabulates). thiamine deficiency. Mamillary bodies/dorsal medial nucleus of the thalamus most effected.
Which area of the hippocampus proper is most affected by seizure, ischema and pathological insult?
CA1
What are the symptoms of an uncinated fit?
unpleasant odor spell, dream like state seing and hearing memories
What is the connection betwenn Broca’s and Wernike’s? Where is it?
arcuate fasciculus, extreme capsule
What are the symptoms of Receptive (Wernicke) aphasia?
cannot comprehend, fluent, nonsense, jargon, anomia
What are the symptoms of Expressive (Broca) aphasia?
can comprehend, nonfluent, agrammatic,
What are the symptoms of global aphasia?
receptive and expressive deficits
What are the symtpoms of conduction aphasia?
can’t repeat
Where is the word association area?
parietotemporal cortex
What area is involved in speech initiation and categorization?
supplementary motor and prefrontal cortex
What speech/language functions are impaired in global aphasia?
speech, naming, sentence production (absent), word & sentence comprehension, repetition
What speech/language functions are impaired in conduction aphasia?
speech fluent but paraphrasic, naming and sentence structure paraphrasic, sentence comprehension variable, repetition
What speech/language functions are impaired in Broca’s aphasia?
nonfluent speech, impaired naming, agramtic sentence production, word and sentence comprehension, repetition
What speech/language functions are impaired in Wernicke’s aphasia?
naming, sentence production structured but empty, word and sentence comprehension, repetition
What are the motor aspects of speech?
respiration, phonation, resonance, articulation, prosody
What is responsible for phonation?
vocal cords
What is responsible for resonance?
shape of oral cavity
What is responsible for articulation?
lips, tongue, teeth, oral movements- consonant sounds
What is Prosody?
rate, phrasing, inflection, emotional content
What is spastic speech? Lesion where?
low pitch, harsh, strained,slow rate-UNM
What is Flaccid speech? Lesion where?
hypernasality, soft, muffled, breathy, imprecise articulation- LMN
What is ataxic speech? Lesion where?
scanning, slow, indistinct, cerebellar
What is agnosia?
failure to recognize familiar objects
perceived by sensory stimuli
What is apraxia?
inability to perform purposeful motor
acts on command
What is constructional apraxia?
inablity to draw objects which require use of visual spatial organization
What is Autopagnosia?
inabiltiy to recognize body parts
What is Anosognosia?
unawareness or denial of dysfunction
What is Gerstmann Syndrome?
Dysfunction of the dominant inferior parietal lobe: Acalculia, Finger agnosia, Agraphia, and Right-left confusion
What is achromatopsia?
inability to distinguish colors
What is visual agnosia?
inability to visually identify an object
What is Prosopagnosia?
inability to identify familiar faces
