Cranial Nerves Flashcards
If you have a lesion in the right optic nerve what loss would you expect?
Blindness in right eye
If you have a lesion in the optic chiasm what would you expect the loss to be?
Heteronymous bitemporal hemianopia
Tunnel vision/loss of peripheral vision
If you have a lesion in the RIGHT optic tract what loss would you expect?
Homonymous contralateral hemianopia
LEFT vision field loss of both eyes
If you had a lesion in the left geniculocalcarine tract what loss would you expect?
Homonymous contralateral hemianopia with macula sparing
RIGHT visual field loss of both eyes with macula not lost
Exams that test CN 2?
- visual acuity
- gross visual field test (AKA: peripheral vision/confrontation)
- pupillary light reflex
- swinging flashlight test
- ophthalmoscopic exam
For the gross visual field test/peripheral vision/confrontation what are the directions and angles that patient should see object?
50- superior
60- nasal
70 - inferior
90- lateral
When doing pupillary light reflex and shining light in right eye what cranial nerves in each eye are being tested?
Right: CN. 2 & 3
Left: CN 3
What does the swinging flashlight test for?
Unilateral disease of afferent CN 2 (on side that causes both pupils to dilate)
(Marcus-Gunn pupils)
What condition areMarcus-Gunn pupils seen in?
Optic neuritis
What is Scotoma?
A patch of vision loss
What is the likely description of pain coming from the joint?
Sharp on motion
Constant
What is the likely descriptor of pain from the nerve
Constant Burning/hot Sharp on no motion Stabbing Tingling/numbness
What is the description of pain with bone/ligament
Deep burning, dull pain
Description of pain from myofascial pain
Pinpoint pain over paraspinal tissue
Crawling sensation
Vascular pain description
Throbbing
Peripheral pain description
Well localized
Central pain description
Diffuse
5 relative contraindications
- Articulate hyper mobility /uncertain stability of joint
- Severe demineralization
- Benign bone tumors (spine)
- Bleeding disorders and anticoagulant therapy
- Radiculopathy with progressive neurological signs
What is an absolute contraindication for cervical spinal manipulations
Vertebrobasilar insufficiency syndrome
Area of pain with facet irritation of c2/3
Right lateral and posterior neck
Area of pain in facet irritation pattern of c3/4
Left lateral and posterior neck to base of shoulder
Area of pain in irritation of facets at c4/5
Right lateral and posterior bottom of neck and mid shoulder
Area of pain in facet irritation of c5/6
Left posterior shoulder and above scapula
Area of pain in irritation of facets c6/7
Right posterior shoulder and mid scapular region
Order of diagnostic procedure
Obtain patient history
Develop working hypothesis
Select tests to confirm or refute hypothesis
Sensitivity
Proportion of those with a positive test that will have the condition
SnNOut
What does a positive test in regards to sensativity mean
SnNout
Positive result: may have condition—may not
High sensitivity, a negative test rules out the condition
Negative test-sensativity
SnNout
Highly sensitive—negative test rules condidtion out
Specificity
Proportion of patients with a negative test that do not have the condition
Positive test-specificity
SpPIn
Highly specific-positive has condition
Negative test-specificity
Negative-still might have the condidtion
Highly sensitive meaning
Will catch all of the people who has the condition, but will catch people who don’t have the condition
Highly specific meaning
All the positive tests are for sure positive, but might not catch all the people who have the condition
Interpreting likelihood ratios:
>10
Large, conclusive shift
Negative likelihood ratio of X
Large conclusive shift
Likelihood ratio of 1-2
Small, not important
Test clusters
Each test individually may have a lower LR but when multiple tests for same result combined, LR increases
What is myelopathy
Spinal cord pathology
Initial evaluation for strain/rupture
Active resistance
Initial evaluation for tendinitis/tendonosis
Stretch and contraction
Initial evaluation for tendon rupture
Lack of passive tension
Initial test for sprain or rupture (ligament)
Stability testing
Initial evaluation for synovitis
Capsular pattern of restriction
