Exam 3 Neuro: Assessment of the nervous system (8 questions) Flashcards
Meninges: Dura Mater
Directly beneath the skull, consists of two layers. The outermost adheres to the skull. The inner layer extends into the cranial space.
Meninges: Arachnoid membrane
Delicate, fragile membrane that surrounds the brain. Below this is the subarachnoid space which consists of a fine web-like structure that connects to the pia mater. CSF and cerebral arteries and veins are located here.
Meninges: Pia mater
The innermost portion of the meninges, it follows all of the folds and convolutions of the brain’s surface
Cerebrum
The largest portion of the brain. It has two hemispheres which are linked by the corpus callosum which provides for the communication between the two hemispheres
Frontal lobe
Responsible for higher cognitive functions. These include:
- Voluntary eye movement
- Access to current sensory data
- Access to past information or experience
- Affective response to a situation
- Regulates behavior based on judgment and foresight
Judgment
- Ability to develop long term goals
- Reasoning, concentration, abstraction
- Motor strip for opposite side of body
Broca’s area
located in the inferior frontal gyrus is responsible for the motor aspects of speech.
Damage here will cause expressive aphasia (can’t say right words)
Parietal lobe
Understands sensation, texture, size, shape and spatial relationships
- Receives data from the skin
- Pain, heat, cold, pressure.
Sensory strip for the opposite of the body.
- Awareness of position in space.
- Processes sensory and spatial awareness
- Key component in eye-hand coordination and arm movement.
- Plays a role in our sensations of touch, smell, and taste.
Temporal lobe
- Auditory center for sound interpretation
- Vestibular sense
- Interpretative area…integrates sounds, thoughts and emotions
- memory, understanding music, aggressiveness, and sexual behavior.
Seizures - Auditory, visual and sensory hallucinations
Wernicke’s area
- Located in the temporal lobe. For speech Special senses of taste and smell.
- Damage can cause receptive aphasia (not able to receive words)
Occipital lobe
- Vision
- Visual recognition of objects
- Reading comprehension.
- Damage here will cause blindness
Limbic lobe
- regulates emotion and memory
- Is involved in the formation of long-term memory
Thalamus
called the gateway to the cerebral cortex, as nearly all sensory inputs pass through it to the higher levels of the brain
Hypothalamus
- Temperature
- Food & water intake
- Behavior
- Limbic system
- Aggressive & sexual behavior
- Sleep-wakefulness cycle
- Autonomic responses
- Parasympathetic responses
- Sympathetic responses
- Hormonal secretion of the pituitary gland
ADH - Visible physical expressions (limbic system)
Blushing, dry mouth, clammy hands
Cerebellum
- It influences muscle tone associated with equilibrium, orientation in space, locomotion, and posture.
- Takes over the learned, repetitive tasks (riding a bike), while voluntary motor activity is located in the motor cortex.
Cranial nerve I
Olfactory (smell)
Test: wave a substance under nose
Cranial nerve II
Optic (sight)
Test: Confrontation test
Cranial nerve III
Oculomotor (Moves eyelid and eyeball and adjusts the pupil and lens of the eye)
Test: PERRL, Accommodation, and Whisker test
Cranial nerve IV
Tronchlear (moves eyeballs)
Test: PERRL, Accommodation, and Whisker test
Cranial nerve V
Trigeminal (Facial muscles including chewing; Facial sensations)
Test: Palpate temporal and mandibular muscles while client clinches teeth. Have client close eyes and lightly touch them with a cotton ball on both sides of their forehead, cheeks, and chin.
Cranial nerve VI
Abducens (Moves eyeballs)
Test: PERRL, Accommodation, and Whisker test
Cranial nerve VII
Facial (Taste, tears, saliva, facial expressions)
Test: Grin, frown, show teeth, close eyes tightly and don’t allow me to open them, and raise eyebrows
Cranial nerve VIII
Vestibulocochlear (Acoustic)
Test: Whisper test
Cranial nerve IX
Glossopharyngeal (Swallowing, saliva, taste)
Test: Uvula and soft palate rise simultaneously when client says “ahhh.” Check gag reflex
Cranial nerve X
Vagus (Control of PNS e.g. smooth muscles of GI tract)
Test:Uvula and soft palate rise simultaneously when client says “ahhh.” Check gag reflex
Cranial nerve XI
Accessory (Moving head & shoulders, swallowing)
Test: Rotate head to both sides against my hand. Raise shoulders against my pressure pushing on them.
Cranial nerve XII
Hypoglossal (Tongue muscles - speech & swallowing)
Test: Stick tongue out and look for wasting or tremors. Say light, tight, dynamite and the L, T, N, and D should be clear and distinct
Neuro assessment: Level of consciousness
- Arousal
- Awareness
- Glascow coma scale
Neuro assessment: Motor function
- Spontaneous movement
- Movement response to stimulus
Verbal, tactile, noxious
Central or peripheral stimulation - Arm drift (pronator drift)
- Lateralizing
- Decorticate (up)
- Decerebrate (down/out)
- Reflexes
Normal: cough, blink, gag, swallow
Pathological - Grasp w/o release, babinski, sucking
Neuro assessment: Pupillary function & eye movement
- Pupil size & reaction to light (intracranial pressure)
- Shape (round, irregular shape, oval)
- Consensual response
- EOMs, gaze
Neuro assessment: Respiratory patterns
- Cheynes-Stokes
- Central neurogenic hyperventilation
- Apneustic
- Cluster
- Ataxic
Cheynes-stokes respiratory pattern
- Rhythmic crescendo and decrescendo of rate and depth of respiration; includes brief periods of apnea
- Usually seen with bilateral deep cerebral lesions or some cerebellar lesions
Central neurogenic hyperventilation
- Very deep, very rapid respirations with no apneic periods
- Usually seen with lesions of the midbrain and upper pons
Apneustic respiratory pattern
- Prolonged inspiratory and/or expiratory pause of 2-3 sec
- Usually seen in lesions of the lower pons or upper medulla
Cluster respiratory pattern
- Clusters of irregular, gasping respirations separated by long periods of apnea
- Usually seen in lesions of the lower pons or upper medulla
Ataxic respiratory pattern
- Irregular, random pattern of deep and shallow respirations with irregular apneic periods
- Usually seen in lesions of the medulla
Glascow coma scale (score 3-15): Eye opening
- Spontaneous eye opening: 4
- Eye opening to speech: 3
- Eye opening to pain: 2
- No eye opening: 1
Glascow coma scale (score 3-15): Verbal responses
- Oriented: 5
- Confused conversation: 4
- Inappropriate conversation: 3
- Incomprehensible speech: 2
- No speech: 1
Glascow coma scale (score 3-15): Motor responses
- Obeys commands: 6
- Localizing responses to pain: 5
- Generalizing withdrawal to pain: 4
- Flexor posturing to pain: 3
- Extensor posturing to pain: 2
- No motor response to pain: 1
Electroencephalography (EEG)
- Graphically records electrical activity of cerebral hemispheres
- Patient must be sleep-deprived before procedure
- Anticonvulsants may be withheld
Evoked Potentials
- Measure electrical signals to brain generated by hearing, touch, sight
Auditory
Visual
Somatosensory
Cerebral Blood Flow Evaluation
Particularly useful in evaluating cerebral vasospasms
Dermatome Map
Indicate level of injury by knowing where sensation is felt (T4 nipple line)
Spinal cord: Central gray matter
- Anterior horn
- Lateral horn
- Posterior horn
Spinal cord: White matter
Myelinated ascending & descending tracts
Spinal nerves: Dorsal root
- Afferent pathway in which impulses enter the cord
- Convey sensory input from specific areas of the body known as dermatomes
Spinal nerves: Ventral root
- Efferent pathway in which impulses leave
- Convey efferent impulses from the spinal cord to the body
Ascending tracts
- Sensory
- Carries information to the brain
- Three major sensory tracts
Spinothalamic
Spinocerebellar
Posterior column tract
Spinothalamic tracts
- Transmits to the thalamus and then to the cerebrum
- Opposite side of stimulus
- Anterior
crude touch, pressure - Lateral
Pain, temperature
Spinocerebellar tracts
- Transmits to the cerebellum
- Same side as stimulus
- Proprioception
Posterior column tracts
- Transmits to primary sensory cortex
- Opposite side of stimulus
- Proprioception, fine touch, pressure, vibration
Descending voluntary motor tracts
- Corticospinal
- Subconscious Motor tracts
Corticospinal tracts
- Originates in motor cortex of the frontal lobe & portions of the parietal lobe
- Conscious control of skeletal muscle
Lateral tract
Ventral tract
Subconscious Motor tracts
- Vestibularspinal tracts
- Tectospinal tracts
- Reticulospinal tracts
- Rubrospinal tract:
- Originates in the nucleus of the midbrain
- receives fibers from cerebellum and descends in the lateral and anterior funiculi
- conveys impulses to control muscle synergy and tone
Upper motor neuron syndrome
- Weakness, paralysis
- Spasticity
- Increased tendon reflexes
- Positive Babinski sign
- Loss of abdominal reflexes
- Little or no muscle atrophy
- Facilitates and inhibits descending supraspinal pathways
- Located entirely in the CNS
Lower motor neuron syndrome
- Motor weakness
- Wasting and fasciculations of muscles
- Hypotonia
- Loss of tendon reflexes
- Located in the CNS and the PNS
- Linkage between CNS and voluntary muscles
