Exam 4: Neuro Flashcards
How to assess in infant:
CN XI
Spinal Accessory
- Observe symmetry of shoulders
Which gender has a lower age-specific stroke incidence rate but higher lifetime risk for stroke?
Women
(b/c live longer then men)
The Biceps Reflex:
What spinal nerve roots are involved?
How do you test?
What is a normal reaction?
C5, C6
- The pt’s elbow should be partially flexed and the forearm pronated with palm down.
- Place your thumb/finger firmly on the biceps tendon.
- Aim the strike with the reflex hammer directly through your digit toward the biceps tendon.
Observe flexion at the elbow, and watch for and feel the contraction of the biceps muscle.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/115/932/a_image_thumb.png?1602802307)
How to assess in infant:
CN XII
Hypoglossal
- Observe coordination of sucking, swallowing, and tongue thrusting
- Pinch nostrils; observe reflex opening of mouth w/ tip of tongue to midline.
The Anal Reflex
What spinal nerve roots are involved?
How do you test?
What is a normal reaction?
What does abnormal indicate?
S2-4
- Using a broken applicator stick or pinprick, lightly scratch the anus on both sides.
- Watch for reflex contraction of the external anal sphincter by placing a gloved finger in the anus during testing.
Loss of the anal reflex suggests a lesion in the S2–3–4 reflex arc, seen in cauda equina lesions.
How do you test neck Brudzinski Sign?
What do positive results indicate?
As you flex the neck, watch the hips and knees in reaction to your maneuver. Normally they should remain relaxed and motionless.
+ test: Flexion of both the hips and knees.
Suggests meningeal inflammation from meningitis or subarachnoid hemorrhage.
Cranial Nerve IX
What is the name?
How to perform test?
Abnormal finding indicates
Glossopharyngeal
- Listen to voice (hoarse, nasal?)
- Difficulty swallowing?
- Pt say “ah”- observe mvmt of soft palate/pharynx.
- Gag reflex
Hoarseness-vocal cord paralysis
Dysphagia-pharyngeal or palatal weakness
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/121/656/a_image_thumb.png?1602911898)
What are the corresponding clinical finding(s) to a stroke in the Subcortical circulationa— lenticulostriate deep penetrating branches of MCA
Contralateral motor or sensory deficit without cortical signs
Occlusion of the middle cerebral artery (MCA) has what clinical finding?
- Visual field cuts
- Contralateral hemiparesis
- Sensory deficits
The Brachioradialis Reflex
What spinal nerve roots are involved?
How do you test?
What is a normal reaction?
C5, C6
- The pt’s hand should rest on the abdomen or the lap, with the forearm partly pronated.
- Strike the radius with the point or flat edge of the reflex hammer, about 1-2in. above the wrist.
Watch for flexion and supination of the forearm.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/116/898/a_image_thumb.png?1602802837)
How to assess sensory function in the infant?
What would abnormal findings indicate?
- Test for pain sensation by flicking the infant’s palm or sole with your finger.
- Observe for withdrawal, arousal, and change in facial expression.
If changes in facial expression or cry follow a painful stimulus but no withdrawal occurs, weakness or paralysis may be present.
How to assess in infant:
CN II
Visual acuity
Have infant regard your face & look for facial response & tracking.
How to assess in infant:
CN II, III
Response to light
- Darken room, raise infant to sitting position to open eyes.
- Use light & test for optic blink reflex (blink in response to light).
- Use the otoscope’s light (w/o speculum) to assess pupillary responses.
Positive Support Reflex
What age?
How to assess?
What would abnormal findings indicate?
Birth or 2 mo until 6 mo
- Hold infant around the trunk & lower until feet touch flat surface.
- The hips, knees, & ankles will extend, the infant will stand up, partially bearing weight, sagging after 20-30 seconds.
Lack of reflex suggests hypotonia or flaccidity.
Fixed extension & adduction of legs (scissoring) suggests spasticity from neurologic disease (CP).
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/221/528/a_image_thumb.png?1602906254)
How is muscle strength graded?
0 —No muscular contraction detected
1 —A barely detectable flicker or trace of contraction
2 —Active movement of the body part w/ gravity eliminated
3 —Active movement against gravity
4 —Active movement against gravity and some resistance
5 — Active movement against full resistance w/o evident fatigue (normal muscle strength)
Cranial Nerve X
What is the name?
How to perform test?
Vagus
- Listen to voice (hoarse, nasal?)
- Difficulty swallowing?
- Pt say “ah”- observe mvmt of soft palate/pharynx.
- Gag reflex
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/121/725/a_image_thumb.png?1602912172)
The Abdominal Reflexes
How do you test?
What is a normal reaction?
- Lightly but briskly stroke each side of the abdomen, above (T8, T9, T10) and below (T10, T11, T12) the umbilicus towards the center.
- Use a key, the wooden end of a cottontipped applicator, or a tongue blade twisted and split longitudinally.
- If obese or previous abd surgery, retract pt’s umbilicus away from the side being tested with your finger and feel for the muscular contraction.
Note the contraction of the abdominal muscles and movement of the umbilicus toward the stimulus.
Abdominal reflexes may be absent in both central and peripheral nerve disorders.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/118/945/a_image_thumb.png?1602804384)
What are some common or concerning symptoms that the FNP should assess for as part of the neurological history?
- Headache
- Dizziness or vertigo
- Weakness (generalized, proximal, or distal)
- Numbness, abnormal or absent sensation
- Fainting and blacking out (near syncope and syncope)
- Seizures
- Tremors or involuntary movements
Cranial Nerve I
What is the name?
How to perform test?
Abnormal finding indicates
Olfactory
- Present pt w/ familiar non-irritating odors (cloves, coffee, soap, vanilla)
- Compress 1 side of nose & sniff thru other
- Close both eyes, occlude 1 nostril & test smell in other w/ substance.
- Repeat on the other side.
Loss of smell occurs in sinus conditions, head trauma, smoking, aging, use of cocaine, and Parkinson disease.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/120/645/a_image_thumb.png?1602909352)
Asymmetric Tonic Neck Reflex
What age?
How to assess?
What would abnormal findings indicate?
Birth to 2 mo
- With the infant supine, turn head to one side, holding jaw over shoulder.
- The arms/legs on side to which head is turned will extend while the opposite arm/leg will flex.
- Repeat on other side.
Persistence > 2 mo suggests asymmetric CNS development & sometimes predicts development of CP.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/220/045/a_image_thumb.png?1602902730)
How do you test Stereognosis? What could abnormal findings indicate?
- The ability to identify an object by feeling it.
- Place a familiar object (coin, paper clip, key) in pt’s hand and ask the patient to tell you what it is.
- Normally a patient will manipulate it skillfully and identify it correctly w/in 5 sec.
- Astereognosis refers to the inability to recognize objects placed in the hand.
Parachute Reflex
What age?
How to assess?
What would abnormal findings indicate?
8 mo & does not disappear
- Suspend infant prone & slowly lower head toward a surface.
- The arms & legs will extend in a protective fashion.
Delay in appearance may predict future delays in voluntary motor development.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/221/453/a_image_thumb.png?1602906140)
What are the five categories of the neurological exam?
1. Mental status
2. CNs I-XII
3. Motor system: muscle bulk, tone, strength, coordination, gait, stance
4. Sensory system: pain, temperature, position, vibration, light touch, discriminative sensation
5. Deep tendon, abdominal, plantar reflexes
Rooting Reflex
What age?
How to assess?
What would abnormal findings indicate?
Birth to 3-4 mo
- Stroke the perioral skin at the corners of the mouth.
- The mouth will open & the infant will turn head toward the stimulated side & suck.
Absence of rooting indicates severe generalized or CNS disease.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/219/973/a_image_thumb.png?1602902495)
Moro Reflex (Startle Reflex)
What age?
How to assess?
What would abnormal findings indicate?
Birth to 4 mo
- Hold the infant supine, supporting the head, back, & legs.
- Abruptly lower the entire body about 2 ft.
- The arms will abduct & extend, hands will open, & legs will flex. Infant may cry.
Persistence > 4 mo suggests neurologic disease (e.g., CP); > 6 mo strongly suggests it.
Asymmetric response suggests fracture of clavicle or humerus or brachial plexus injury.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/219/994/a_image_thumb.png?1602902638)
What presents with severe headache and stiff neck?
Meningitis
Cranial Nerve XII
What is the name?
How to perform test?
Abnormal finding indicates
Hypoglossal
Tongue symmetry, position, & movement
- Listen to word articulation
- Inspect tongue lying on floor of mouth (atrophy, fasciculations)
- Protrude tongue (asymmetry, atrophy, deviation from midline?)
- Tongue side to side (symmetry of mvmt)
Tongue atrophy and fasciculations are present in ALS and past polio.
In a unilateral cortical lesion, the protruded tongue deviates away from the side of the cortical lesion. In CN XII lesions, the tongue deviates to the weak side.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/121/894/a_image_thumb.png?1602912554)
The Achilles (Ankle) Reflex
What spinal nerve roots are involved?
How do you test?
What is a normal reaction?
Primarily S1
- If pt is sitting: partially dorsiflex the foot at the ankle. Patient relax. Strike the Achilles tendon.
- If pt is lying down: flex 1 leg at both hip and knee and rotate it externally so that the lower leg rests across the opposite shin. Then dorsiflex the foot at the ankle and strike the Achilles tendon.
Watch and feel for plantar flexion at the ankle and note the speed of relaxation after muscular contraction.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/117/149/a_image_thumb.png?1602803355)
What exam findings would be present in the newborn that has been exposed to maternal substance abuse or the infant experiencing neonatal abstinence syndrome?
Subtle neonatal behaviors may indicate withdrawal from nicotine if the mother smoked during pregnancy such as:
- fine tremors
- persistent irritability
- poor self-regulation
What are Resting (Static) Tremors? Give example.
Are most prominent at rest and may decrease/disappear w/ voluntary movement.
Common relatively slow, fine pill-rolling tremor of parkinsonism, about 5/second.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/113/127/a_image_thumb.png?1602800466)
What are stroke risk factors for women?
- Autoimmune collagen vascular disease
- History of preeclampsia
- Gestational diabetes
- Pregnancy-induced HTN
How do you test neck Kernig Sign?
What do positive results indicate?
- Flex the pt’s leg at both the hip and the knee
- Then slowly extend the leg and straighten the knee.
Discomfort behind the knee during full extension is normal but should not produce pain.
+ test: Pain and increased resistance to knee extension.
Suggests meningeal inflammation from meningitis or subarachnoid hemorrhage.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/122/756/a_image_thumb.png?1602808277)
The Plantar Response
What spinal nerve roots are involved?
How do you test?
What is a normal reaction?
What does abnormal indicate?
L5, S1
- With a key or the wooden end of an applicator stick, stroke the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball.
- Closely observe movement of the big toe, normally plantar flexion.
- Some pts withdraw from this stimulus by flexing the hip and the knee.
Dorsiflexion of the big toe is a positive Babinski response, arising from a CNS lesion affecting the corticospinal tract. The Babinski response can be transiently positive in unconscious states from drug or alcohol intoxication and during the postictal period following a seizure.
A marked Babinski response is occasionally accompanied by reflex flexion at hip and knee.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/324/119/133/a_image_thumb.png?1602804810)
What presents as dull headache increased by coughing and sneezing, especially when recurring in the same location
Mass lesions (brain tumors, abscess)
Individuals with TIA have a 1-year mortality of ___%.
10-year risks for stroke from cardiovascular disease are ___%.
10-year risks for death from cardiovascular disease are ___%.
1 year: ∼12%
10 year stroke: 19%
10 year death: 43%