Exam & Neurolocalization Flashcards
Components of the neuro exam
- Mentation
- Gait and posture
- Cranial nerves
- Postural reactions
- Segmental reflexes
- Palpation and ROM
Characteristics of cerebellar ataxia
Wide-based stance
Hypermetria
Truncal sway
NO weakness
Characteristics of vestibular ataxia
Wide-based stance
Leaning
Listing
“Drunken sailor”
Characteristics of proprioceptive ataxia
Lack of coordination with lack of awareness and paresis
Decerebrate posture
Comatose
Rigid extension in all limbs
Decerebellate posture
Extended TL’s
Flexed PLs
Mentally appropriate
Schiff-Sherrington posture
Extended TL’s
Limp PLs
Severe, acute T3-l3 lesion, not prognostic
CNs: menace
Afferent: CN II
Efferent: CN VII
CNs: PLR
Afferent: CN II
Efferent: PS CN III
CNs: Palpebral
Medial canthus:
Afferent: V (ophth)
Efferent: VII
Lateral canthus:
Afferent V (Max)
Efferent: VII
CNs: facial symmetry
CN VII
CNs: physiologic nystagmus
Afferent: CN VIII
Efferent: CN III, IV, VI
How are CN III, IV, and VI connected to CN VII?
MLF
CNs: gag
Afferent: CN IX, X
Efferent: IX
CNs: tongue function
CN XII
Spinal region of cutaneous trunci
C8-T1
Clinical signs localized to brain only
Behavior changes
CN deficits
Seizures
Clinical signs definitely not brain lesion
Segmental reflex deficits
Clinical signs with forebrain lesion
Seizures Circling Compulsive Behavior changes Non-ocular blindness (amaurosis) Postural reaction deficits
Clinical signs with cerebellar lesion
Head tilt Nystagmus Loss of menace Intention tremors Truncal sway Ataxia Hypermetria
NO WEAKNESS
Clinical signs with brainstem lesion
Decreased mentation (ARAS)
CN III-XII deficits
Usually some CN VIII involvement
Vestibular or proprioceptive ataxia
How can you differentiate central vs peripheral vestibular dz?
Central - hypermetria, CP deficits, paresis, mentation change
Peripheral- head tilt, nystagmus
What should you always ask owner when eval patient for vestibular dz?
Metronidazole use
What do postural reactions and segmental reflexes tell you with a myelopathy?
Postural reactions: if there is a lesion
Segmental reflexes: where it is
Reflexes and postural reactions with C1-C5 lesion
TL and PL postural reaction: dec to absent
TL and PL reflex: N to inc
Reflexes and postural reactions with C6-T2 lesion
TL postural reactions: N to dec to absent
TL reflexes: dec to absent
PL postural reaction: dec to absent
PL reflexes: N to inc
Reflexes and postural reactions with T3-l3 lesion
TL postural reaction: N
TL reflexes: N
PL postural reaction: dec to absent
PL reflexes: N to inc
Postural reaction and reflexes with L4-S3 lesio
TL Postural reactions and reflexes: N
PL: N to dec
UMN lesion results in
Extended, difficult to flex limb
LMN lesion results in
Flaccid, unable to support any weight
Face-planting, tetraparesis, reflexes N to inc x 4
C1-C5
Two engine gait
C6-T2
Kyphosis, inc PL tone, schiff-sherrington
T3-L3
Spinal shock
Physiologic or anatomic transection of spinal cord results in temporary loss or depression of all/most muscle tone or spinal reflex activity below level of injury
Not prognostic
Dec PL tone, incontinence
T4-S3
