Exam & Neurolocalization

Question 1

Components of the neuro exam

Answer 1

1. Mentation
2. Gait and posture
3. Cranial nerves
4. Postural reactions
5. Segmental reflexes
6. Palpation and ROM

Question 2

Characteristics of cerebellar ataxia

Answer 2

Wide-based stance
Hypermetria
Truncal sway
NO weakness

Question 3

Characteristics of vestibular ataxia

Answer 3

Wide-based stance
Leaning
Listing
“Drunken sailor”

Question 4

Characteristics of proprioceptive ataxia

Answer 4

Lack of coordination with lack of awareness and paresis

Question 5

Decerebrate posture

Answer 5

Comatose

Rigid extension in all limbs

Question 6

Decerebellate posture

Answer 6

Extended TL’s
Flexed PLs
Mentally appropriate

Question 7

Schiff-Sherrington posture

Answer 7

Extended TL’s
Limp PLs

Severe, acute T3-l3 lesion, not prognostic

Question 8

CNs: menace

Answer 8

Afferent: CN II
Efferent: CN VII

Question 9

CNs: PLR

Answer 9

Afferent: CN II
Efferent: PS CN III

Question 10

CNs: Palpebral

Answer 10

Medial canthus:
Afferent: V (ophth)
Efferent: VII

Lateral canthus:
Afferent V (Max)
Efferent: VII

Question 11

CNs: facial symmetry

Answer 11

CN VII

Question 12

CNs: physiologic nystagmus

Answer 12

Afferent: CN VIII
Efferent: CN III, IV, VI

Question 13

How are CN III, IV, and VI connected to CN VII?

Answer 13

MLF

Question 14

CNs: gag

Answer 14

Afferent: CN IX, X
Efferent: IX

Question 15

CNs: tongue function

Answer 15

CN XII

Question 16

Spinal region of cutaneous trunci

Answer 16

C8-T1

Question 17

Clinical signs localized to brain only

Answer 17

Behavior changes
CN deficits
Seizures

Question 18

Clinical signs definitely not brain lesion

Answer 18

Segmental reflex deficits

Question 19

Clinical signs with forebrain lesion

Answer 19

Seizures
Circling
Compulsive
Behavior changes
Non-ocular blindness (amaurosis)
Postural reaction deficits

Question 20

Clinical signs with cerebellar lesion

Answer 20

Head tilt
Nystagmus
Loss of menace
Intention tremors
Truncal sway
Ataxia
Hypermetria

NO WEAKNESS

Question 21

Clinical signs with brainstem lesion

Answer 21

Decreased mentation (ARAS)
CN III-XII deficits
Usually some CN VIII involvement
Vestibular or proprioceptive ataxia

Question 22

How can you differentiate central vs peripheral vestibular dz?

Answer 22

Central - hypermetria, CP deficits, paresis, mentation change

Peripheral- head tilt, nystagmus

Question 23

What should you always ask owner when eval patient for vestibular dz?

Answer 23

Metronidazole use

Question 24

What do postural reactions and segmental reflexes tell you with a myelopathy?

Answer 24

Postural reactions: if there is a lesion

Segmental reflexes: where it is

Question 25

Reflexes and postural reactions with C1-C5 lesion

Answer 25

TL and PL postural reaction: dec to absent

TL and PL reflex: N to inc

Question 26

Reflexes and postural reactions with C6-T2 lesion

Answer 26

TL postural reactions: N to dec to absent
TL reflexes: dec to absent
PL postural reaction: dec to absent
PL reflexes: N to inc

Question 27

Reflexes and postural reactions with T3-l3 lesion

Answer 27

TL postural reaction: N
TL reflexes: N
PL postural reaction: dec to absent
PL reflexes: N to inc

Question 28

Postural reaction and reflexes with L4-S3 lesio

Answer 28

TL Postural reactions and reflexes: N

PL: N to dec

Question 29

UMN lesion results in

Answer 29

Extended, difficult to flex limb

Question 30

LMN lesion results in

Answer 30

Flaccid, unable to support any weight

Question 31

Face-planting, tetraparesis, reflexes N to inc x 4

Answer 31

C1-C5

Question 32

Two engine gait

Answer 32

C6-T2

Question 33

Kyphosis, inc PL tone, schiff-sherrington

Answer 33

T3-L3

Question 34

Spinal shock

Answer 34

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

Question 35

Dec PL tone, incontinence

Answer 35

T4-S3