Examination of the Sensory of Function Flashcards
Where do the sensory impulses travel through in the brain for sensory of function?
Spinothalamic tract
Posterior columns
explain the STT?
1st order neurons: pain, cold, or warm sensation (DORSAL ROOT GANGLION)
2nd order neurons: decussate via ventral commissure
3rd order neuron: Thalamic relay nuclei
what does the SST convey?
pain, temperature, crude & light touch
what parts of the brain is the SST clinically relevant to?
peripheral neuropathy
ridiculopathy
spinal cord
cerebral cortex - parietal lobe
explain the dorsal column-medial lemniscal pathway?
1st order neurons: DRG -> ipsilateral medulla
2nd order: medulla (decussate to CL side)
3rd order: Ventral Posterior lateral thalamus –> Primary somatosensory cortex
what does the DCLM convey?
2-point discirmunation
position (proprioception)
vibration
fine touch
where is the DCLM clinically relevant?
tabes dorsalis
posterior cord syndrome
subacute degeneration of the spinal cord
brown-squared syndrome
untreated syphilis can result to weakness or slow degeneration of dorsal columns & roots to?
Tabes dorsalis
What DCLM abnormality is caused by vit B12 def ?
subacute combined degeneration of the spinal cord
what peripheral nerve fiber type has touch & vibration sense? what are equipments used during test of these?
A & Beta
Touch = fingers, piece of cotton wool or soft brush
Vibration = tuning fork (128Hz)
What peripheral nerve fiber type has sensation of pinrpick, sharp pain, & cold?
A & Delta
Pinprick, sharp pain = Wooden cocktail sticks
Cold = cold object
What peripheral nerve fiber type has sensation of warmth? equipment used for this test?
C = warmth
Warmth = warm object (42)
what are the necessary body parts to evaluate for examination of sensory function?
dorsum of hands & feet
laeral aspect of upper thighs
inner aspect of upper arms
what are abnormal symptoms seen in assessing sensory function?
pain
numbness
tingling sensation
what are the important dermatomes from cervical to S1?
C3 = front of neck
T4 = nipples
T10 = umbilicus
C6= thumb
C7 = middle finger
C8 = little finger
T1 = posterior arm
L1 = inguinal
L3/L4 = knee
L5 = =big toe
S1 = pinky toe, posterior aspect of leg & thigh
what pattern of sensory loss has it lost throughout the opposite side of the face, arm, & legs?
Thalamic lesion - central from the thalamus up
What pattern of sensory loss has CL sensory loss below face & IL loss on the face?
Brainstem lesion
What pattern of sensory loss has asymmetrical & dissociation like pain, temp loss but light touch is intact?
Central cord lesion
What pattern of sensory losss is a Brown-Sequard syndrome where there is CL pain & temp loss, IL weakness & DC loss below lesion, UMN?
Hemisection of cord or unilateral cord lesion
What pattern of sensory loss has loss of modalities below lesion where spinal cord is transected?
transverse cord lesion
What pattern of sensory lass has demyelination, loss of proprioception, vibration & light touch?
isolated dorsal column lesion
what pattern of sensory loss has cervical root compression, shingles (T5), lumbar root compression (L4) peripherally?
Individual sensory root lesions
what pattern of sensory loss has distal, symmetric polyneuropathy where multiple nerves are affected?
Typical glove & stocking distribution
What are other sensory losses of Typical glove & stocking distribution?
- Wullerian degeeneration = nerve gets damaged from tip of toes bilaterally to up and back to the root
- peropheral nerve problem
- metabolic & systemic problems
what is the presentation of Brown Sequard syndrome?
ST & DCML on the same side but presents CL
what type of nerve pattern loss has median nerve innervating the first 3 1/2 fingers on the palmar aspect but the dorsal aspect is only the giners?
Focal neuropathy
what are other clin features of focal neuropathy?
ulnar nerve innervates the PINKy side
Radial nerve involves 3 1/2 aspects on the dorsal hand
what is the order of asssessment for sensory loss?
Superficial (exteroceptive) sensation
Proprioceptive (deep) sensation
Combined cortical sensations
what are the diff superficial sensations?
pain perception
temperature awareness
touch awareness
pressure perception
what are the diff deep sensations?
Kinesthesia awareness (proprioception)
Vibration proprioception
what are the diff combined cortical sensation?
stereogenesis perception
tactile localization
two-point distribution
double simultaneous stimulation
graphesthesia
recognition of texture
barognosis
what are the 3 superficial sensations?
light touch sensation
temperature
pain
in what conditions do you see abnormal findings of light touch sensation?
diabetes
folic acid def
alcoholism
in what conditions do you see abnormal findings of pain sensation?
analgesia
hypoalgesia
hyperalgesia
when do you test for temperature sensation?
when pain sensation is abnormal
what are the 2 types of deep sensation?
vibration
position/kinesthesia
what neuro pathway is observed in vibration?
Dorsal column pathway
in px with length dependent polyneuropathies & glove & stocking distribution, what is the first site to be affected?
distal sites -> toes
what if position sense is intact distally, what does it mean?
proximal position sense is also intact
can px with severe dorsal column problems detect kinesthesia?
no
what are the main features of gait of sensory ataxia?
“stamp & stick”
var degrees of difficult standing & walking
intact muscular power (motor strength)
no dizziness
+ Romberg sign
loss of position sense & vibratory sense of both lower extremities
what are interprative sensory functions that require analysis of indiv sensory modalities by parietal lobes?
cortical sensation
what are the diff cortical sensations tested?
Stereognosis - identify obejcts by feel
Graphesthesia = number identificaiton
2 point discrimination = paper clips
Sensory attention = perceive 2 simultaneous sensory stimuli
what are the diff typical patterns in charting?
Thalamic lesion or higher = half of whole body
spinal cord lesion = half of upper/lower body
peripheral nervous system = peripheries (hands & legs)
