ICL 1.0: The Language of Neurology & Neurologic Exam Flashcards
what are the parts of the body you’re testing during a neurologic exam?
- Mental Status
- Cranial Nerves
- Motor system
- Reflexes
- Sensory system
- Gait and Co-ordination
what is localization?
“the determination of a site or place for any process or lesion”
what are the components for a mental status exam?
Evaluation of higher integrative functions including:
1. level of alertness
- orientation to time, place, person and situation
- recent and remote memory
- attention span and concentration
- language (e.g., naming objects, repeating phrases, spontaneous speech) and speech
- fund of knowledge (e.g., awareness of current events, past history, vocabulary)
what is the difference between speech and language?
language is making sense
speech is making coherent sense when you talk
what is the ascending reticular activating system?
it goes through a bunch of structures of the brain = hypothalamus, thalamus, pons, medulla, midbrain
it’s responsible for keeping us awake and alert so if you have a problem with it, then you’ll have drowsiness or coma
there might be a lesion of the brainstem or the thalamus that’s causing this decreased awareness!
if someone has decreased alertness, what is the localization of the lesion?
- brainstem (bilateral)
- thalamus (bilateral)
- cerebral hemisphere (Bilateral)
- diffuse cortical dysfunction
what are the types of aphasia?
- Broca’s/Motor
- Wernicke’s/Sensory
- Global aphasia
- Conduction aphasia
what is Broca’s/motor aphasia?
impaired fluency, repetition, naming, writing
inferior frontal gyrus lesion
what is Wernicke’s/sensory aphasia?
impaired comprehension, repetition, naming, reading, writing
superior temporal gyrus lesion
what is global aphasia?
a lesion so big it effects both broca’s and wernicke’s areas
what is conduction aphasia?
impaired repetition
arcuate fasciculus lesion aka the fibers connecting the two is effected
what is the function of the 2nd cranial nerve?
visual acuity, visual fields, fundi
what is the function of the 3rd, 4th and 6th cranial nerves?
pupils, eye movements
what is the function of the 5th cranial nerve?
facial sensation, corneal reflexes
what is the function of the 7th cranial nerve?
facial symmetry, strength
what is the function of the 8th cranial nerve?
hearing with tuning fork, whispered voice and/or finger rub
what is the function of the 9th and 10th cranial nerve?
spontaneous or reflex palate movement
what is the function of the 11th cranial nerve?
shoulder shrug strength
what is the function of the 12th cranial nerve?
tongue protrusion
what is decerebrate posture?
arms and legs are extended
it’s caused by upper pontine damage
this is worse than decorticate posture because pons and medulla are effected which control the heart rate and respiration
what is decorticate posture?
the arms are flexed while the legs are extended
it’s due to upper midbrain damage; pos and medulla are spared which is good!
what is the caloric reflex?
the pupillary light response
helps you decide where the lesion is that’s causing the coma
what things do you assess in the motor system?
- muscle bulk
- fasciculations of the tongue
- muscle tone
- muscle strengths
- abnormal movements, such as tremor, chorea, athetosis, ballism, dystonia, tics etc.
in what disease do you get tongue fasciculations?
ALS
due to lower motor neuron damage
what could be causing muscle weakness in a patient?
weakness could be due to a lesion from anywhere between the cortex all the way down to the muscle
so it could be effecting the anterior horn, the brain stem, the spinal cord, cortical lesion etc.
you differentiate based on anatomy and distribution of weakness
where is the lesion if you have weakness on 1/2 of the body weakness?
cerebral hemisphere lesion
where is the lesion if you have face weakness on the opposite side of the rest of the body’s weakness?
brainstem lesion
where is the lesion if you are paraplegic?
spinal cord lesion
where is the lesion if you have weakness in the hands and legs?
polyneuropathy like with diabetes
the longer the nerve the more likely it is to be damaged so that’s why the leg and hand muscles are effected first
where is the lesion if you have weakness in the shoulders and hips and thigh?
myopathy
more proximal areas of the body are involved
what if there is a cortical lesion?
it will effect the motor homunculus
if a muscle needs very precise movements like in the face and hands, they will have a higher representation in the motor homunculus because they have lots of nerves going to them to produce these fine movements – the large muscles have much smaller representation
which reflexes should be testing during a neuro exam?
- deep tendon reflexes (actually muscle stretch reflex; not Golgi tendon reflex)
- planter response
- superficial reflexes
- other pathological reflexes
what is a deep tendon reflex?
you hit the tendon and the muscle stretches
depending on how much the tendon is stretched, you will have more/less deep tendon reflexes
the angle of the limb when you test the reflex is important!
what sensory factors should you test during a neuro exam?
- examination of sensation to touch, pain, temperature, vibration, proprioception
- cortical sensation (graphaesthesia, stereognosis etc.)
- Romberg test
you can tell where the lesion is in the spinal cord based on which areas of the body are effected and the associated pathway
