ICL 1.0: The Language of Neurology & Neurologic Exam

Question 1

what are the parts of the body you’re testing during a neurologic exam?

Answer 1

1. Mental Status
2. Cranial Nerves
3. Motor system
4. Reflexes
5. Sensory system
6. Gait and Co-ordination

Question 2

what is localization?

Answer 2

“the determination of a site or place for any process or lesion”

Question 3

what are the components for a mental status exam?

Answer 3

Evaluation of higher integrative functions including:
1. level of alertness

2. orientation to time, place, person and situation
3. recent and remote memory
4. attention span and concentration
5. language (e.g., naming objects, repeating phrases, spontaneous speech) and speech
6. fund of knowledge (e.g., awareness of current events, past history, vocabulary)

Question 4

what is the difference between speech and language?

Answer 4

language is making sense

speech is making coherent sense when you talk

Question 5

what is the ascending reticular activating system?

Answer 5

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!

Question 6

if someone has decreased alertness, what is the localization of the lesion?

Answer 6

1. brainstem (bilateral)
2. thalamus (bilateral)
3. cerebral hemisphere (Bilateral)
4. diffuse cortical dysfunction

Question 7

what are the types of aphasia?

Answer 7

1. Broca’s/Motor
2. Wernicke’s/Sensory
3. Global aphasia
4. Conduction aphasia

Question 8

what is Broca’s/motor aphasia?

Answer 8

impaired fluency, repetition, naming, writing

inferior frontal gyrus lesion

Question 9

what is Wernicke’s/sensory aphasia?

Answer 9

impaired comprehension, repetition, naming, reading, writing

superior temporal gyrus lesion

Question 10

what is global aphasia?

Answer 10

a lesion so big it effects both broca’s and wernicke’s areas

Question 11

what is conduction aphasia?

Answer 11

impaired repetition

arcuate fasciculus lesion aka the fibers connecting the two is effected

Question 12

what is the function of the 2nd cranial nerve?

Answer 12

visual acuity, visual fields, fundi

Question 13

what is the function of the 3rd, 4th and 6th cranial nerves?

Answer 13

pupils, eye movements

Question 14

what is the function of the 5th cranial nerve?

Answer 14

facial sensation, corneal reflexes

Question 15

what is the function of the 7th cranial nerve?

Answer 15

facial symmetry, strength

Question 16

what is the function of the 8th cranial nerve?

Answer 16

hearing with tuning fork, whispered voice and/or finger rub

Question 17

what is the function of the 9th and 10th cranial nerve?

Answer 17

spontaneous or reflex palate movement

Question 18

what is the function of the 11th cranial nerve?

Answer 18

shoulder shrug strength

Question 19

what is the function of the 12th cranial nerve?

Answer 19

tongue protrusion

Question 20

what is decerebrate posture?

Answer 20

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

Question 21

what is decorticate posture?

Answer 21

the arms are flexed while the legs are extended

it’s due to upper midbrain damage; pos and medulla are spared which is good!

Question 22

what is the caloric reflex?

Answer 22

the pupillary light response

helps you decide where the lesion is that’s causing the coma

Question 23

what things do you assess in the motor system?

Answer 23

1. muscle bulk
2. fasciculations of the tongue
3. muscle tone
4. muscle strengths
5. abnormal movements, such as tremor, chorea, athetosis, ballism, dystonia, tics etc.

Question 24

in what disease do you get tongue fasciculations?

Answer 24

ALS

due to lower motor neuron damage

Question 25

what could be causing muscle weakness in a patient?

Answer 25

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

Question 26

where is the lesion if you have weakness on 1/2 of the body weakness?

Answer 26

cerebral hemisphere lesion

Question 27

where is the lesion if you have face weakness on the opposite side of the rest of the body’s weakness?

Answer 27

brainstem lesion

Question 28

where is the lesion if you are paraplegic?

Answer 28

spinal cord lesion

Question 29

where is the lesion if you have weakness in the hands and legs?

Answer 29

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

Question 30

where is the lesion if you have weakness in the shoulders and hips and thigh?

Answer 30

myopathy

more proximal areas of the body are involved

Question 31

what if there is a cortical lesion?

Answer 31

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

Question 32

which reflexes should be testing during a neuro exam?

Answer 32

1. deep tendon reflexes (actually muscle stretch reflex; not Golgi tendon reflex)
2. planter response
3. superficial reflexes
4. other pathological reflexes

Question 33

what is a deep tendon reflex?

Answer 33

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!

Question 34

what sensory factors should you test during a neuro exam?

Answer 34

1. examination of sensation to touch, pain, temperature, vibration, proprioception
2. cortical sensation (graphaesthesia, stereognosis etc.)
3. 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