intro to neurology Flashcards
what are important associated symptoms to ask about during HPI
headache, numbness, pins and needles, cold or warmth, weakness, unsteadiness, stiffness or clumsiness,N/V, visual disturbances, altered consciousness
what are the different portions of a neurological exam
mental status
cranial nerve
motor system
sensory system
coordination and gait
reflex testing
what is within the mental status exam
general appearance and behavior
speech
mood and affect
thought and perception
cognition: MMSE
Judgement and insight
what is MMSE
Mini-mental state exam
what is assessed within the MMSE?
orientation
registration
attention and calculation
recall
language
what are the cranial nerves
- olfactory
- optic
- oculomotor
- Trochlear
- trigeminal
- Abducens
- Facial
- Vestibulochochlear
- glossopharyngeal
- vagus
- Accessory
- Hypoglossal
what type of scale is muscle strength graded on for a neurologic exam
0-5 scale
0 is no muscle contraction
5 is muscle can move the joint it crosses through a full ROM against gravity as well as against full resistance
what is assessed during sensory neurologic exam
touch
pain
deep pain
temperature
joint position sense
vibration sense
two-point discrimination
what is stereognosis test
object identification with eyes closed
what is graphesthesia test
ability to feel/identify a number being traced in their palm
what used to assess coordination in the neurologic exam
rapid alternating movements
(first with hands and then with feet)
what is diadochokinesia
ability to perform RAM (rapid altenating movements)
what is dysdiadochokinesis
slow, irregular, clumsy, movements
how is the gait evaluated
walk across the room, turn and come back
walk heel-to-toe in a straight line (tandem walking)
walk on their toes in a straight line
walk on their heels in a straight line
hope in place on each foot
do shallow knee bend
rise from a sitting position
what is a hemiplegic gait
abnormal gait: affected leg is held extended and internally rotated, the foot is inverted and plantar flexed and leg moves in circular direction at hip (circumducation)
what is a diplegic gait
abnormal gait: slow and stiff with legs crossing in front of eachother (scissoring) - often with CP, used to be called spastic gait
what is a cerebellar ataxic gait
abnormal gait: wide-based and may be associated with staggering/reeling as in drunkness
what is a sensory ataxic gait
abnormal gait: wide based, the feet are slapped onto the floor, a patient may watch their feet
what is a neuropathic or steppage gait
abnormal gait: inability to dorsiflex foot, often due to peroneal nerve lesion. results in exaggerated elevation hip/knee to allow foot to clear floor
what is a dystrophic gait
abnormal gate; pelvic muscle weakness produces lordotic/waddling gait (with trendelenberg tilt)
what is parkinsonian gait
abnormal gate; flexed posure, starts are slow, steps are small and shuffling, there is reduced arm swing, and involuntary acceleration may occur
what is festination gait
another name for parkinsonian gait
what is a choreic gait
abnormal gait: jerky and lurching yet falls are supprizingly rare
what is a apraxic gait
abnormal gait; difficulty initiating walking and may appeared to be glued to the floor. once started, gait is slow and shuffling. however no difficulty performing same leg movements when lying and not bearing weight
what is a antalgic gait
favoring one leg over other to avoid pain (limp)
how are reflexes graded
on a scale 0-4+
what reflexes do we assess?
biceps, brachioradialis, achilles, triceps, patellar and plantar
what is GCS
glasgow coma scale
what is being assessed during CSF labs
appearance
total protein
glucose
cell count (WBC and there should be NO RBCs)
opening pressures
what are the indications for lumbar puncture
CNS infection, concern for meningitis
suspected on Subarachnoid hemorrhage
unexplained seizure/SE
intrathecal chemotherapy/contrast
thoraco-abdominal aortic aneurysm repair
idiopathic intracranial hypertension (pseudotumor cerebri)
when are LPs contraindicated
infection in tissue near puncture site
space occupying lesion, especially brain abscess
anticoagulation
thrombocytopenia with PLT
complete spinal block
non-communicating hydrocephalus
what labs are used for strokes
CBC, ESR/CRP, serum glucose (HGB A1C), lipids (LDL, HDL, triglycerides)
what are the indications for CT
stroke, tumor, trauma, dementia, SAH
what is CT better at assessing than MRI
acute bleeds
what is MRI indicated for
stroke
tumors
trauma
dementia
Multiple Sclerosis
Infections
Seizures
when is MRI indicated over CT scan
pregnancy and MRI is more sensitive than CT in detecting certain structural lesions such as tumors and vascular abnormalities
better contrast between white and grey matter
what is a DW-MRI
diffusion weighted MRI - detect stroke within an hour of onset with high specificity
what do DW-MRI discriminate between
Cytotoxic (strokes) and Vasogeneic dema (cerebral lesions)
what is a PET scan
positron emission tomography
may demonstrate function brain abnormalities for structural abnormalities
what are the indication for PET scans
medical refractory epilepsy and evaluations for surgery
dementia
gradng fliomas
can provide early confirmatory evidence in huntingtons disease
what are the different types of angiography used for neurologic cases
formal cerebral angiography
Ct angiography
MR angiography
what are the indications for angiography
acute stroke to evaluate for LVO
intracranial aneurysms/AVMs/Fistulas
SAH - evaluating for above etiology
venous sinus thrombosis
space occupying lesions
when are fibrillation potentials and positive waves found on EMG
typically found in denervated muscle as in myopathic disorders and especially in inflammatory disorders like polymyositis
what do fasiculation potentials seen in EMG mean
they reflect spontaneous activation of individual motor units characteristic of neuropathic disorders especially involving anterior horn cells as in ALS
what are myotonic discharges in EMG
high frequency discharges of potential from muscle fibers that wax and wane in amplitude and frequency as in myotonic dystrophy and myotonia congenita
what do myopathic disorders show on EMG
increase incidence of small, short duration, polyphasic motor units in affected muscles
what do neuropathic disorders show on EMG
number of units activated during a maximal contraction is reduced and units fire faster than normal
What are Evoked potentials
visual, auditory and somatosensory
when are evoked potentials indicated
detection of lesion in MS
evaluating efficacy of treatment in MS
detection of lesions in other CNS disorders
assessment and prognosis after CNS trauma/hypoxia
intraoperative monitoring
evaluation of visual/auditory acuity
