L17: approaches to patient with CNS disorder pt 2 Flashcards
optic nerve tests (5)
- visual acuity (snellens chart)
- Visual fields
- visual accommodation
- Pupillary response to light and darkness
- Fundal examination
complete oculomotor nerve lesion =
- eyes situated down and out
- pupil dilated
- ptosis
apart from the extraocular muscles what other muscles does oculomotor nerve supply
- levator palpebrae superioris
- superior tarsal muscle
Horner’s syndrome=
abnormal sympathetic supply
ptosis=
falling of upper eyelid
where do fibres elevating the eye run in the ocularmotor nerve
in the centre
what do the sympathetic fibres run with
the blood vessels
where do parasympathetic fibres in the ocular motor nerve run
outside the nerve
cranial nerve motor/sensory mneumonic
some say marry money; but my brother says big boobs matter most
trochlear nerve palsy–>
difficulty looking down and in
abducens nerve palsy–>
can’t look right
what can abducens nerve palsy indicate
pontine lesion
UMN nerve lesion in face –>
lower face weakness
LMW facial nerve lesion
whole one side of face palsy
accessory nerve lesion–>
right trapezius does not contract when patient shrugs
hypoglossal lesion –>
- wasting of tongue
- fasciculation’s
- weakness of tongue
- dysarthria
- tongue deviates to side of weakness (NOT lesion)
UMNL has increased (2)
tone and reflexes
UMNL has decreased (2)
muscle bulk and power
LMNL has more
fasiculations
LMNL has decreased (5)
- muscle bulk
- tone
- power
- reflexes
decerebrate posture=
- arms adducted and extended, wrists pronated and fingers flexed
- legs extended
decorticate posture=
- arms adducted and flexed, wrists and fingers flexed
- legs extended and internally rotated
decerebrate posturing= lesion in the
upper brain stem
decorticate posture= lesion in the
corticospinal tract
grading of muscle power=
0-5 (5 normal)
Babinsky response=
extensor or up going hallux
babinsky’s suggests
an UMNL
which are the only 2 places where lower limb is more medial to upper limb
DCML and motor homoculus in brain
Brown-sequard syndrome=
hemispinal cord lesion
central cord lesion–.
loss of motor and sensation in arms and hands
anterior spinal artery syndrome –>
- complete motor loss below
- loss of spinothalamic function below
Romberg’s test=
patient stands with feet together and closed eyes (wobble if vestibular dysfunction)
4 types of stroke
- haemorrhagic
- Thromboembolic
- Embolic
- Lacunar
causes of stroke (virchow’s triad)
- blood vessel wall
- blood flow
- blood constituents
multiple sclerosis=
decreased nerve function due to inflammation of myelin sheath
