lecture 1: neurology Flashcards
central nervous system is considered a ____
upper motor neuron disorder
what are 2 examples of my or neuron disorders in the peripheral nervous system (UMN/LMN)
• Amyotrophic Lateral Sclerosis (Lou Gherig’s disease)*
• Polio/post polio syndrome*
what are 3 examples of peripheral nerve disorders in the peripheral nervous system
• Radiculopathies
• Plexopathies
• Polyneuropathy
• Myasthenia gravis
• Lambert Eaton’s myasthenic syndrome
• Botulism
these are all examples of what kind of disorders
neuromuscular junction
what is capgras delusion
recurrent belief that a person has been replaced by an imposter
capgras delusion , stiffperson syndrome , and prosopagnosia are examples of what
fascinomas
capgras delusion is reported with lesions in the ___ hemisphere
right
what syndrome is diffuse stiffness without weakness or numbness and is an autoimmune disorder
stiffperson syndrome
define prosopagnosia and what side hemispheric lesion is it
inability to recognize faces of familiar people
right side
good ___ is essential tp the diagnosis
history
• Disordered mentation, attention, memory, behavior
• Language and communication disturbances
• Excessive daytime sleepiness, insomnia, fatigue
• Visual disturbances (vision loss, diplopia)
• Weakness, numbness, other sensory alterations, balance
problems
• Sphincter disturbances (urinary or fecal incontinence, inability
to void)
• Erectile or ejaculatory dysfunction
• Sudden (paroxysmal) behavioral changes (seizures, loss of
consciousness)
these are all complaints of what
neurologic
what are the 8 things that weakness could mean
– Fatigue
– Apathy
– Pain
– Decreased sensation
– Imbalance
– Incoordination
– Drowsiness
– Loss of muscle strength
what are the 7 things to check for neurologic exam
I. Mental Status & Language
II. Cranial Nerves
III. Motor
IV. Sensation
V. Reflexes
VI. Coordination
VII.Gait
what are the 4 levels of consciousness
alert
lethargy
stupor
coma
what level of consciousness are you awake and interactive
alert
what level of consciousness will the pt appear asleep but may be aroused with stimulation to interact with environment
lethargy
what level of consciousness will the pt arouse briefly to vigorous stimuli but not to the point of being interactive
stupor
what level of consciousness is the pt unresponsive to external stimuli
coma
what is apraxia
inability to carry out a motor act int he absent of weakness or ataxia
what is dysarthia and what kind of disorder is it and ehat does it affect
slurred speech
motor disorder affecting the muscles of articulation
what is aphasia
impairment of lang production or comprehensions
- broca’s area
- wernickes area
whar are the 6 components of language
spontaneous speech
naming
comprehension
repetition
reading
writing
what is the path of language in the brain
- heschl’s gyrus , primary auditory cortex
- wernickes area , superior temporal gyrus
- arcuate fasciculus
- broca’s area , left inferior frontal
what links written words with language
angular gyrus
what is anosmia mean
loss of smell
what is dysguesia
altered taste
what are common path for cranial number 1 (olfactory nerve) sumptomatic and asymptomatic
symp: post viral , head trauma
asymptomatic: alzheimer’s , parkinson’s
what CN deals with
– Visual acuity
– Visual fields
– Ophthalmoscopy
– Pupillary reactivity
(afferent limb)
– Color perception
cn II: optic
what mm goes with CN IV: trochlear N
superior oblique mm
what mm does the motion for CN VI: abducens N
lateral rectus MM
what exam do you do for CN III, IV and VI
extraocular movements , ptosis
what mm do the motion for CN III: oculomotor
superior rectus
inferior rectus
medial rectus
inferior oblique
when you are doing the swinging flashlight test what is the direct response and consensual response
the direct response is shine light into pupil and look for constriction
consensual response is look for opposite pupil constriction
if you do the swinging flash light test and there is no direct response what is the problem
problem with ipsilateral optic never
if you do the swinging flashlight test and there is no consensual response what can be the 3 problems
problem with opposite optic nerve , ipsilaterla parasympathetic of CN 3 or pupillary constrictor mm
what CN is
– Muscles of mastication (chewing)
– sensation of the face, conjunctiva, sinuses
CN V: trigeminal nerver
what is the exam for CN V: trigeminal
corneal reflex
strength of jaw
facial sensation
what 2 CN does the corneal reflex test and what are u doing and looking for
CN V and VII
touch cornea gently with cotton swab and look for eye lid blinking
what CN is this
– Muscles of facial expression, stapedius
– Lacrimal glands (tearing)
– Taste of anterior 2/3 of tongue
CN VII: facial
what is the exam for CN VII: facial
show teeth , wrinkle forehead, close eyes tight
if there is a central lesion for CN VII what does that mean
lower half of face weak on the contralateral side (stroke)
if there is a right sided lesion then the left half od the lower face will be weak bc it crosses
if there is a peripheral lesion for CN VII: facial what does tha mean
entire half of face weak on the ipsilateral side
bell’s palsy
what is the exam for CN VIII: vestibulochoclear nerve
hearing to finger rubs or tuning fork
eye movements , nusyagmus
head thrust
dix hall pike
what cn is this
– Sensation/taste from posterior 1/3 tongue, back of the throat
– Motor nerve elevates pharynx, contributes to gag
– Parasympathetics to parotid
CN XI: glossopharyneal nerve
what CN is this
– Motor nerve innervating muscles of pharynx, larynx, tongue,
smooth muscles
– Major autonomic nerve - parasympathetic efferent
CN X: vagus nerve
what is the exams for CN XI and X
palatial elevation
gag reflex
taste
swallowing
assessment of speech
what 2 mm does the CN XI: accessory n inn
SCM and traps
what CN INN the tongue MM
CN XII: hypoglossal n
what are the 3 different tones
flaccidity
rigidity
spasticity
what is flaccidity define as
little resistance to passive movement
what tone is steady muscular tension that is equal in degree in opposing mm groups
rigidity
what tone is sustained increase in tension of a mm when it is passively lengthened
spasticity
which tone is speed dependent
spasticity
what brain strucutre has to do with rigidity
BG
atrophy, pseudohypertrophy these are consider what in the motor exam
bulk
what 2 things do you check in the motor exam
bulk and tone
what are the 5 upper motor neuron signs
- stiffness , spasticity
- weakness in pyramidal pattern ( flexor strong in UE and extensors stronger in LE )
- hyperreflexia
-pathological reflexes
- babinskis
what are the 4 lower motor neuron sign
-•Weakness, muscle atrophy,
fasciculations, cramps.
•NO SENSORY INVOLVEMENT
•NO PAIN
•Hypoactive reflexes
what grade of power is partial arc of movement with gravity eliminated
2
what grade of power is full arc against gravity and some added resistance
4
what number is it if the reflex is normla
2+
what do you rate a clonus reflex
4+
what is a Series of rhythmic involuntary muscle
contractions induced by sudden passive stretching of
a muscle
clonus (UMN lesion)
is hoffmann sign UMN or LMN and what finger do you do it on
UMN and middle
what is the babinski sign
extensor plantar response
when is the babinski sing abnormal
when the toes goes up (except in babies)
what tract is pain and temperature
lateral spinpthalamic tract
what tract is light touch
ventral spiniothalamic tract
what tract is vibration and proprioception
DCML
what part of the neurologic exam do you – Screen for distal/proximal gradient, asymmetry,
dermatomes
V. sensation
what is one of the more earliest signs of dorsal column disease
romberg sign
when sit he romberg sign positive
when pt is able to stand with his feet together while his eyes are open but sways or falls when they are closed
when is the romberg sign included during the neurologic exam
sensory or coordination exam
when during the neurologic exam do you test the function of the cerebellum, basal ganglia, and related connections.
VI. coordination exam
disorders of the coordination exam manifest as what 5 things
imbalance
incoordination
ataxia
dusdiadochokinesia
abnormal movements
what 2 coordination test assess for dysmetria and intention tremor
finger nose finger test and heel to shin test
what does rapid alternation movements test for
dysdiadochokinesia
define station
attitude or manner of standing , including posture
what does fiat assess
width of the base , arm swing , pelvis rotation , height of step and symmetry
MRI, CT, myelography, angiography,
perfusion, DAT are all examples of what
neuro imaging
electroencephalography (EEG),
electromyography (EMG), nerve conduction studies,
evoked potentials these are examples of what
neurophysiology
– Inflammatory and infectious conditions, including
meningitis, encephalitis, multiple sclerosis
– Subarachnoid hemorrhage
– Pseudotumor cerebri (idiopathic intracranial
hypertension): high opening pressure
– Cancer involving meninges
what is a diagnosis of these things
lumbar puncture
lumbar puncture inject what medications
chemotherapy , anesthesia
what levels of the spinal cord does the lumbar puncture go in at and into what space
L4/L5
epidural
what is normla measure pressure for lumbar puncture ____ mm H2O
80-200
what are some complications for lumbar puncture
post LP HA
bleeding
infection
back pain
what are 5 advantages of computed tomography
– Emergency diagnosis of acute conditions (stroke, trauma).
Blood easily seen.
– Quick and readily available
– Only option for those with contraindications to MRI
– Visualization of bone (skull)
– High resolution of vascular structures
what are disadvantages of computed tomography
radiation exposure and poor visualization of BS
what is hyper dense on a CT
calcium and bone
what is hypodense (dark) on CT
CSF, fat
is white matter or grey matter darker on CT
white
is blood hyper dense or hypodense on CT
hyper dense
on a CT , stroke , edema , fluid and air are ____
hypodense
what are the 3 advantages of MRI
no radiation exposure
much higher resolution
unmarred by bony artifact
what are 3 disadvantages of MRI
some contraindications (pacemaker)
can’t assess bone
long acquisition time
what is the test of choice for imaging most central nervous system disease/lesions
MRI
what choice of imaging would you do for these … infarcts, hemorrhages, vascular malformations,
aneurysms, tumors, degenerative disorders,
contusions, demyelination (MS), epilepsy,
infections
MIR
can an MRI be done with or without contrast material (gadolinium)
yes
MRI: delusion weighted imaging is ___ in acute stroke
bright
what is an injection of 5-25 mL of radiopaque dye into
subarachnoid space via lumbar puncture.
myelography
myelography is combined with what to allow for visualization of subarachnoid space
CT scanning
what are the 4 things that myelography evaluates for
spinal stenosis , cord arteriovenous malformation , tumor and abscess
what do you usually do instead of a myelography
MIR
what is injection of dye into cranial arteries (via
catheterization from femoral artery)
conventional angiography
what can you visualize with a conventional angiography
occlusion , dissections , primary angiitis , aneurysms , vascular malformations
conventional angiography is. an intra arterial injection of ___
thrombolytic
what is interventional for conventional angiography
clot removal , stenting , angioplasty , coils and glue
what measure brain electrical activity thru scale electrodes
EEG
what does an EEG evaluate for
seizures , brain death , encephalopathy , dementia , coma
what is a Recording of electrical activity in central
sensory pathways produced by visual (VEP),
auditory (BAEP), or sensory (SSEP) stimulation
evoked potential
what does VEP evoked potentials mean
alternation checkerboard pattern
what is BAEP (auditory) evoked potientials mean
auditory clicks thru earphones
what does SSEP ( sensory) evoked potential mean
electrical stimuli applied to peripheral nerves
what do you use for Diseases of muscle, nerve, neuromuscular junction
EMG (electromyography) and NCV ( nerve conduction velocities)
what is an Insertion of a small needle
into individual muscles and recording of motor unit
potentials at rest and with activity
electropgyogrpahy
what is an Electrical
stimulation over nerves with recording of sensory
and motor nerve potentials and velocities
nerve conduction velocities
what will an axonal neuropathic show for an eMG and NCV
decreased amplitudes on NCV , abnormal spontaneous activity on EMG
what will a demyelinating neuropathies show on a EMG and NCV
slowed condution
what will a myopathies show on an EMG and NCV
normal NCV , small duration , low amplitude potentials
what does myasthenia gravis show on an EMG and NCV
abnormalities on repetitive nerve stimulation
what does this describe
– Increased tone
– Hyperreflexia
– No atrophy
UMN
what does this describe
– Decreased/normal tone
– Hyporeflexia
– Atrophy
LMN
