Localization - Cartwright Flashcards
6 Sections of the Nervous System
There are 6 main parts of the nervous system:
- ___
- ____
- __ ___
- ___ ___
- __ ____
- ___
6 Sections of the Nervous System
There are 6 main parts of the nervous system:
1. Brain
2. Brainstem
3. Spinal Cord
4. Peripheral Nerve
5. Neuromuscular Junction
6. Muscle
__ ___ System
- Brain
- Brainstem
- Spinal cord
__ __ System
- Peripheral nerve
- Neuromuscular junction
- Muscle
Central Nervous System
- Brain
- Brainstem
- Spinal cord
Peripheral Nervous System
- Peripheral nerve
- Neuromuscular junction
- Muscle
There are 6 main parts of the neurological exam:
- ___ ___
2 __ ___
- ___
- ___
- ___
- ___ and ____
There are 6 main parts of the neurological exam:
- Mental status
2 Cranial Nerves
- Strength
- Reflexes
- Sensation
- Coordination and Gait
Checking Mental Status in Neuro Exam:
- __ of ____
- ____
- ____
- ____
- ____
- ____
Checking Mental Status:
- Level of consciousness (alert, upright and interactive)
- Orientation (if patient knows date, name and location then O3)
- Attention (spell WORLD forwards and backwards)
- Language (not aphasic. Ask patient to name objects)
- Speech
- Memory (remember a car, table and apple. Wait 3-5 minutes and ask them to recall)
What is the difference between language and speech?
Language is a higher cortical thing (comprehension, fluency, etc).
Speech is just the mechanical production of words.
How to test Cranial Nerves
- I – ___, ___test
- II – optic; acuity, fields
- III – oculomotor; eye ____
- IV – trochlear; eye ____
- V – trigeminal; facial sensation, muscles of ____
- VI – ____; eye movement
- VII – facial; face movement (have patient lift eyebrow)
- VIII – acoustic; hearing
- IX – glossopharyngeal; ____ elevation
- X – vagus; ____ elevation
- XI – accessory; ___ movement
- XII – hypoglossal; ____ movement
Cranial Nerves Test
•I – olfactory; smell test
•II – optic; acuity, fields
•III – oculomotor; eye movement
•IV – trochlear; eye movement
•V – trigeminal; facial sensation, mastication
•VI – abducens; eye movement
•VII – facial; face movement
•VIII – acoustic; hearing
•IX – glossopharyngeal; palate elevation
•X – vagus; palate elevation
•XI – accessory; neck movement
•XII – hypoglossal; tongue movement
Testing Strength in the Neuro Exam
In this test, we are looking for 2 things:
- ____ (right arm vs left arm, right leg vs left leg)
- ___ to ___ gradiant (is the patient more weak in distal or proximal muscles?)
These are graded from __ to __
What do these grades mean?
0 = Nothing
1 = ___ but no ____
2 = Patient can pull arm up when they are on their ____
3 = Can go up against little ____
4 = Can go up against some more ____
5 = Totally normal
Sometimes, you can see a patient with 4-, or 4+ strength.
Testing Strength in the Neuro Exam
In this test, we are looking for 2 things:
- Asymmetry (right arm vs left arm, right leg vs left leg)
- Proximal to Distal gradiant (is the patient more weak in distal or proximal muscles?)
These are graded from 0 to 5
What do these grades mean?
0 = Nothing
1 = Twitching but no movement
3 = Patient can pull arm up when they are on their side
3 = Can go up against little resistance
4 = Can go up against some more resistance
5 = Totally normal
Sometimes, you can see a patient with 4-, or 4+ strength.
How to Test Reflexes in Neuro Exam
How is this graded?
0 = tap patella and there is nothing (___)
1+ = reflex but ____ there
2+ = ____
3+ = brisk ____
4+ = very brisk reflex with _____ (which means, in addition to leg kicking out it ____)
How to Test Reflexes in Neuro Exam
How is this graded?
0 = tap patella and there is nothing (areflexia)
1+ = reflex but barely there
2+ = normal
3+ = brisk kick
4+ = very brisk reflex with clonus (which means, in addition to leg kicking out it shake)
Testing Sensation in Neuro Exam
Again, testing arms versus legs, side to side, distal to proximal.
In the sensation test, we are testing:
- ____ for pain and temp.
- ____ for touch and proprioception
Testing Sensation in Neuro Exam
Again, testing arms versus legs, side to side, distal to proximal.
In the sensation test, we are testing:
- STT for pain and temp.
- DCML for touch and proprioception
Testing Gait and Coordination in Neuro Exam:
_____:
- Finger-nose-finger (making sure the movement is ____)
- Heel-to-Shin
- Rapid Alternating Movements
___\_
- Can they stand up?
- How fast do they walk?
- What is their stride (length and width)?
- Are they steady?
- ______ Test: ask patient to close eyes, stand still and see if they sway or fall in any direction…good to check for any cerebellar deficit).
Testing Gait and Coordination in Neuro Exam:
Coordination:
- Finger-nose-finger (making sure the movement is smooth)
- Heel-to-Shin
- Rapid Alternating Movements
Gait
- Can they stand up?
- How fast do they walk?
- What is their stride (length and width)?
- Are they steady?
- Romberg Test: ask patient to close eyes, stand still and see if they sway or fall in any direction…good to check for any cerebellar deficit).
Some Terminology of Localization:
- ______ – one side of the body is affected
- ______ – lower half of the body is affected
- ___ ___ ___ (___ nervous system lesion) – causes spasticity, increased tone, brisk reflexes, upgoing toes (Babinski reflex), clonus (rapid movement of the foot)
__ ___ ___ (___ nervous system lesion) – lesion is anywhere from _____ horn cells to distal muscles. It causes flaccidity, atrophy, and fasciculations.
Some Terminology of Localization:
- Hemiparesis – one side of the body is affected
- Paraparesis – lower half of the body is affected
- Upper motor neuron lesions (central nervous system lesion) – causes spasticity, increased tone, brisk reflexes, upgoing toes (Babinski reflex), clonus (rapid movement of the foot)
Lower motor neuron lesons (peripheral nervous system lesion) – lesion is anywhere from anterior horn cells to distal muscles. It causes flaccidity, atrophy, and fasciculations.
Fasiculations:
A patient comes with fasciculations that they cannot feel are are in multiple spots. You should immediately think of what disease?
ALS is a common finding for people who hae fasciculations.
Note: everyone has SOME fasciculations. The difference is that people who have ALS cannot feel their fasciculation. It is also not just in one spot…they are in multiple spots.
Upper motor neuron lesions (central nervous system lesion) – causes _____, increased ___, brisk ___, ____ reflex, meaning that toes point ___, ___ (clue: it is rapid movement of the foot)
Lower motor neuron lesons (peripheral nervous system lesion) – lesion is anywhere from anterior horn cells to distal muscles. It causes ____ (weak, lax or soft) , ____ (wasting of muscle), and ____ (a brief, spontaneous contraction affecting a small number of muscle fibers, often causing a flicker of movement under the skin).
Upper motor neuron lesions (central nervous system lesion) – causes spasticity, increased tone, brisk reflex, babinski reflex, meaning that toes point up, clonus (clue: it is rapid movement of the foot)
Lower motor neuron lesons (peripheral nervous system lesion) – lesion is anywhere from anterior horn cells to distal muscles. It causes flaccidity, atrophy, and fasciculations.
If you have a lesion in the ___, you will see abnormalities in:
- ___ ___ (Broca’s or Wernicke’s, Neglect)
- ___ ___ (facial droop on side opp. of lesion)
- Strength – hemiplegia (weak on ___ side of body). Why? (draw!)
- Reflexes – side-to-side asymmetry (increased reflexes on ___ side of body)
- Sensation – side-to-side asymmetry (sensory loss of ___ side)
- Coordination and gait
If you have a lesion in the brain, you will see abnormalities in:
- Mental status (Broca’s or Wernicke’s, Neglect)
- Cranial nerves (facial droop on side opp. of lesion)
- Strength – hemiplegia (weak on side of body). Why? –> b/c it has not decussated yet (draw!)
- Reflexes – side-to-side asymmetry (increased reflexes on opposite side of body)
- Sensation – side-to-side asymmetry (sensory loss of opposite side)
- Coordination and gait
If you have a lesion in the ____, you will have problems with:
- Cranial nerves
- Strength – hemiplegia on ___ side of lesion)
- Reflexes – side-to-side asymmetry. Hypereflexia on __ side of lesion)
- Sensation – side-to-side asymmetry (sensory loss on __ side of lesion)
- Coordination and gait
*** Crossed findings ***
What does crossed findings mean?
Note: brain stem lesions generally do not alter mental status. Sometimes they can, but in general they do not affect mental status.
If you have a lesion in the brainstem, you will have problems with:
- Cranial nerves
- Strength – hemiplegia (paralysis on one side of the body) on opp. side of lesion
- Reflexes – side-to-side asymmetry. Hypereflexia on opp. side of lesion)
- Sensation – side-to-side asymmetry (sensory loss on opp. side of lesion)
- Coordination and gait
*** Crossed findings ***
What does crossed findings mean?
Crossed findings are key in a brainstem lesions. You can have right facial droop and left arm and leg weakness. This is a cross-finding.
What is this?
- 50 year old female
- Confusion, trouble speaking
- Right face weakness and decreased sensation
- Right arm and leg weakness
- Brisk reflexes on the right side
- Decreased sensation on right side
- Trouble walking
She states that she had increasing symptoms starting 3 months ago. What does she have?
Glioblastoma Multiforma
- 50 year old female
- Confusion, trouble speaking
- Right face weakness and decreased sensation
- Right arm and leg weakness
- Brisk reflexes on the right side
- Decreased sensation on right side
- Trouble walking
What is this, and what symptoms would the patient have?
Glioblastoma Multiform
- 50 year old female
- Confusion, trouble speaking
- Right face weakness and decreased sensation
- Right arm and leg weakness
- Brisk reflexes on the right side
- Decreased sensation on right side
- Trouble walking
Hemmorrhagic Stroke
