Localization - Cartwright - Exam 2 Flashcards
There are 6 main parts of the neurological exam:
- _____ _____
- _____ ____
- _____
- _____
- _____
- _____ and _____
There are 6 main parts of the neurological exam:
- Cranial Nerves
- Mental Status
- Strength
- Reflexes
- Sensation
- Coordination and gait
Mental Status
- L____ of _________
- O_______
- A_______
- L_______
- S_______
- M_______
Mental Status
- Level of Consciousness (alert i.e. typing, interactive)
- Orientation (date? where are you? what floor? full name?)
- Attention (spell world backwards…, not aphasic, test her name)
- Language (difference between language and speech? Language is higher fluency, understanding, speech is just motor function of words)
- Speech
- Memory (3 things: car table and apple wait 3-5 minutes)
Cranial Nerves
- I – olfactory; smell test
- II – optic; acuity, fields
- III – oculomotor; eye movement
- IV – trochlear; eye movement
- V – trigeminal; facial sensation, ______ of _____
- VI – abducens; eye movement
- VII – facial; face movement
- VIII – acoustic; hearing
- IX – glossopharyngeal; _______ elevation
- X – vagus; ____ elevation
- XI – accessory; neck movement
- XII – hypoglossal; tongue movement
Cranial Nerves
- I – olfactory; smell test
- II – optic; acuity, fields
- III – oculomotor; eye movement
- IV – trochlear; eye movement
- V – trigeminal; facial sensation, muscles of 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 a Neuro Exam.
We typically look two things:
- _____(right arm vs left arm, right leg vs left leg)
- ____ and ____ Gradient (is the patient more weak in proximal or distal muscles)
•Graded from a __ to __ scale:
What do these grades mean?
0 = ____
1: muscle ___ but no ____
2: pull arm up when they are on their ___
3. go up against a little ____
4. can go up against some ___ (sometimes can be labeled as __)
5. normal strength
Testing Strength in a Neuro Exam.
We typically look two things:
- Symmetry (right arm vs left arm, right leg vs left leg)
- Poximal and Distal Gradient (is the patient more weak in proximal or distal muscles)
•Graded from a 0 to 5scale:
What do these grades mean?
0 = nothing
1: muscle twitching but no movement
2: pull arm up when they are on their side
3. go up against a little resistance
4. can go up against some resistance (sometimes can be labeled as 4+/-)
5. normal strength
How to test reflexes in neuro exam:
This exam includes arms and legs
scored as 0, 1+, 2+, 3+, 4+,
0: tap patella and there’s nothing, _____
1+: ________
2+: _____
3+: _____ _____
4+: very brisk reflex with _____
How to test reflexes in neuro exam:
This exam includes arms and legs
scored as 0, 1+, 2+, 3+, 4+,
0: tap patella and there’s nothing, areflexia
1+: reflex but barely there
2+: normal
3+: brisk kick
4+: very brisk reflex with clonus (in addition to leg kicking out it shakes)
Testing sensation in neuro exam:
Again, testing arms vs legs, _____vs _____
in sensation test, we want to test _____for pain and temperature (tuning fork stays cold)
_______ (dorsal column) for proprioception and vibration
Testing sensation in neuro exam:
Again, testing arms vs legs, distal vs proximal
in sensation test, we want to test spinalthelamic for pain and temperature (tuning fork stays cold)
Medial lemniscus (dorsal column)
Coordination and Gait
Touch ___ to ____to ___to make sure movement is smooth
___ to _____, rapid ______movements
Gait: Can you ____ ____? ____ _____ is their walk? How is your _____? Are they ____?
______test: close eyes, stand still, see if they fall to either direction (good to check cerebellar deficit)
Coordination and Gait
Touch finger to nose to finger to make sure movement is smooth
Heel to shin, rapid alternating movements
Gait: Can you stand up? How fast is their walk? How is your stride? Are they steady?
Romberg test: close eyes, stand still, see if they fall to either direction (good to check cerebellar deficit)
Terminology of localization:
- ____ – one side of the body is affected
- ____ – lower half of the body is affected
- ____ ____ _____ lesion (_____nervous system) – hyperreflexia (3+ or 4+) causes spasticity, increased tone, brisk reflexes, upgoing toes, clonus (rapid movement of the foot)
- ____ _____ _____ lesion: anywhere from the ______ horn cells to distal muscles (_____ nervous system) – causes flaccidity, atrophy, and fasciculations
Terminology of localization:
- Hemi– one side of the body is affected
- Para– lower half of the body is affected
- Upper Motor Neuron lesion (Central nervous system) – hyperreflexia (3+ or 4+) causes spasticity, increased tone, brisk reflexes, upgoing toes, clonus (rapid movement of the foot)
- Lower Motor Neuron lesion: anywhere from the anterior horn cells to distal muscles (peripheral nervous system) – causes flaccidity, atrophy, and fasciculations
- Upper Motor Neuron lesion (Central nervous system) – hyperreflexia (3+ or 4+) causes ______, increased _____, brisk _____, upgoing ____, ______(rapid movement of the foot)
- Lower Motor Neuron lesion: anywhere from the anterior horn cells to distal muscles (peripheral nervous system) – causes ___ _____ and _____
- Upper Motor Neuron lesion (Central nervous system) – hyperreflexia (3+ or 4+) causes spasticity, increased tone, brisk reflexes, upgoing toes, clonus (rapid movement of the foot)
- Lower Motor Neuron lesion: anywhere from the anterior horn cells to distal muscles (peripheral nervous system) – causes ___ _____ and _____
Fasciculations:
If you take a test, and the test stem has something about fasciculations, you instantly think of ___
Fasciculations are something everyone has, it is completely normal in people without ALS
Everybody gets fasciculations, but people with ALS most likely ____ ____ _____ ____ (“arm looks like a bag of worms”)
People with ALS experience fasciculations in ____ _______ (not just one)
_______ increases fasciculations in normal people
Fasciculations:
If you take a test, and the test stem has something about fasciculations, you instantly think of ALS
Fasciculations are something everyone has, it is completely normal in people without ALS
Everybody gets fasciculations, but people with ALS most likely won’t know they’re having fasciculations (“arm looks like a bag of worms”)
People with ALS experience fasciculations in multiple spots (not just one)
Caffiene increases fasciculations in normal people
_______ or muscle twitch, is a small, local, involuntary muscle contraction and relaxation which may be visible under the skin.
A fasciculation or muscle twitch, is a small, local, involuntary muscle contraction and relaxation which may be visible under the skin.
Localizations:
- If you have a lesion in the _____, you will see abnormalities in:
- ___ _____: depending on part of the brain: Broca’s or Wernicke’s aphasia, neglect, etc
- ____ ______: facial droop on opposite side of lesion
- Strength – hemiplegia (weak on _____ side of body) why?
- Reflexes – side-to-side asymmetry (increased ____ on ____ side of the body)
- Sensation – side-to-side asymmetry. Sensation loss on ___ side of the body
- Coordination and gait
Localizations:
- If you have a lesion in the brain, you will see abnormalities in:
- mental status: depending on part of the brain: Broca’s or Wernicke’s aphasia, neglect, etc
- Cranial Nerves: facial droop on opposite side of lesion
- Strength – hemiplegia (weak on opposite side of body)
- Reflexes – side-to-side asymmetry (increased reflexes on opposite side of the body)
- Sensation – side-to-side asymmetry. Sensation loss on ___ side of the body
- Coordination and gait
- If you have a lesion in the _____ – you’ll see abnormalities in:
mental status is going to be ________
- Cranial nerves
- Strength – hemiplegia on ____ side of lesion (paralysis on the _____ side of the lesion)
- Reflexes – side-to-side asymmetry; hyperreflexia on ___ side of lesion
- Sensation – side-to-side asymmetry, loss on ___ side of lesion
- Coordination and gait
- *** Crossed findings ***
what does crossed findings mean?
- If you have a lesion in the brainstem– you’ll see abnormalities in:
mental status is going to be relatively normal
- Cranial nerves
- Strength – hemiplegia on opposite side of lesion (paralysis on one side of the body)
- Reflexes – side-to-side asymmetry; hyperreflexia on ___ side of lesion
- Sensation – side-to-side asymmetry, loss on ___ side of lesion
- Coordination and gait
- *** Crossed findings ***
what does crossed findings mean?
They are key in brainstem lesions, you can have left side facial droop and right side arm and leg weakness; this indicates that you have the 7th cranial nerve nucleus and the cortical spinal tracts crossing over to the left side
If you have a lesion in your ___ _____ – you’ll see abnormalities in:
your mental status will be ____ and your cranial nerves will be _____
if your lesion is below _____ you will have weakness below the legs
•Strength – _____ paralysis of all four limbs, _____, paralysis of the legs and lower body
Symmetrical weakness
- Reflexes – all brisk, would it be hyper or hypo?
- Sensation – sensory level
- Coordination and gait
- *** Bowel and bladder involvement ***
if spinal cord is affected, you often lose _____ tone resulting in ___ _____
If you have a lesion in your ___ _____ – you’ll see abnormalities in:
•Strength – quadraparalysis of all four limbs, para, paralysis of the legs and lower body
symmetrical weakness
- Reflexes – all brisk: hyper below the lesion, babinsky relex
- Sensation – sensory level
- Coordination and gait
- *** Bowel and bladder involvement ***
if spinal cord is affected, you often lose rectal tone resulting in urinary incontinence
If you have a problem with your ______ you will see:
you will have _____ mental status and cranial nerves
- decreased ______ distal to the nerve lesion
- decreased _____ distal to lesion
- changed or altered or absent sensation distal to the lesion
sensation- changed and altered distal to the lesion: stocking-glove sensory loss
Explain what stocking-glove sensory loss means:
- Coordination and gait is affected
- *** Motor neuron disease has brisk reflexes (UMN involvement) and no sensory involvement *** This is an exception to the rule
ALS affects both upper and lower motor neurons (exception to the rule)
fasciculations or weakness in the hand, but patella exhibits brisk (hyper) reflexes
also no sensory involvement in people with ALS
lower motor neuron problem in their hand, and hyperreflexive in their arm, it’s most likely ALS
If you have a problem with your nerves you will see:
normal mental status and cranial nerves
- decreased strength distal to the nerve lesion
- decreased reflexes distal to lesion
- Sensation – changed or altered or absent sensation distal to the lesion
stocking-glove sensory loss means you lose sensation in the hands and feet
- Coordination and gait is affected
- *** Motor neuron disease has brisk reflexes (UMN involvement) and no sensory involvement *** This is an exception to the rule
ALS affects both upper and lower motor neurons (exception to the rule)
fasciculations or weakness in the hand, but patella exhibits brisk (hyper) reflexes
also no sensory involvement in people with ALS
lower motor neuron problem in their hand, and hyperreflexive in their arm, it’s most likely ALS
