MT1 Neuro Exam and more Flashcards
What is it and the Aim of the Neurological Exam
Series of tests conducted by a neurologist to evaluate the integrity of the nervous system
to Localize injury or dysfunction to a part of the nervous system (or determine if its global) level/ lateralization
List some reasons for a Neurological exam
Differential Diagnosis
Determine rehab needs
Triaging (thunderclap headache vs. migraine)
Determine capacity for Work/study
Legal reasons etc.
Composition of the Neurological Exam?
Composed of Observation and formal testing of cranial nerves, motor functioning and Mental status
How many pairs of cranial nerves are there
Twelve (12)
What is cranial nerve 1
The olfactory nerves
How to test cranial nerve 1
(olfactory nerves)
ask them to identify familiar smells, one nostril at a time
check for laterality of the nostrils functioning
Bilaterally abnormal could mean anosmia
What is Cranial nerve 2
Optic Nerves
How to test cranial nerve 2
(optic nerves)
Visual acuity tests for each eye. This is either snellen chart/ near card
Check pupillary light reflexes are appropriate speed and size
How would dysfunction manifest in cranial nerve 2
(optic nerves)
When doing a Fundoscopy, finding optic disk swelling, a papilledema
Indicates high pressure in the brain (TBI/ brain tumour etc.)
Functions of Cranial nerve 3,4,6 and how to test them
They control eye position
Tested by asking someone to follow object/light using their eyes
Dysfunction of cranial nerve 3,4,6
Gaze Palsy, the weakness or loss of certain eye movements (type of palsy it is indicates location)
Nystagmus, which is involuntary rapid eye movement (issues with inner ear, cerebellum)
What is cranial nerve 5 and how to test it
The Trigeminal Nerve
Testing motor function: feel muscles when biting down
Testing sensory function: detecting location of prod, sharp/dull/hot/cold
Disorder of cranial nerve 5 and causes of it
Trigeminal Neuralgia, a chronic pain condition
when the trigeminal nerve carries inappropriate pain signaling
Caused by blood vessels pressing on nerve, could be MS too
What is Cranial Nerve 7 and its disorder
The Facial Nerve
(check if their face is asymmetrical/ sagging)
Bells Palsy is the paralysis/weakness on one side of the face
What is cranial nerve 8 and how to test it
The Vestibulocochlear nerve
its involved in balance and hearing
tested using whisper test and hearing a tuning fork
Manifestation of damage to cranial nerve 8
(Vestibulocochlear nerve)
unilateral hearing loss means peripheral damage
Bilateral hearing loss means central structures being damaged
names and function of cranial nerve 9 and 10
Glossopharyngeal (9) and Vagus (10)
Linked to controlling muscles of the voice and throat
Disorders of Cranial nerve 9 and 10
(Glossopharyngeal and Vagus)
Pseudobulbar palsy shows as strained, strangled voice, emotional lability
Bulbar Palsy shows as nasally speeches, no gag reflex and involves bilateral peripheral lesions
What is cranial nerve 11 and how to check it
The Accessory nerve
Shrugging shoulders, head resistance
(proper symmetry, speed, strength)
Name and testing of cranial nerve 12
Hypoglossal Nerve
Ask to stick our their tongue and move it
List all the cranial nerves names as we know it
On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How
Olfactory, Optic, —,—, trigeminal,—,Facial, Vestibulocochlear, Glossopharyngeal, vagus, accessory, Hypoglossal
List the six stages of evaluating mental status
0- level of consciousness
1-attention and orientation
2-language
3-memory
4-visuospatial function
5-executive functions
How is the MOCA scored
Add up the scores and if they did less than 12 years of education, add one extra point
Scoring is out of 30. 26+ is normal
less than 7 is severe cognitive impairment
List the three cerebral arteries
Anterior CA
Middle CA
Posterior CA
What is a stroke
The death of brain tissue due to an interruption in blood flow to the brain
Two regions affected by stroke in the brain
Infarct (dead/dying tissue)
Penumbra (dysfunctional area surrounding infarct, but can be saved)
Two types of Strokes
Ischemic and Hemorrhagic
What is an Ischemic stroke
Stroke caused by the blockage of a blood vessel
What is an hemorrhagic stroke
Stroke caused by bleeding from a vessel due to breaking of a vessel wall
- blood isnt going to intended destination and its pooling in the brain
List the types of Ischemic stroke
Thrombosis
Embolism
Arteriosclerosis
What is thrombosis
a type of ischemic stroke
When the blood vessel is blocked by something
What is Embolism
Type of Ischemic stroke
Blockage of a blood vessel but the thrombus is moving
travels to another area and blocks the vessel there
higher risk after surgery
What is arteriosclerosis
Type of Ischemic stroke
The thickening, hardening and narrowing of arteries due to fatty plaque buildup
can interact with thrombosis/ embolism to cause blockage
List two mechanisms of damage by Ischemic stroke
Cell death signaling, when the apoptosis is over activated, driving the death of cells
Neuroinflammation. When cells are being damaged, microglia are triggered to activate but they can be overactive and start eating more cells than necessary. Can affect the blood-brain barrier
Excitotoxicity is when cells release excessive glutamate, triggering pathological processes and immune response
Two treatments of aneurysms
Clipping and Coiling
Treatments of stroke
Tissue Plasminogen Activator tPa (breaks up blood cells)
Therapeutic hypothermia (cooling down the head, more in animals)
List the four categories of tumors
Encapsulated/ Infiltrating
benign/Malignant
Examples of Bacterial Infections
Meningitis
Neurosyphilis
Consequence of Neurosyphilis
General Paresis,
delusions and personality changes
Two examples of Viral infections
Rabies (nervous system specific)
Covid-19 (indiscriminate)
Example of a parasitic infection
Neurocysticercosis
tapeworm in the brain caused by contact with pigs/ fecal matter
List two Neurotoxins
Mercury and Lead
