Nervous System Flashcards
Motor Pathway (also known as Corticospinal or Pyramidal Pathway) have what kind of effect on lower motor neurons?
Inhibitory
Damage to the Corticospinal Tract System would cause what?
Weakness
Damage to this system could cause: rigidity, slowness of movement (bradykinesia), involuntary movements, and or disturbances in balance and gait.
Basal Ganglia System
Damage to this system could cause: impaired coordination (ataxia) gait equilibrium, and decreased muscle tone. Nystagmus and dysarthria (difficulty of speech) may also be present.
Cerebellar System
Damage of what neurons would cause INCREASED muscle tone and HYPER-reflexia.
Upper Motor Neuron damage
Damage of what neurons would case DECREASED muscle tone, HYPO-reflexia, atrophy, and fasciculations (involuntary twitches in a small area).
Lower Motor Neuron damage
Sensory pathway that detects pain, temperature and crude touch.
Spinothalamic Tract
Sensory pathway that detects proprioception (sense of body movement), vibration, kinesthesia, pressure, and fine touch. (Dorsal Root Ganglion)
Posterior Column System
Two important questions to consider when taking a health history of the nervous system.
- Localization of the responsible lesion
- Underlying Pathophysiology
- Pattern of Symptoms
- Time course of Symptoms
Type of headache WITHOUT an identified underlying disease
- Migraine
- Tension Headache
- Cluster Headache
- Trigeminal Autonomic Cephalgias
- Chronic Daily Headache
Primary Headache
Type of headache WITH an identified underlying disease (Sudden and Severe)
- Meningits
- Subarachnoid Hemorrhage
- “Worst headache of my life”
- Thunderclap
Secondary Headache
Dizziness or lightheadedness may be a sign of what three things?
Vestibular Disease
Vertebrobasilar TIA
Stroke
Feeling faint or like you are about to pass out.
Pre-syncope
Unsteady or off balance.
Ataxia
Disequilibrium
Spinning sensation within patient or of their surroundings.
Vertigo
An actual loss of strength.
Weakness
What are some pathologies that may cause weakness?
TIA
Stroke
Guillan-Barre
Myopathies
Myasthenia Gravis
Polyneuropathy
What are some pathologies that may cause numbness, or sensations that are abnormal or absent?
Herniated Disc
Stroke
Multiple Sclerosis
Diabetes
Pins and needles sensation.
Paresthesia
Distorted sensations
Dysesthesia
Reduced or complete loss of sensation
Hypoesthesia (reduced)
Anesthesia (complete)
What is the most common cause of syncope?
Vasovagal Syncope
A sudden, but temporary loss of consciousness and postural tone from transient hypo perfusion of the brain.
True Syncope
A sudden excessive electrical discharge from cortical neurons.
Seizure
2+ seizures that are not provoked by other illnesses or circumstances.
Epilepsy
What pathologies may cause tremors or involuntary movements?
Parkinson’s Disease
Essential Tremor
Restless Leg Syndrome
Smell Test
CN I - Olfactory
Visual acuity test. Ishihara. Snellen/Rosenbaum. Direct pupillary light reflex. Near test, near far test. Static Wiggle. Ocular Fundi.
CN II - Optic
Big H. Consensual Pupillary Light Reflex. Hirshberg’s Corneal light reflex (cover, uncover).
CN III - Oculomotor
(AO3)
Moves eyes towards nose. Big H.
Possible contralateral head tilt.
CN IV - Trochlear
(SO4)
Sharp and dull x3. Corneal Reflex. Clench Teeth and feel temporal and masseter muscle.
CN V - Trigeminal
Moves eyes away from nose. Big H
CN VI - Abducens
(LR6)
Squeeze eyes with resistance, raise your eyebrows. Show teeth. Smile, frown. Puff cheeks.
CN VII - Facial
Whisper Test. Weber and Rinne. Finger Rub.
Coma –> Caloric & dolls eye test.
CN VIII - Vestibulocochlear
Taste and Gag Reflex
CN IX - Glossopharyngeal
Gag reflex and movement of soft palate. Activates parasympathetic nervous system. Responsible for VasoVAGAL syncope.
CN X - Vagus
Turn head and shrug shoulders against resistance.
CN XI - Spinal Accessory
Stick out tongue and move it side to side.
CN XII - Hypoglossal
Test used to check for corticospinal tract lesion in the contralateral hemisphere. Both arms are held up with the palms supinated.
Pronator Drift
(Abnormal = Hands Drift Down or Pronates)
Active movement against full resistance without evident fatigue.
Grade 5
(Normal Muscle Strength)
Active movement against gravity and some resistance.
Grade 4
Active movement against gravity.
Grade 3
Active movement of the body part with gravity eliminated (planar motion).
Grade 2
A barely detectable flicker or trace of contraction.
Grade 1
No muscular contraction detected.
Grade 0
Inability to perform rapid and coordinated successive movements.
Rapid Alternating Movements
(Dysdiadochokinesia)
- Rapid Alternating Arm Movements
- Rapid Finger Tapping
- Tapping balls of foot
Lack of coordination of movement typified by the undershoot or overshot of intended position.
Point-to-Point Movements
- Finger to Nose Test
- Heel to Shin Test
Shoulder Abduction
C5
C6
Elbow Flexion
C5
C6
Elbow Extension
C6
C7
C8
Finger Extension
C7
C8
Radial Nerve
Wrist Extension
C6
C7
C8
Radial Nerve
Finger Abduction
C8
T1
Ulnar Nerve
Thumb Abduction
C8
T1
Median Nerve
Hip Flexion
L2
L3
L4
Hip Adduction
L2
L3
L4
Hip Abduction
L4
L5
S1
Hip Extension
S1
Knee Extension
L2
L3
L4
Knee Flexion
L5
S1
S2
Foot Dorsiflexion
L4
L5
Foot Plantar Flexion
S1
Biceps Flexion
C5
C6
Brachioradalis
C5
C6
Triceps
C6
C7
Knee Extension
L2
L3
L4
Grab big toe and move it up and down. First with eyes open and next with eyes closed.
Proprioception
- Syphilis
- Multiple Sclerosis
Identify an object held in the hand
Stereognosis
(Diabetic Neuropathy)
Identify number drawn in hand
Graphesthesia
(Diabetic Neuropathy)
Smallest distance between 2 points with perception of both distinct stimuli.
Two-Point Discrimination
Tuning fork (128 Hz) tap on hand and place the tuning fork on DIP joint in the finger and Big Toe IP Joint.
Vibration
- Peripheral Neuropathy
- Posterior Column Disease
Difficulty standing with feet together with the eyes either opened or closed would indicate what?
Cerebellar Ataxia
Patient should first stand with feet together and eyes open and then close both eyes for about 30 seconds without support. Used to test their sense of position.
Romberg Test
Walk heel-to-toe (sobriety test)
Ataxia
Walk on heels and toes
Distal Leg Weakness
Casual walk
Ataxia
Rise from sitting position without pushing up.
Proximal Weakness (Hip Extensors)
Quadriceps (Knee Extensors)
Very brisk reflex, with clonus (rhymes oscillations between flexion and extension)
Reflex Grade: 4
Brisker than average reflex; possibly but not necessarily indicative of disease.
Reflex Grade: 3
Average or normal reflex.
Reflex Grade: 2
Somewhat diminished reflex, or requires reinforcement.
Reflex Grade: 1
Absent reflex.
Reflex Grade: 0
Hyperactive (hyperreflexia) may indicated what kind of lesion?
CNS Lesion
Hypoactive (hyporeflexia) may indicate what kind of lesion?
PNS Lesion
Contraction of muscles and deviation of umbilicus towards stimuli.
Abdominal Reflex
Stroke lateral aspect of the sole from the heel to the ball of the foot.
Babinski Sign
(Dorsiflexion of Toes and Flaring Out = Positive)
Stroke anus on both sides, watch for reflex contraction of external anal sphincter.
Anal Reflex
- Absence suggests lesion of S2 - S4
- Cauda Equina Lesions
With the patient supine, flexion the neck forward for the chin to touch the chest.
Brudzinski Sign
(Flexion of Hip and Knees = Positive Test)
Flex patient’s leg at the hip and knee. Then slowly extend leg to straighten the knee.
Kernig Sign
(Pain and Increased Resistance = Positive Test)
Patient’s hands are in the “stop” position while extending both arms. Wrists are dorsiflexed and fingers spread. Wait 1 - 2 minutes.
Asterixis
(Flapping Tremor) - Metabolic Encephalopathy
GCS - Eyes
4 Points
- Spontaneously
- To Command
- To Pain
- No Response
GCS - Verbal
5 Points
- Oriented Conversation
- Disoriented Conversation
- Inappropriate Words
- Inappropriate Sounds
- No Response
GCS - Motor
6 Points
- Obeys Verbal Orders
- Localizes Pain
- Withdraws from Pain
- Flexion with Pain
- Extension with Pain
- No Response
What two things should you not do when assessing a comatose patient?
Don’t dilate the Pupils
Don’t flex the neck
Eyes move in the opposite of the direction that the head is being turned.
Doll’s Eye Movement Test
(Eyes moving in opposite direction of head turn)
= Intact Brainstem
COWS Nystagmus
Cold Opposite
Warm Same
- Detects intact brainstem
- Fast Phase
CSWO Initial
Cold Same
Warm Opposite
- Initial Phase