Nervous System Flashcards
upper motor neurons vs lower in cell bodies
upper – cerebral cortex
lower – spinal corn in ANTERIOR HORN
corticospinal tract
mediate voluntary movement, also integrate skilled, complicated movements
carry impulses that INHIBIT muscle tone
spinothalamic tract
SENSORY pathway
pain temperature and touch
posterior column
SENSORY pathway
position, propioception, vibrationo, pressure and fine touch
mental status
A + O X 3
- awake and oriented THREE TIMES
- say is patient awake and oriented
self – know their name
place
time
mental status
A + O X 3
- awake and oriented THREE TIMES
self – know their name
place
time
ankle reflex
sacral 1 primarily
ankle rested and hit from behind
example of deep tendon reflex
knee reflex
deep tendon reflex
lumbar 2,3,4
extremity must be hanging
biceps reflex
C 5 and 6
example of deep tendon reflex
patient can be sitting or lying down
finger over the brachial tendon
trriceps reflex
C 6 and 7
crnaial nerves to check
I, II (visual acuity check) , III, IV (superior oblique movement) ,V
light reflex
CN III - do you get constriction of pupil with light reflex?
keeps it open
- if harmed then get ptosis – drooping of eyelid
physical exam standpoint with eye
III, IV, or VI
patient cant do something - that nerve is effected - then do more tests to determine if muscle or nerve
CN VI
ABDUCENS
lateral rectus
EOM - how can check this
muscle activation determined on level of
0-5
deep tendon relfexes
ankle, biceps, knee
deep tendon relfexes
ankle, biceps, knee
biceps reflex gets
C5 and 6
deep tendon relfexes graded on scale of
0-4+
4+ with deep tendon
very brisk hyperactive with clonus
3+ with deep tendon reflexes
brisker than average
2+?
average response with deep tendon reflex
1+
somewhat diminshed with deep tendon relfexes
1+
somewhat diminshed with deep tendon relfexes
glasgow coma scale
used to evaluate the level of consciousess following a traumatic brain injury
score is based on: eye opening (4 points )
verbal response (5 points)
motor response (6 points)
three things examines
best score = 15
worst score = 3
=<8 = coma
glasgow coma scale lowest score
3 (1 of each)
best score = 15
8 or below = coma status
eye opening in terms of glasgow coma scale
4 points response
4 – spontaneous (best)
3 = to voice
2 = to pain
1 = none
verbal with glasgow coma scale worth
5 points
5 = normal conversatino (best)
4 = disoriented conversation
3 = words but not coherent
2 = NO words only SOUNDS
1 = none
motor response in terms of glasgow coma scale
6 points total
6= obeys commands
5= localizes to pain
4= withdraws to pain
3= FLEXION to pain
2= EXTENSION to pain
1= no motor response
sucking and snout reflexes
special techniques / specific signs
more utalized in infants
sucking reflex
suckin movement of an infant’s lips elicited by touching them or adjacent skin
snout reflex
a pouting or pursing of the lips that is caused by light tapping of the closed lip near the midline
gray matter
consists of aggregations of neuronal cell bodies
rims surfaces of cerebral hemispheres - forming cerebral cortex
deep in brain
- basal ganglia
- thalamus
- hypothalamus
basal ganglia - general
deeper cluster of gray matter and effects movement
thalamus - general
deeper cluster of gray matter and processes sensory impulses and relays to the cerebral cortex
hypothalamus - general
deeper cluster of gray matter and maintains homeostasis and regulates temperature, HR, BP,
-releasing factors at directly on the pituitary gland
white matter - basic
neuronal AXONS that are coated with myelin - give the color
cerebellum basic function and locatrion
lies at the base of the brain and coordinates all movement and helps maintain the body upright in space
axons in upper vs lower motor neuron
upper
- synapse in brain (CN), spinal tract (PN)
lower
- terminate at NMJ
lesions in upper motor neuron
- spasticity and rigidity
- increase deep tendon reflexes
- extensor plantar response
lesions in lower motor neuron
weaness, loss of reflexes, muscle wasting
tract that can carry impusles that inhibit muscle tone
corticospinal tract
corticobulbar associated with
CN - motor pathway
extrapyrimadal system
maintains muscle tone and control body movement - like walking
basal ganglia pathway responsible for
automatic movements
cerebellar system - general
coordinates muscle activity, equilibrium, control posture
one to note if basal ganglia pathway affected
parkinsonism
one eto note if cerebellar system affected
nystagmus
upper motor neuron systems are damaged ABOVE THE CROSSOVER OF ITS TRACT IN MEDULLA (still in brain) ….
motor impairment develops on the OPPOSITE / CONTRALATERAL SIDE
upper motor neuron systems are damaged BELOW THE CROSSOVER, …
motor impairment occurs on the SAME SIDE / IPSILATERAL side of the body
two main sensory pathways
spinothalamic and posterior column
reflex - basic
affarent sensory — posterior root ganglion — anterior horn cell — anterior root – efferent motor fiber
chec CN V
trigeminal
since it controls muscles of mastication and sensation to face and oral cavity we can test stregth of muscles of mastication and sensation and corneal relfex
corneal reflex
associated with CN V
- have to touch the cornea NOT the sclera
CN III palsy
patient cannot move eye up and in
- controls the inferior oblique
so patient looing STRAIGHT ahead – unable to move eye in that direction hence the CN III palsy
CN VI
abducent – lateral recture
do an EOM
Cn VII
function - facial movement, taste of anterior 2/3
examine in 5 dimensions
VIII
vestibulo-cochlear –> hearing and balance
gross hearing test
CN IX
glossopharyngeal
- sensory to pharynx and posterior 1/3 of tongue and tympanic membrane
secretory to parotid
gag reflex - say ‘AH’
examine CN IX by
also examines?
gag relfex - say ‘AH’
CN X - vagus
test ___ with head rotation against resistance , shoulder elevation
CN XI – spinal accessory as it innervates SCM and trapezius
CN XII
hypoglossal – motor to tongue
examine by midline protrusion
midline protruion examines
hypoglossal nerve – CN XII
motor system exam numbers
0-5
graded based on a five , 5/5 or 3/5
motor test of 3
active movement against gravity
BUT CAN NOT resist additional pressure
motor test of 5
active movement against gravity with FULL RESISTANCE to normal motor strength
motor test of 4
movement against gravity with resistance
motor test 2
active movement of the body with GRAVITY ELIMINATED
motor test 1
barely detectable flicer or contraction
motor test 0
no muscular contractino detected
sucking and snout reflex normal in?
infants – NOT in adults
bell’s palsy
lower portion of face recieves from opposite side
peripheral lesion
- takes out that whole one side
CN VII –> takes it ALL out on that side
- lower portion is only from opposite side
central lesion
- still have some from the ipsilateral side
- maintain some of the UPPER portion
- still have connection of ipsilateral side not beig knocked out
meningeal signs
brudzinski sign
kernig’s sign
brudzinski sign
flexion of the neck toward the chest causes the patient to flex his hips and knee
seen in patients with meningitits
what is seen in patients with meningitis
brudzinski signs
- flexion of the neck toward the chest causes patient to flex hips and knees
kernig’s sign
seen in patients with meningitis
inability to straighten the leg when the hip is flexed to 90 degrees
plantar response
stimulation of the outside of the sole, results in plantar flexion of the big toe
so like points toes downwards – normal response
babinski reflex
abnormal plantar response
stimulation of outside of the sole results in dorsi-flexion (flexes toward TOP of the foot) of the big toe
babinki reflex can be normal in?
children younger than 2
babinski reflex implication
abnormal
POSITIVE = abnormal = babinski
plantar reflex response AFTER the age of 2
- indicated a CNS lesion in the CORTICOSPINAL TRACT
