Neuro Flashcards
Neuro-System Health History
-Any changes in your ability to move around or ADLS?
-Any history of head or spinal cord injury?
-History of stroke?
-Medications
-Family history of neurological problems?
-Social history? Alcohol use?
-Previous neurological surgeries/procedures
-Proprioception chages?: Awareness of the body’s position and movement
Problem-Based History
Types of complaints
-Headache
-Seizure
-Altered LOC (level of consciousness)
-Change in mobility
-Change in sensation
-Dysphagia: difficulty swallowing
-Red flag “worst headache of my life” - Emergency get CT scan
Health Promotion
-Stroke prevention: Smoking
-TBI prevention: Helmets, safe driving, seatbelts
-Meningitis prevention: Vaccine
Neurological Anatomy
Anatomy Review - Central Nervous System (CNS)
-Brain
-Cerebrum
-Brainstem
-Cerebellum Spinal Cord
Peripheral Nervous System (PNS)
-Cranial Nerves: 12 pairs
-Spinal Nerves: 31 pairs
Autonomic Nervous System (ANS)
-Sympathetic Nervous System
Speed up, fight or flight
-Parasympathetic Nervous System
Slow down, breed and feed
What are the brain’s 3 major intracranial components?
Cerebrum, Brainstem, Cerebellum
Cerebrum
Right, and left cerebral hemispheres. If the stroke is on the right side, the left side of the brain is affected.
Brainstem
Connects brain to spinal cord
Cerebellum
Muscle movement, posture, equilibrium, and muscle tone
Dermatone Map
The map that indicates where spinal nerves innervate regions of the skin
Neurological Physiology
3 main functions
Sensory input
Integration of data
Motor output
Neurological Physical Assessment
Elements of Neurological Exam
-Mental status: mood, affect, LOC, A&O
-Cranial nerves
-Motor
-Sensory
-Reflexes
-Gait, balance, and coordination
Cranial Nerve 1
Olfactory (S)
Cranial Nerve 2
Optic (S)
Cranial Nerve 3
Oculomotor (M)
Cranial Nerve 4
Trochlear (M)
Cranial Nerve 5
Trigeminal (B)
Cranial Nerve 6
Abducens (M)
Cranial Nerve 7
Facial (B)
Cranial Nerve 8
Acoustic (S)
Cranial Nerve 9
Glossopharyngeal (B)
Cranial Nerve 10
Vagus (B)
Cranial Nerve 11
Spinal accessory (M)
Cranial Nerve 12
Hypoglossal (M)
Neurologic Assessment - Cranial Nerves
-Start with the patient seated and assess
Motor
Makes something move
Sensory
Perceives a sense
Parasympathetic
Response
CN I
-Olfactory
-Sensory Function: Smell
Occlude nostril one at a time and sniff
CN II
-Optic
-Sensory Function: Visual activity (Snellen chart), and visual fields
CN III
-Oculomotor
-Motor Function: Eye-opening (raising lid)
Extraocular Movements (H-Test)
-Parasympathetic: Pupillary constriction (PERLL, convergence, and accomodation)
CN IV
-Trochlear
-Motor Function: Downward, inner eye movements (EOM’s)
CN V
-Trigeminal
-Motor Functions: temporal and masseter muscles
-Sensory Functions: facial (ophthalmic, maxillary, mandibular), sharp and dull test
-Parasympathetic: saliva and tears
CN VI
-Abducens
-Motor Function: Lateral eye movement (EOM’s)
Also called 6 cardinal fields of gaze
CN VII
-Facial
-Motor Function: facial movement (ask the patient to smile, frown, puff cheeks)
-Sensory Function: Taste anterior 2/3 tongue
-Parasympathetic: Saliva and tears
CN VIII
-Acoustic
-Sensory Function: Hearing
Balance & Hearing: To check hearing perform Whisper Test. If abnormal, the goal is to distinguish the type of hearing loss using Weber and Rhinne testing
Rhinne: strike tunning fork, place on mastoid bone. Time until no longer heard. Move fork next to ear, time.
Normal= AC > BC
Weber: strike tunning fork, place in center of head. Can they hear it equally in both ears?
Normal= Heard equal in both ears
CN IX
-Glossopharyngeal
-Motor Function: Swallowing. Say “ah” also swallowing, both cause the soft palate rises to block nasal passages
-Sensory Function: Gag reflex
-Parasympathetic: Salivary glands
CN X
-Vagus
-Motor Function: Say “ah”
-Sensory Function: Gag reflex
-Parasympathetic: Heart, lung, and GI “vagal down” Vasovagal response
CN XI
-Spinal Accessory
-Motor Function: Sternomastoid (SCM) and Trapezius
CN XII
-Hypoglossal
-Motor Function: Tongue Movement
Motor
Observe and test muscle bulk, strength, and tone
0- Zero
No muscle contractoin is seen
1- Trace
Flicker or trace of contraction is seen
2- Poor
Active movement only with gravity eliminated
3- Fair
Active movement against gravity but no resistance
4- Good
Active movement against gravity with some resistance
5- Normal
Active movement against gravity with full resistance
Sensory- Tests that are done to make sure we can “feel” sensation
-Light touch
-Sharp v Dull
-Vibratory
Proprioception
Romberg test
Stereognosis
tests the individual’s ability to perceive and integrate a variety of sensory modalities and to interpret the stimuli to identify small objects placed in the hand
Two Point Discrimination
The ability to discern that two nearby objects touching the skin are truly two distinct points, not one
Graphesthesia
The ability to recognize symbols when they’re traced on the skin
Reflexes
The contraction of a muscle when a tendon is percussed
Tricep
hold arm, strike above elbow
Bicep
thumb on tendon, hold arm, strike your thumb with pointed end
Brachioradialis
hold arm strike 2 inches above wrist, either side of hammer
Patellar
sit, relax leg, strike below patella
Achilles
Knee 90 deg, dorsiflex foot, tap with flat end behind ankle, feel for “tap” of foot
Babinski
end of hammer, stroke lateral side of foot, toes dorsiflex adult
Deep Tendon Reflexes
-Issues with this are usually related to the spinal cord
-Asses with patient seated using a reflex hammer
-Pt may need a distraction
-Response to stimulation of tendon that communicates with the spinal cord (Peripheral Nervous System)
Deep Tendon Reflexes - Neurological Assessment
Scoring DTR
0= no response
1+ = sluggish or diminished
2+ = active or expected response
3+ = slightly hyperactive
4+ = brisk; hyperactive
Triceps Reflex
Cervical 6, 7
Biceps Reflex
Cervical 5, 6
Brachioradialis
Cervical 5, 6
Patellar Reflex
Cervical 2, 3, 4
Achilles Reflex
Sacral 1
Reflexes - Pediatric
Moro Reflex
-startle
-Birth to 1-4 months
Palmar Grasp
Birth to 3-4 months
Rooting Reflex
Tonic Neck
Birth to 6 weeks up to 4-6 months
Babinski Reflex
- Toes flare (opposite than adults)
-Birth-18 months
Step Reflex
Birth-3 months
Motor and Cerebellar Function
Motor Function
- Gait: Heel to toes walking and tandem walking
-Balance and Cerebellar Function: Cerebellum - coordination, balance, equilibrium, posture
-Muscle strength and Tone
Gait, Balance and Coordination
Multiple systems working together
- Heel strike, and tandem walking
Balance
-Rhomberg Test: stand feet together, arms to side, eyes open then close, then open = observes
-Positive Rhomberg: foot moved with eyes open and closed to keep balance. Suggests a cerebellar or vestibular issue
-Negative Rhomberg: no movement, sway, or fall
Rhomberg
Assesses balance
-Vestibular, proprioception, and cerebellar function
-Vision: eyes open first, close eyes, 30 seconds, provide support
Coordination - Cerebellar Testing
-Finger to nose
-Heel to shin
-Rapid alternating movements
-Gait
Sensory Function
Sensory Function- Peripheral Nerve Assessment
-Pain
-Temperature
-Light sensation
-Vibration: 1st lost in peripheral neuropathy
Additional Neuro Tests
-Stereognosis: Tactile recognition
-Two point discrimination: distinguish two points of stimuli
Common Neurological Disorders
Meningitis
Inflammation of the meninges that surround the brain and spinal cord
-Headache
-Fever
-Malaise
-Nuchal rigidity: very stiff neck
-Decreased LOC
Parkinson’s Disease
Chronic and Progressive: movement disorder resulting in decreased dopamine in the brain
-Resting tremors
-Bradykinesia: slow movement
-Rigidity
-Shuffling gait
-Finger pill rolling
Cerebral Vascular Accident (CVA)
-Stroke (CVA):
Mental status changes
Impaired orientation
Inability to follow commands
Slurred speech
Weakness
Numbness
-Transient Ischemic Attack (TIA)- mimics a stroke
Symptoms lasting less than an hour
No neurological impairment
Signs and Symptoms that could represent neurological issues
-Change in sensation
Numbness or tingling
Possibly chronic disease
-Dysphagia: difficulty swallowing
-Speech or communication: Aphasia
Receptive- Wernicke’s area
Expressive- Broca’s area
