Neuro Flashcards
Frontal lobe
problem solving, emotional traits, reasoning, speaking, voluntary activity
temporal lobe
understanding, behaviour, memory, hearing
Brainstem
breathing, body temp, digestion, alertness/sleep, swallowing
Cerebellum
balance, coordination and control of voluntary movements, fine muscle control
occipital lobe
vision, color perception
Parietal lobe
knowing right from left, sensation, reading, body orientation
Central nervous system involves
spinal cord, brain, cerebrum, brainstem, cerebellum
Peripheral nervous system
Somatic (Voluntary) sensory and motor
Automatic: sympathetic (fight or flight) Parasympathetic (maintain normal body function)
(includes all the the nerves that branch out from the brain and spinal cord and extend to other parts of the body muscles and organs) sends info to spinal cord
Brain cerebrum includes
2 hemispheres, 4 functional lobes
what does the cerebrum control
sensory, touch, sight, hearing, taste, smell, voluntary movement, learning, memorizing, language, speech, personality
What are the 4 lobes in brain cerebrum
frontal, temporal, parietal and occipital
Wernicke area
Area in temporal lobe assoc. with language comprehension
If damaged will cause ‘Receptive Aphasia’
Person hears language but sounds like foreign language
Brocas area
In frontal lobe
Mediates motor speech
When injured “Expressive Aphasia” results
Persons knows what they want to say and understand but it comes out garbled.
Midbrain contains
-motor and sensory tract
-neurons that produce dopamine
-cranial nerves CNIII, CNIV
Pons
Involved in skeletal muscles for breathing
-contains CNV, CNVI, CNII, CNVIII
Medulla
involved with atomic functions like breathing, BP, digestion, sneezing, swallowing
-sensory and motor neurons
CN VIII, CN IX, CNX, CNXI, CNXII
The spinal cord contains
Ascending and descending fibre tract, nerve cell bodies with anterior posterior horns, sensory pathways, motor pathways
Acending tracts are
sensory – deliver info to brain
Descending tracts are
motor – deliver info to periphery
Left cerebral cortex
receives sensory info from and controls motor function to the right side of the body
Right cerebral cortex
receives sensory info from and controls motor function to the left side of body
There are sensory receptors in
skin, mucous membranes, muscles, tendons & viscera
Where do sensations travel through
the afferent fibers in the peripheral nerve, then through the posterior root to the spinal cord
2 pathways in the spinal cord
spinothalamic tract, Posterior dorsal
spinothalamic tract
Fibres that transmit sensations: pain, temp, light or crude touch
Posterior dorsal
Fibres that conduct position, vibration, finely localized touch
Somatic nervous system
directs contraction of skeletal muscle
Automatic nervous system
directs the activity of glands, smooth muscle, and cardiac muscle
4 types of reflexes
deep tendon
superficial
visceral
pathological (abnormal)
what part of the nervous system are reflexes involved in
peripheral
what is happening when tapping of tendons happen
Tapping tendon activates the sensory afferent nerve – message travels through the dorsal root into spinal cord and synapse directly with the motor neuron = travels to muscle to stimulate contraction
why do we assess reflexes
intact sensory nerve (afferent)
- functional synapse in the cord
- intact motor nerve fiber (efferent)
- a neuromuscular junction
- competent muscle
- reveals the intactness of reflex arc at specific spinal levels
Visceral reflexes
Monitored & mediated by autonomic nerves & initiated in the viscera (internal organs eg. peristalsis
Superficial reflex
abdominal and plantar
Deep tendon reflex
“Normal response”
-Bicep
-Tricep
-Quad
-Achillies
Bicep reflex
(intactness of the reflex arc at spinal levels C5 to C6)
Response: contraction of bicep muscle & flexion of forearm
Tricep reflex
(intactness of the reflex arc at spinal levels C7 to C8)
-response is extension of forearm
Quadracep reflex
(intactness of the reflex arc at spinal levels L2 to L4)
Response: extension of lower leg & contraction of quadricep
Achillies reflex
(intactness of the reflex arc at spinal levels L5 to S2)
Response: foot plantar flex
DTR scale (rate reflex)
4+ very brisk, hyperactive with clonus – disease (upper motor neuron disease)
3+ brisker than average, may indicate disease
2+ average, normal
1+ diminished, low normal
0 no response (lower motor neuron disease)
Abdominal reflex
T8-T10 above umbilicus
T10-T12 below umbilicus
Superficial plantar response
(L4-S2)
Plantar flexion
Babski response
Dorsi flexion of toe can indicate upper motor neuron disease
Dermatones
Sensory nerves gives sensation to the skin which are called dermatomes
Dermatomes exist for each spinal nerve
Sensory info from a specific dermatome is transmitted by a sensory nerve fiber to spinal nerve of a specific segment of the spinal cord
Cranial nerve I
Olfactory
Craial nerve II
Optic
cranial nerve III
Oculomotor
Cranial nerve IV
Trochlear
Cranial nerve V
Trigeminal
Cranial nerve VI
Abducens
Cranial nerve VII
facial
Cranial nerve VIII
Acoustic
Cranial nerve IX
Glossopharyngeal
Cranial nerve X
Vagus
Cranial nerve XI
Spinal accessory
Cranial nerve XII
hypoglassal
cranial nerves in Cerebral hemisphere
I, II
Cranial nerves in midbrain
II, IV
Cranial nerves in Pons
V, VI, VII, VIII
Cranial nerves in Medualla
IX, X, XI, XII
How to test Cranial nerve I (olfactory)
(sensory)
Assess nasal patency, one nare at a time.
Occlude one nostril and present a scent (i.e. toothpaste)
How to test Cranial nerve II: Optic
(sensory)
Test vidual acuity snellen eye, confrontation test, peripheral vision
How to test cranial nerves III, IV, VI
III (mixed)
IV (motor) down and up
VI (Motor) lateral
Eye movements
Assess pupils
How to test cranial nerve V
Light tough sensation by brushing cotton on forehead, (opthamlic division of the trigeminal nerve), cheeks (maxillary division) and chin (mandibular division)
How to test VII
(facial)
Mobility and facial symmetry
How to test cranial nerve VIII
Acoustic sensory
Whisper voice test
test IX and X
Motor: Depress the tongue w/ a tongue blade and note pharyngeal movement (ahhhhh, or yawns).
Uvula and soft palate should rise at midline and tonsillar pillars should move medially.
Touch posterior pharyngeal wall w/ tongue blade – note gag reflex.
Sensory: Taste on posterior 1/3 of tongue. Too difficult to test.
Testing Cranial nerve XI
Examine sternomastoid muscle and trapezius muscles for equal size & strength
Ask patient to rotate head forcibly against resistance applied to the chin
Ask patient to shrug shoulders against resistance.
cerebellar functions tests for balance
Gait
Tandem walking (heel to toe walking)
Romberg test
Shallow knee bend
Cerebellar tests for coordinations
Rapid alternating movements – pat knees w/ back of the hands and pad of hands
or you can:
Touch thumb to each finger on same hand
Finger-to-finger test – Patient eyes are open and they reaches out to touch your finger and then to his/her own nose
Finger-to-nose test - Patients eyes are closed and stretch arms forward, repeatedly touch their own nose, alternating hands
Heel-to-shin test – Patient supine, run heel up along opposite shin
when testing sensory system make sure:
Person is alert, cooperative, and comfortable
Adequate attention span
Compare side to side
Avoid leading questions (i.e. “Can you feel that light feather?”
Eyes should be closed
Tactile discrimination (Fine touch) Tests
Stereognosis – object recognition
Graphesthesia – read a number tracing
Position (kinesthesia)
ability to perceive passive movement – move finger/toe up or down & ask which way it is moved (pt has eyes closed)
Common neurological problems in elderly
Epilepsy, stroke, Parkinson’s disease, dementia & Alzheimer’s are increased in older adulthood.
Falls are common, followed by car accidents
Language changes, hearing loss, taste and smell changes
Balance & emotional changes - Difference in gait