Neuro Flashcards
Cranial nerve I
Olfactory nerve
- Relays sense of smell
Cranial nerve II
Optic nerve
- Relays visual information
- Visual field
- Acuity
Cranial nerve III
Oculomotor nerve
- Innervates eye muscles
- Eyelid elevation (prevents ptosis)
- Elevation, depression, adduction
- Pupil constriction
Cranial nerve IV
Trochlear nerve
- Innervates eye muscles
- Depression and abduction
Cranial nerve V
Trigeminal nerve
- Innervates muscles for chewing, biting, and rotary jaw movements
- Sensory branch innervates skin, mucous membranes, and sinuses of the face
Cranial nerve VI
Abducens nerve
- Eye abduction
- Accommodation for far vision
Cranial nerve VII
Facial nerve
- Facial expression
- Taste for anterior 2/3 of tongue
Cranial nerve VIII
Vestibulocochlear nerve
- Hearing
- Balance
- Postural control
Cranial nerve IX
Glossopharyngeal nerve - tested with cranial nerve X and associated with
- Gag reflex
- Blood pressure regulation
- Swallow
- Salivation
- Taste and sensation for posterior 1/3 of tongue
Cranial nerve X
Cranial nerve - tested with cranial nerve IX and associated with
- Gag reflex
- Blood pressure regulation
- Innervates pharyngeal and laryngeal muscles (Phonation)
- Parasympathetic innervation of chest and abdomen
Cranial nerve XI
Spinal accessory nerve
- Innervates sternocleidomastoid and trapezius for motor movements of shoulder and neck
Cranial nerve XII
Hypoglossal nerve
- Motor movement of tongue
Functions of frontal lobe
Emotional control
Impulse control
Motor function
Short-term memory
Initiation
Executive function
Social and sexual behavior
Functions of occipital lobe
Visual reception
Color recognition
Neurologic deficits associated with right hemisphere dysfunction
Left hemiparesis/plegia
Left sensory impairment
Unilateral body and spatial neglect
Left motor apraxia
Left visual field cut
Visuospatial problems
Attention deficits
Decreased insight into deficits
Left side motor and sensory impairment
Visual field deficits
Spatial neglect
Poor insight and judgment
Impulsive
Attention span
Initiating activities
Drawing
Remembering visual objects
Recognition of faces
Emotional stability
Neurologic deficits associated with left hemisphere dysfunction
Right hemiparesis/plegia
Right sensory impairment
Language impairment
Bilateral motor apraxia
Frustration
Right side motor impairment
Aphasia
Apraxia
Motor speech
Expressive speech
Emotional control
Understanding math
Writing
Proprioception
Reading numbers and letters
Recognizing objects
Remembering written information
Functions of the temporal lobe
Long term memory
Receptive language
Processing of auditory and visual sensory information
Function of parietal lobe
Integration of sensory information
Knowledge of numbers and their relations
Object manipulation
Visuospatial processing
Praxis
The motor speech system includes…
Cerebellum
Basal nuclei
Somatic muscles
Dysarthria
Incoordination and/or slowness of speech
Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them.
Aphasia
Absence of speech
Involves multiple anatomic regions
Can be a result of damage to any area of the cortex
The characteristics of the aphasia can reveal the area of the lesion
Broca’s aphasia
Middle cerebral artery serves this area.
Difficulty expressing thought
Nonfluent
Speaks slowly and with difficulty
Spoken and written language comprehension is relatively preserved
Repetition is poor
Wernicke’s aphasia
Unilateral lesion in the dominant hemisphere
Difficulty comprehending the spoken word and is unable to read
Even if speech is fluent the combination and order of the words is meaningless and makes no sense to him or others (fluent paraphasia speech)
Individual is unaware of his deficiencies.
Global aphasia
Unable to comprehend what he hears of reads
Cannot write
Unable to formulate normal language
Nonfluent
Apraxia of speech
Inability to execute
Neurological damage leading to apraxia of speech can occur in the following area:
- Broca’s area
- supplementary motor area
- insula (insular cortex)
- basal nuclei
Describe the function of Wernicke’s area.
Comprehension and formulation of language
Describe Broca’s area lesion.
Only uses main or necessary words of a sentence
Describe global aphasia lesion.
Unable to comprehend what he hears or reads, cannot write, and in addition is unable to formulate normal language
Anomic aphasia
Fluent
Word finding issues
Comprehension and repetition are good
Timeline after stroke
- Stroke occurs
- Hyperacute - first 24 hours
- Acute - 1-7 days
- Early subacute - 1 week - 3 months
- Late subacute - 3-6 months
- Chronic - 6+ months
Handling UE after stroke
Teach patient as early as possible proper positioning
Use gait belt or draw sheet instead of pulling on arm
Orthotics as needed
Avoid motions above 90 degrees unless there is scapular mobility
- No overhead pulleys
Encourage touching and handling of the extremity by the patient
- Self range
Use the limb
Modified Ashworth Scale
UMN symptoms
Spastic
Hypertonic
Hyperreflexic
Disuse atrophy
Positive babinsky
LMN symptoms
Flaccid
Hypotonic
Hyporeflexic
Denervation atrophy
Negative babinsky
Flexor reflex
Withdrawal reflex
Response of an entire limb to noxious stimulus resulting in flexion/ withdrawal
The flexor reflex is elicited by stimulation of cutaneous receptors and includes a reflex response across several joints involving an entire limb.
Crossed extension reflex
Maintains balance/posture
The crossed extension reflex occurs to maintain balance and upright posture following contact with a noxious stimulus.
The “crossed extension reflex” occurs in the contralateral limb that does not encounter the noxious stimulus.
Functions of the limbic system
Species preservation
Self preserfavtion
Expression of emotions and memory
Function of hypothalamus
Maintain homeostasis
- appetite
- fluid/electrolyte balance
- glucose balance
- metabolism
- sleep
- body temperature
Function of the thalamaus
Relay signals to:
- motor areas
- sensory areas
- speech and vision
Brown Sequard syndrome
Ipsilateral motor
- LMN paralysis at level of lesion
- UMN signs after first few days below level of injury followed by spastic paralysis
Sensory at and below level of lesion
- loss of pain, temp, and crude touch
- loss of sensory info from contralateral side of body
Sacral sparing
Can help diagnose whether any signals are passing an injured area of the spinal cord
Assessed by examining the sensation and contraction of the external anal sphincter and the skin around the anus.
Cerebellar dysarthria
Ataxic
A slowing down of articulatory movements, increased variability of pitch and loudness, monotonous and “scanning” speech, and articulatory impreciseness.
Neuroplasticity
the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury
Decorticate
Injury at the level of the cerebral cortex or below
- flex arms
Decerebrate
Injury at the level of the midbrain of below
- extension
Minimally conscious state
Patient is capable of some rudimentary behavior such as following a simple command
Always in an inconsistent way
Locked in syndrome
Only an inability of the patient to respond adequately with motor activity and speech
Akinetic mutism
Patient is motionless and mute
Catatonia
Individual appears unresponsive
Most often seen with psychosis
Which cranial nerves would be spared by brainstem damage?
Olfactory (CN I)
Optic (CN II)
Accessory (CN XI)
Paralysis vs. paresis
Paralysis - complete loss of muscular action
Paresis - muscle weakness or partial paralysis
CNS area involved in planning
cerebral cortex
CNS area involved in command
motor cortex (motor strip)
CNS area involved in organizing muscle groups
basal nuclei
CNS area involved in adjustment
cerebellum
CNS area involved in associations
brainstem
CNS area involved in pathways
spinal cord
CNS area involved in final transmission
peripheral nerves
Spasticity vs. rigidity
Spasticity: velocity related increase in tone
- hypereflexia
Rigidity: increased constant resistance to passive movement
- normal reflexes
Radial nerve
Innervates extensor wad
Responsible for wrist, thumb, and MP extension
Clinical presentation:
- Weakness of wrist dorsiflexion and finger extension, causing wrist drop and MP drop
Ulnar nerve
Ulnar n. in ulnar groove - funny bone
- innervates adductor pollicis long head
- flexes intrinsic and ulnar half of lumbricals
- Guyon’s tunnel
- when power comes from
Ulnar nerve palsy
Occurs due to compression at the elbow (cubital tunnel) or at the wrist (Guyon’s tunnel)
Muscle weakness and atrophy predominate the clinical presentation
If it gets trapped at the cubital tunnel, there will be numbness and tingling
Can cause ulnar claw hand
- caused by an imbalance between strong extrinsic muscles and weakened intrinsic muscles
- MCP hyperextension
- PIP and DIP flexion
Median nerve
Injury at elbow or wrist
Commonly compressed at the wrist causing carpal tunnel syndrome
Deformity or ape-like hand
- flat thenar eminence and adducted thumb
Opposition and abduction aren’t possible leading to loss of pincer-like action of hand
- difficulty with fine motor tasks like buttoning
Cause:
- paralysis and wasting of the muscles of the thenar eminence
- adductor pollicis is unopposed since it is supplied by ulnar n.
- opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis
Big driver of thumb flexion and adduction, except for deep adductor pollicis
If anterior interosseous n. injury is present, the patient will be unable to bring together the distal phalanx or thumb and index finger to make the OK sign.
