Neuro Flashcards
in an action potential, which ion flows in and which flows out of the cell?
Na+ in; K+ out
Na+ perm inc, repolarization by activation of K+ chan
resting membrane potential of a nerve cell
-70mV
CN I and test
Olfactory, Sensory, smell!
CN II and test
Optic, Sensory
visual acuity
visual fields
pupil light reflex
CN III and test
Oculomotor, motor/parasymp
eye mvt: up, down, in
pupil light reflex
CN IV and test
Trochlear, motor eye mvt (down & in)
CN V and test
Trigeminal, both
Sensory: face and cornea
Motor: temporal and masseter
corneal reflex ipsi
CN VI and test
Abducens, motor eye mvt (out)
CN VII and test
Facial, both/parasymp
facial expression
CN VIII and test
Vestibular, sensory
finger rub, weber fork on head, rinne on bone & front of ear
CN IX and test
Glossopharyngeal, both/parasymp
voice quality, uvula deviation
gag reflex
CN X and test
Vagus, both/parasymp
Palate and pharynx control
gag reflex
Arthrogryposis
nonprogressive, nongenetic, congenital disorder; rigid joints of extremities, weak/nonfunctioning mm
Gout has elevated serum levels of:
deposits crystals where?
Uric Acid;
deposits urate crystals in joints, soft tissue, kidney
symptoms of gout (location, pain, etc)
feet: toe, ankle, midfoot
night pain, warmth, erythema, tenderness
Tx for gout
anti inflam, colchicine, diet, allopurinol
ITB syndrome associated with hip IR or ER in stance
IR
Pivot shift test
ACL integrity
Valgus F and IR tibia, slowly flex knee, (+) is when tibia starts in anterior subluxed pos’n and returns to neutral around 30 deg
noble compression test
ITB friction synd: press prox to lat fem condyle, extend knee, pain before 30 deg (+)
myositis ossificans Tx
AROM and AAROM, no passive stretching
anosmia - what is it?
inability to detect smells CN I
Myopia - what?
impaired far vision
presbyopia - what?
impaired near vision
Homonymous Hemianopsia
CN II half of vision is impaired in ea eye, contra to lesion
anisocoria
unequal pupils
Strabismus
eye deviates from normal position
esotropia
eye pulled in, CN VI
Bell’s Palsy - CN?
VII
Dysphonia - what is it?
hoarseness, vocal cord paralysis
dysphagia - what is it? CN?
difficulty swallowing, CN IX, X
Dysarthria - what? CN?
articulation, CN X, XII
Broca’s aphasia aka & where?
nonfluent, expressive, L frontal lobe
Wernicke’s aphasia aka & where?
fluent, receptive, L temporal lobe
Cheyne-stokes respiration - what and where?
10-60s apnea then increasing depth & freq of breaths; frontal & diencephalic
hyperventilation - where in the brain?
midbrain and pons
temperature is controlled in
hypothalamus
Kernig’s sign
90-90 test, if B cause pain= meningeal irritation
brudzinski’s sign
flex neck, hips & knees flex
Which is faster and worse: bacterial or viral meningitis?
bacterial
increased intracranial pressure effect on BP, HR, temp
inc BP, dec HR, inc temp
intracranial pressure signs
HA, vomit (CNX) pupil change (CNIII), papilledema
spmatognosia
body scheme disorder
anosognosia
denial/unaware of issue
agnosia
inability to recognize objects c one sense, can recognize c another sense
apraxia
inability to perform voluntary, learned mvts
Modified ashworth scale
spasticity 0 1: end ROM 1+: <1/2 ROM 2 3 4: rigid
decerebrate rigidity - what and where
rigid extension, lesion bet sup colic & vestib nuc
decorticate rigidity - what and where
UE flexion, LE ext
lesion above sup colic
opisthotonos
head back, arch back
meningitis, tetanus, strychnine, epilepsy
chorea
relatively quick twitches/dance
athetosis
slow, irreg twisting sinuous
cerebellar disorder - what kind of tremor?
intention tremor
CTSIB - dependent on vision is unstable in
EC, Stable surface
visual conflict, stable surf
EC, moving surf
VC, moving surf
CTSIB - dependent on somaotsens is unstable in
EO, moving surf
EC, moving surf
VC, moving surf
CTSIB - vestib loss is unstable in
EC, moving surf
visual conflict, moving surf
CTSIB - sensory selection problems unstable in
visual conflict, stable surf
EO, moving surf
EC, moving surf
VC, moving surf
LP normal csf amount, pressure, protein
90-150mL
90-180 mm H2O
15-45 mg/dL
fibrillation is? means?
spontaneous contraction of individ mm fiber,
denervation for 1-3 wks
fasciculation is? means?
spontaneous contraction of all/most fibers in motor unit,
LMN disorders & denervation
complete LMN lesion will show fib or fascic?
fibrillation only
Partial LMN lesion will show fib or fascic?
Both
akinesia
inability to initiate mvt
Broca’s aphasia accompanied by
object naming, writing, R hemiplegia usu
Wernicke’s aphasia accompanied by
auditory comprehension, reading, writing, word recognition
ideational apraxia
person doesn’t get the idea of how to do a task
idomotor apraxia
person can’t do task on command, but can do spontaneously
steriognosis
recognize object by touch
ataxia
uncoordinated mvt - esp gait
morton’s neuroma
excessive pronation causes compression bet 3rd & 4th toes, metatarsalgia, enlarged n
somatognosia
lack of awareness of relationship of own body parts or other’s body parts
apneustic breathing
prolonged inspiration, damage to upper pons
jaw reflex - what n?
CN V - trigeminal
Hamstrings DTR - what n?
L5-S3?
abdominal reflex
stroke lateral to medial toward umbilicus in 4 quadrants, should deviate toward stimulus; T6-L1
Cremasteric reflex
L1-L2; stroke skin prox and medial thigh = elevation of testicle
ATNR
rotation of head = flexion of back limbs and ext of front limbs
STNR
flexion of head = flexion of UE/ext LE
ext of head = ext of UE/ Flex LE
positive supporting reflex
contact to ball of foot in stancing = rigid ext of LE
associated reactions
strong voluntary mvt = involuntary mvt of another extremity
DMD weakness progresses in what direction?
prox to distal
DMD posture, issues in what mm?
heel cord contracture, TFL, lumbar lordosis, kyphoscoliosis
peds: fwd walker encourages what posture
forward leaning of trunk
peds: posterior walker encourages what posture/mm activation
trunk extension, sh depression, elb ext, neutral wrist, dec scissoring in LE
Tonic Labyrinthine reflex
The tonic labyrinthine reflex is stimulated through the labyrinth in the inner ear. If the infant is in a supine position, the body and extremities are held in extension; in a prone position, the body and extremities are held in flexion. This reflex not only interferes with the ability to roll, but also the ability to prop on elbows, balance in sitting, and attain an upright posture from a supine position. Integration of the reflex is often associated with the ability to roll from supine to prone.
Signs and symptoms of unilateral vestibular dysfunction
Abnormal VOR produces nystagmus, loss of gaze stabilization during head movements, oscillopsia. Veering to one side when walking shows abnormal vestibulospinal function
BPPV signs and symptoms
episodic vertigo, nausea, blurred vision and autonomic changes that occur with head movement and usually stop after 30 seconds of static head position
Acoustic Neuroma
benign tumor affecting CN 8. Progressive hearing loss, tinnitus, and disequilibrium.
Meniere’s disease signs and symptoms
nausea, vomiting, episodic vertigo, and fullness in the ear with low-frequency hearing loss
CN XI and test
Spinal accessory, motor
Trap and SCM muscles
shrug shoulders or turn head against resistance
CN XII and test
Hypoglossal, motor
tongue movements
Posterior cord syndrome
A relatively rare syndrome that is caused by compression of the posterior spinal artery and is characterized by loss of pain perception, proprioception, two-point discrimination, and stereognosis. Motor function is preserved.
Brown-Sequard’s Syndrome
An incomplete lesion usually caused by a stab wound, which produces hemisection of the spinal cord. There is paralysis and loss of vibratory and position sense on the same side as the lesion due to the damage to the corticospinal tract and dorsal columns. There is a loss of pain and temperature sense on the opposite side of the lesion from damage to the lateral spinothalamic tract.
Cauda equina syndrome
An injury that occurs below the L1 spinal level where the long nerve roots transcend. Cauda equina injuries can be complete, however, they are frequently incomplete due to the large number of nerve roots in the area. A cauda equina injury is considered a peripheral nerve injury. Characteristics include flaccidity, areflexia, and impairment of bowel and bladder function. Full recovery is not typical due to the distance needed for axonal regeneration.
Central cord syndrome
An incomplete lesion that results from compression and damage to the central portion of the spinal cord. The mechanism of injury is usually cervical hyperextension that damages the spinothalamic tract, corticospinal tract, and dorsal columns. The upper extremities present with greater involvement than the lower extremities and greater motor deficits exist as compared to sensory deficits.
Anterior cord syndrome
An incomplete lesion that results from compression and damage to the anterior part of the spinal cord or anterior spinal artery. The mechanism of injury is usually cervical flexion. There is loss of motor function and pain and temperature sense below the lesion due to damage of the corticospinal and spinothalamic tracts.
Frontal lobe
Function
voluntary movement, intellect, orientation
Brocaʼs area (typically located in the left hemisphere): speech, concentration
personality, temper, judgment, executive functions
Impairment
contralateral weakness perseveration, inattention personality changes, antisocial behavior Brocaʼs aphasia (expressive deficits) delayed or poor initiation; emotional lability
Parietal lobe
Function
associated with sensation of touch, kinesthesia, perception of vibration, and temperature
receives information from other areas of the brain regarding hearing, vision, motor, sensory, and memory
interprets language and words
spatial and visual perception
Impairment
dominant hemisphere (typically located in the left hemisphere): agraphia, alexia, agnosia
non-dominant hemisphere (typically located in the right hemisphere): dressing apraxia, anosognosia
contralateral sensory deficits
impaired language comprehension
Temporal lobe
Function
primary auditory processing and olfaction
Wernickeʼs area (typically located in the left hemisphere): ability to understand and produce meaningful speech, verbal and general memory, assists with understanding language
the rear of the temporal lobe enables humans to interpret other peoplesʼ emotions and reactions
Impairment
learning deficits Wernickeʼs aphasia (receptive deficits) antisocial, aggressive behaviors difficulty with facial recognition difficulty with memory, memory loss inability to categorize objects
Occipital lobe
Function
main processing center for visual information
processes visual information regarding colors, light, and shapes
judgment of distance, seeing in three dimensions
Impairment
homonymous hemianopsia
impaired extraocular muscle movement and visual deficits
reading and writing impairment
cortical blindness with bilateral lobe involvement
Fasciculus Cuneatus (posterior or dorsal column)
Ascending
Sensory tract for trunk, neck, and upper extremity proprioception, vibration, two-point discrimination, and graphesthesia
Fasciculus Gracilis (posterior or dorsal column)
Ascending
Sensory tract for trunk and lower extremity proprioception, two-point discrimination, vibration, and graphesthesia
Spinocerebellar Tract (dorsal)
Ascending
Sensory tract that ascends to the cerebellum for ipsilateral subconscious proprioception, tension in muscles, joint sense, and posture of the trunk and lower extremities
Spinocerebellar Tract (ventral)
Ascending
Spinocerebellar Tract (ventral) Sensory tract that ascends to the cerebellum, some fibers crossing with subsequent recrossing at the level of the pons for ipsilateral subconscious proprioception, tension in muscles, joint sense, and posture of the trunk, upper extremities, and lower extremities
Spino-olivary Tract
Spino-olivary Tract
Ascends to the cerebellum and relays information from cutaneous and proprioceptive organs
Spinoreticular Tract
Spinoreticular Tract
The afferent pathway for the reticular formation that influences levels of consciousness
Spinotectal tract
Spinotectal Tract
Sensory tract providing afferent information for spinovisual reflexes and assists with movement of eyes and head towards a stimulus
Spinothalmic tracts
Spinothalamic Tract (anterior) Sensory tract for light touch and pressure
Spinothalamic Tract (lateral) Sensory tract for pain and temperature sensation
Cortiospinal tracts
Corticospinal Tract (anterior) Pyramidal motor tract responsible for ipsilateral voluntary, discrete, and skilled movements
Corticospinal Tract (lateral) Pyramidal motor tract responsible for contralateral voluntary fine movement. Damage to the corticospinal (pyramidal) tracts results in a positive Babinski sign, absent superficial abdominal reflexes and cremasteric reflex, and the loss of fine motor or skilled voluntary movement
Reticulospinal tract
Reticulospinal Tract
Extrapyramidal motor tract responsible for facilitation or inhibition of voluntary and reflex activity through the influence on alpha and gamma motor neurons
Rubrospinal tract
Rubrospinal Tract
Extrapyramidal motor tract responsible for motor input of gross postural tone, facilitating activity of flexor muscles, and inhibiting the activity of extensor muscles
Tectospinal Tract
Tectospinal Tract
Extrapyramidal motor tract responsible for contralateral postural muscle tone associated with auditory/visual stimuli
Vestibulospinal tract
Vestibulospinal Tract
Extrapyramidal motor tract responsible for ipsilateral gross postural adjustments subsequent to head movements; facilitating activity of the extensor muscles and inhibiting activity of the flexor muscles
C4 SCI functional outcomes
capable of respiration and scapular elevation
key muscles: diaphragm and traps
dependent bed mobility, transfers, positioning, wc management
Wheelchair Mobility: supervision to modified independent with power wheelchair. chin control
C5 fnx outcomes
capable of elbow flexion and supination, shoulder external rotation, abd to 90 degrees and limited shoulder flexion
key muscles: biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, supinator
Bed Mobility: moderate to maximal assist
Transfers: dep- maximal assist with sliding board
needs assistance for caughing
power chair with hand controls for community and manual with rim projectors for home
C6 fnx outcomes
capable of shld flexion, ext, IR and ADD
scapular ADD and UR
forearm pronation
wrist extension (tenodesis grip)
key muscles: ECR, infra, lats, pec major, SA, teres minor
can become ind with self care equip and slide board transfers
LTG: ind with rolling and supported sitting
can drive car with hand controls
C7 fnx outcomes
capable of elbow extension, wrist flexion, finger extension
ind with LE self ROM exercises
can use manual WC with friction rims for community integration with some difficulty on rough terrain
able to get wc in/out of car
Closed skill
Performer initiates the action
Environmental context is stable (does not change from trial to trial)
open skill
Performer must act according to the actions of skill
Performer must act according to the actions of the changing environment
left hemisphere
language sequence and perform movements understand language produce written and spoken language analytical controlled logical rational mathematical calculations express positive emotions such as love and happiness process verbally coded info in an organized, logical, and sequential manner
right hemisphere
non-verbal processing process info in holistic manner artistic general concept comprehension hand-eye coordination spatial relationships kinesthetic awareness understand music understand nonverbal communication mathematical reasoning express negative emotions body image awareness
C1-C3 SCI outcomes
capable of talking, blowing, sipping, mastication
key muscles: face and neck
dependent self care
ventilator/phrenic nerve stimulator
WC ind on smooth level surfaces (power tilt in space with mouth control and seatbelt)
C8 SCI functional outcomes
capable of full use of UE except for hand intrinsics
ind living at home
may be able to do curbs in wc
T1-5 functional outcomes
capable of full UE use, increased respiratory reserve, and improved trunk control
can participate in wc sports
T6-T8 fnx
improved trunk control, increased respiratory reserve
ind in swing-to gait in parallel bars with B KAFOs for short distances
T9-T12 fnx
increased endurance and improved trunk control
lower abs and intercostals
ind swing to or swing through on level surfaces with walker/forearm crutches and B KAFOs
ind floor to wc and tub transfers
may be ind household ambulators
T12-L3 fnx
capable of hip flexion, add, knee extension
B KAFOs and forearm crutches in home
may use wc for energy conservation or connivence
can be community ambulatory
L4-L5 fnx
capable of strong hip flexion and knee extension, weak knee flexion, impv trunk control
ind home ambulators
can use wc for community/energy conservation
perception problems of R vs L CVA
R hemisphere effected (L hemi)
- problems with spacial relationships and hand eye coordination
- irritability, short attn span
- cannot retain info, difficulty leaning individual steps
- poor judgement affecting personal safety
- diminished body image with left-sided neglect
- quick and impulsive
L CVA
- apraxia
- difficulty starting and sequencing tasks
- perseveration
- easily frustrated with high levels of anxiety
- inability to communicate verbally
- cautious and slow
rinne vs weber
rinne: positive if normal. AC>BC. IF BC > air conduction = abnormal
weber: negative if normal.
in an affected person:
if normal side hears better= Sensorineural hearing loss in other ear
if affected side hears better= conductive loss in that ear
wallenberg syndrome (lateral medullary syndrome)
Occlusion of PICA
vertigo, nausea, etc etc.... but main feature= ips face (loss of pain and temp, horners) contr body (loss of pain and temp)
vestibulocerebellum
responsible for adjustments in muscle tone in response to vestibular stimuli
spinocerebellum
controls muscle tone and synergistic movements on the same side of body in the extremities
APGAR scale
Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration
norms of BERG TUG TINETTI FR
TINETTI: max score=28… 20 seconds is increased risk of falls… >30 is high risk of falls
FR:<10 inches is increased risk of falls
DGI: normal = 21, falls=11
flexion synergy components
scapular retraction/elevation, shoulder abduction, ER, elbow flexion, forearm sup, wrist and finger flexion
hip flexion, abd, er. knee flexion. ankle DF and eversion
ptosis can be caused by damage to which CN?
3, oculomotor
inability to close eye fully could be caused by damage to which CN
7, facial
medial strabismus can be caused by damage to which CN?
6, abducent (innervated lateral rectus)
difficulty looking inferior medially can be caused by damage to which CN?
4, trochlear
