neuro Flashcards
key motor tests
Drift of upper extremity (and lower if necessary)
o Have pt. close eyes and hold arms horizontally forward, palm up for
15-30 sec
o If +, hand will drop and rotate in***
*often combined with rhomberg balance test
Hand grasp and toe dorsiflexion
o Weakness is commonly seen in upper motor neuron lesion
o Cross hands, have pt. grasp index and middle fingers
o Move toe and foot against resistance
Coordination, stance and gait tests
- Finger-to-nose and Heel-to-shin
o Cerebellar lesions: awkwardness of movement - Rapid alternating movements
o Slowness may results from cerebellar lesion,
Balance tests
- Tandem gait (walk heel to toe) 2. Rhomberg
o We all need 2 out of the following 3 senses to maintain balance • Vision
• Vestibular sense
• Proprioception
o (+) test”pt sways when eyes are closed
• either vestibular or proprioceptive defect
o If pt. sways when eyes are open this is not a positive test and
therefore suspect a cerebellar lesion
ROS HEENT
- Headache?
- Visual changes?
- dizziness
ROS neuro
- Tremor?
- Weakness or sensory loss?
- LOC?
- Motordysfunction
Mental status FOGS
- FamilyStoryofMemoryLoss
- Orientation
o To precise time (month, day, year) - GeneralInformation
o e.g. Who are the president and vice president of the U.S.? 4. Spelling
Sensory Testing
Pain: Sharp and dull testing Proprioception, stereogenesis, vibration 1. With pts. eyes closed, bend big toe up and down and then test vibration with tuning fork o Decreased proprioception in MS Light touch
ReflexTesting
- Triceps
- Biceps
- Knee Jerk
- Ankle Jerk
- Babinski
o + (abnormal dorsiflexion of the great toe and fanning of the other toes)” UMN lesion
Normal responses are symmetrical
Asymmetryisgenerallymorereflectiveofpathology
Tests for meningeal irritation (r/o meningitis or subarachnoid hemorrhage)
- Kernig
o (+)”pain in low back on straightened lower extremity) - Brudzinski
o (+) “ flexion of the head results in marked neck pain and
involuntary flexion of the hip and lower extremities
neuro Basic Labs
a. CBC
b. CMP
c. TSH
d. Bedside glucose***
consider:
Celiac (anti-gluten Abs, TTG)
Heavy metal testing (whole blood, hair analysis, urine with and without provocation)
Environmental testing for solvents, pesticides, etc
Imaging and further studies
a. Lumbar Puncture*
b. CT*
c. MRI***
d. MRA
e. MRV
f. Echoencephalography
g. Cerebral Catheter angiography
h. Duplex Doppler Ultrasonography
etc. ..
Cerebrovascular Accident (Stroke)
Definition: sudden interruption of cerebral blood flow that results in neurologic deficit
i. Causes brain damage
ii. mc cause of neuro disability, 3rd mc cause of death
if anterior brain blood supply affected by stroke
(2/3 of the brain)
- Internal Carotid
- Strokes involving this blood supply to the brain typically have unilateral sxs
if Posterior Supply affected by stroke
(posterior portion of temporal and parietal lobes, brainstem, and cerebellum)
- Vertebrobasilar
- Strokes involving this blood supply to the brain can have unilateral or bilateral sxs and is more likely to affect consciousness
stroke Risk Factors
i. Prior stroke
ii. Older age
iii. family hx
alcohol, male, HTN, cigarettes, cholesterol?, DM…
S/SX of stroke
Sudden!
i. Numbness,weakness or paralysis of the contralateral limbs, face
ii. Aphasia
iii. Confusion
iv. Visual disturbances in one or both eyes
v. Dizziness or loss of balance and coordination
vi. Headache
ischemic stroke
80%
1. Thrombosis–sites of turbulent flow, branching
MC• Atherosclerotic plaques
LC vascular inflamm dt infection, hypercoagulable state
2.Emboli
MC: cardiac–atrital fib, post MI, prosthetic valves, etc
LC: fat emboli, air, venus clots thru patent foramen ovale
- Lacunar (small vessel dz)
DM, poorly controled HTN
4. TIA (Transient Ischemic Attack) internal carotid artery dz sx < 1 hr st precede stroke onset by days/months often no brain damave
ssx embolic stroke
o Quicker onset of neurologic deficit: minutes
o Often during the day
o Headache may precede neurologic deficit
ssx thrombotic stroke
o Tend to occur during the night and are noticed upon first waking
o May have slower onset of sxs: over 24-48hrs (aka “evolving stroke” or “stroke in evolution”)
• Evolving stroke: Unilateral neurologic dysfunction often
beginning in one arm and then spreading ipsilaterally
• Extends without headache, pain or fever
ssx lacunar stroke
o Pure motor hemiparesis
o Pure sensory hemianesthesia
o Ataxic hemiparesis
dx imaging
o CT
• Done first to exclude intracerebral hemorrhage
o MRI
• Generally done 2nd; many smaller infarcts may only be found with MRI
stroke ddx
- Hypoglycemia
- Postictal paralysis
- Hemorrhagic stroke
- Migraine
- Tumor
- Systemic condition: Guillian Barre, Bell’s Palsy
- syncope
Intracerebral Hemorrhage
Definition: Focal bleeding from a blood vessel in the brain parenchyma caused by HTN! or...Arteriovenous Malformations (AVMs) • Aneurysm • Trauma • Brain tumor • Bleeding disorder
Intracerebral Hemorrhage ssx
Focal neuro deficit w/: • Headache • Nausea • Impairment of consciousness o Nausea o Vomiting o Delirium
ssx Intracerebral Hemorrhage in hemisphere
hemiparesis
ssxIntracerebral Hemorrhage in posterior fossa
Brain stem and cerebellar dysfunction
intracerebral hemorrhage ddx
DDX
o Ischemic stroke
o Subarachnoid hemorrhage o Hypoglycemia
o seizure
Subarachnoid Hemorrhage (SAH)
Definition: sudden bleeding into the subarachnoid space
SAH etiol
mc ruptured aneurysm
SAH ssx
Sudden severe headache with LOC
• Headache is severe; peaking within seconds!!!
o Severe neurologic deficits
o Seizures are possible
o No neck stiffness initially but chemical meningismus may appear with
vomiting
SAH dx
Non-contrast CT
( if negative, lumbar puncture)
• blood in CSF
SAH etiol
mc TRAUMA, or ruptured aneurysm
