Neuro Flashcards
How would you test cranial nerve 2?
Visual acuity, visual fields, accommodation, direct light reflex and consensual reflex, fundoscopy
How would you test cranial nerves 3, 5 and 6
Inspect resting gaze, look for ptosis, test eye movements, ask about double vision
How would you test cranial nerve 5?
light touch on 3 parts of the face, corneal reflex (if needed), palpate temporalis and masseter and pterygoid
How would you test cranial nerve 7?
Raise eyebrows, screw up eyes, smile and show teeth, blow out cheeks
How would you test cranial nerve 8?
Whisper in ear, Rinne’s test, Weber’s test
How would you test cranial nerve 9 and 10?
Cough, soft palate movement, gag reflex (if necessary)
How would you test accessory?
shrug shoulders, turn head to each side and push against neck
How would test cranial nerve 12?
Wasting of tongue, fasciculations of tongue, protrude tongue, tongue movement
Explain rinnes and webers test
Rinnes - hearing the fork longer in bone than in air means there is a conductive hearing loss in the ear
Webers - Hearing the fork lateralise to one side means there is a sensorineural hearing loss in the other ear or a conductive loss in the same ear
What is a bitemporal hemianopia? Where is the lesion? Give e.g. of lesion
Loss of temporal visual fields
lesion in optic chiasm e.g. pituitary tumour
What is homonymous hemianopia? Where is the lesion? Give e.g.
Loss of either right or left visual fields on both eyes.
Lesion of optic tract
e.g. vascular, tumour
What is upper quadrant homonymous hemianopia? Where is the lesion? Give e.g.
Upper left or right quadrant gone
Lesion in part of optic radiation affecting that quadrant - temporal lobe
e.g. vascular, tumour
What is a lower quadrant homonymous hemianopia? What is it caused by? e.g.
Loss of lower quadrant of vision. Same side
Lesion in part of optic radiation which corresponds to that quadrant - Parietal lobe lesion
tumour, vascular
What happens in a CN 3 lesion? What can it be caused by?
Down and out eyes, ptosis, dilated pupil unreactive to light
compressive lesions, tumour
What happens in a CN4 lesion?
Loss of Superior oblique. Difficulty reading, patient may tilt head.
What happens in a CN6 lesion?
Weak lateral gaze in affected eye
Is bells lower or upper lesion?
lower
How do you differentiate between upper facial nerve lesion and bells palsy? Why is this the case?
Forehead sparing in upper facial nerve lesion, not in bells
The contralateral corticobulbar tract supplies the innervation of the facial nucleus, however there is also some ipsilateral corticobulbar innervation that supplies ONLY the forehead. So an upper motor neurone lesion spares the ipsilateral innervation from the corticobulbar tract, but a lower motor neurone lesion takes out all innervation from the facial nerve.
What does uvula deviation indicate? To what side does it deviate?
Deviates to normal side, 10th nerve palsy
To what side does the tongue deviate to? What is it a lesion of
Deviates towards affected side. Lesion of hypoglossal nerve
If blood forms between these layers, what is it called and what type of blood is it:
a) Skull and periosteal layer of dura
b) Meningeal layer of dura and arachnoid mater
c) within subarachnoid space
a) extradural haematoma - arterial
b) subdural hameatoma - venous
c) subarachnoid haematoma - arterial
Explain the first order, second order, and third order neurones in the somatosensory system
First order - pass electrical stimulus to spinal cord
Second order - ascends to the brain and synapses with the third order neurone
Third order - Cell body Located in the ventral posterior nucleus in the thalamus of the brain takes the impulse to the necessary part of the brain
Label the ascending pathways
What fibres do the fasciculi gracilis and cuneatus contain?
gracilis - lower limb
cuneatus - upper limb
In what part of the spinal cord can descending tracts be found?
Anterior or lateral funiculus
What are the clinical signs of lower motoneurone lesions?
Muscle weakness, hypotonia or atonia, hypo or areflexia, atrophy, fasciculations
What is the difference between a LMN and an alpha-motoneurone?
usually synonymous term.
Explain the distinction between pyramidal and extra-pyramidal UMN. What tracts does each contain?
Pyramidal - consists of corticospinal (begins in cerebral cortex and terminates in spine) and corticobulbar tracts which are both responsible for voluntary movement of body and fascial muscles respectively. Directly innervates motor neurons
Extra-pyramidal - Modulate motor activity without directly innervating motor neurons. Involved in reflexes, locomotion, complex movement and postural control. Consists of vestibulospinal, reticulospinal, rubrospinal, and tectospinal tracts.
Give the strict definition of a reflex
An automatic, unlearned, repeatable response to a specific stimulus that does not require the brain to be intact
What could cause hearing impairments?
Loud noises, congenital defects, infections (glue ear), trauma
How would you assess hearing function?
Audiogram
What would cause conductive hearing loss
blockage, ruptured ear drum, otitis media
What would cause sensory hearing loss?
hair cell destruction or death
What would cause neural hearling loss?
Age related, ototoxic drugs, tumours
Explain decorticate posturing
Damage to the connections between thalamus and cortex. Lower limbs extended and upper limb flexed, like a mummy.
Explain decerebrate posturing
Damage to the lower parts of the brain (brain stem), resulting in loss of descending inhibition. Complete extension of lower, upper limbs and head.
