Neuro Flashcards
Most common neuro disease
stroke
who gets stroke?
people with HTN and diabetics are at the highest risk
how many pairs of cranial nerves do we have?
12
how many pairs of spinal nerves do we have?
31
important info to gather about headache location
- frontal: could be sinus-related
- occipital: tension or migraine
- temporal: brain freeze
what types of headache onset are concerning?
- if it wakes them up in the middle of the night
- if there is no onset, and it has not gone away in three or more weeks
when should you go to the ER for a headache?
if it is the worst you’ve ever had- could be aneurysm
what pattern of headaches is not concerning?
every 4 weeks or in sync with menstrual cycle
What associated symptoms with headaches are concerning?
vision problems, N/V
What do we need to know about seizures?
what happened before, during and after
- before: aura, involuntary articulations like screaming?
- during: tonic clonic movements, pass out, awake and alert, hit their head, lose bladder function?
what is the biggest concern about seizing?
muscle contractions over and over → acidosis builds up in the muscles
Most concerning type of memory loss
long term
Cranial nerve mnemonic
On Old Olympus Towering Top, A Fin and German Viewed Some Hopps
Sensory or motor mnemonic
Some Say Marry Money, But My Brother Says Big Boobs Matter More
CN I
- olfactory
- sensory
CN I test
smell two scents
CN II
- optic
- sensory
CN II test
- Snellen (20/20 normal, 20/200 blind)
- Rosenbaum: 14 in away from face
CN III
- oculomotor
- sensory
CN IV
- trochlear
- sensory
CN VI
- abducens
- sensory
CN III, IV, VI function and test
- work together to innervate the eyes and eyelids
- test extraocular movements: follow finger as it moves
- test PEARL (pupils eaqual and reactive to light): both eyes constrict when either is stimulated with light
Where should eyelids be when eyes are open?
about 2 mm over the iris
If iris is greater than 3mm
exopthalmos
CN V
- trigeminal
- sensory and motor
CN V test
temporal and masseter muscles: clench jaw while feeling those muscles- should be equal in strength on both sides
CN VII
- facial
- sensory and motor
CN VII test
test by smiling, frowning, puffing cheeks, gritting teeth, closing eyes against resistance
-should be equal on both sides
CN VIII
- acoustic/ vestibulocochlear
- sensory
CN VIII test
- cold water test if you’re mean
- hearing: whisper test
- Weber: tuning fork on top of head, should hear in both ears
- Rinne: should hear in front of ear twice as long as behind ear
CN IX
- glossopharyngeal
- sensory and motor
CN X
- vagus
- sensory and motor
CN IX and X test
- uvula and soft palate rise evenly when pt says “ah”
- gag reflex
- swallowing symmetrically
- hoarseness is a bad finding
CN XI
- spinal accessory
- motor
CN XI test
- shrug shoulders against resistance (tests trapezius)
- turn head against resistance (tests sternocleidomastoid)
CN XII
- hypoglossal
- motor
CN XII test
-tongue strength
How to evaluate balance
- heel to shin
- stand on one foot and hop
- gait: opposite arms swings
Romberg test
eyes closed, watch for swaying… test cerebellum function
Tests for meningitis
- Brudzinski’s sign: severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
- Kernig’s sign: inability to straighten the leg when the hip is flexed to 90 degrees
Brown-Sequard syndrome
when half the brain (hemisphere) has an injury and you get ipsilateral weakness and loss of proprioception
central cord syndrome
- sacral sparing: lose control of bowels and bladder
- mostly upper etremity
anterior cord syndrome
problem with anterior corf artery (compression, tumor, or lytic problem), causes loss of pain and temperature
posterior cord syndrome
- posterior artery issue
- loss of proprioception and variable loss of motor function (upper and lower)
atrophy and fasciculations of the tongue
fasciculations- twitching/ rapid, uncontrolled movements
-seen a lot in ALS and parkinsons
Tics
- involuntary muscle contractions, often in face and upper extremities
- tourettes, drugs like phenethylamines and amphetamines
postural tremors
- activity generated tremors
- usually benign
- fatigue, hyperthyroidism
intention tremors
- may or may not go away and the intensity is steady
- absent at rest
- when you go to grab something you get a tremor or movement gets bigger
- MS and parkinsons
congenital unilateral athetosis
- twisting and writhing movements
- cerebral palsy
cerebellar ataxia
- ataxia: irregular movement
- how you walk when you’re drunk
- often seen in intoxication
parkinsonian gait
- shuffling, stooped, and cogwheel (moves fast, then stops, fast, then stops)
- Parkinsons… clearly.
scissors gait
- thighs are overlapping
- partial paralysis
spastic hemiparesis
- hand is flexed very close to them and drag same sided toe or swing it around when they walk
- stroke
food drop
- also called slap foot
- pull knee up really high and slap it down
- cannot land on their heel
- lower motor neuron diseases
paralysis
loss of movement
paresis
weakness
plegia
stroke or paralysis
mono
one limb
hemi
both limbs on one side
di- or para-
both upper limbs or both lower limbs (divided at the waist)
quadri- or tetra-
all four limbs
hypotonia
less than normal
flaccidity
absent
-use it or lose it… if you don’t use muscles they will atrophy and become flaccid
4 words that mean higher than normal muscle tone
hypertonia, rigidity, spasticity, tetany
lower motor neuron damage: irritated neurons
spontaneous muscle contractions (fasciculations)
lower motor neuron damage: death of neurons
- spinal reflexes are lost
- flaccid paralysis
- denervation atrophy of muscles
Which receptors are involved in lower motor neuron damage?
alpha, beta, and gamma receptors
3 possible problems with the motor unit
- muscle atrophy or dystrophy
- neuromuscular junction disorders
- lower motor neuron lesions or infections (peripheral nerve injury)
neuromuscular junction disorders
problem with ACH
types of skeletal muscle atrophy
- disuse atrophy: muscles begin to atrophy within 24 hrs of disuse (all pts in the hospital)
- denervation atrophy
skeletal muscle dystrophy
- contractile proteins are not properly attached to the cell membrane of the muscle cell
- protein movement does not effectively contract the muscle cell
decreased ACH release
botulism, gentamicin toxicity
decreased ACH effects on muscle cell
- myasthenia gravis
- curare: plant that is in the amazon that native people use to cause paralysis
decreased acetylcholinesterase activity
-too much ACH bc enzyme isn’t breaking it down
physostigmine
antidote to ACH overdose
neostigmine
antidote to too much ACH in the NMJ (recovering from anesthesia)
organophosphates
toxins in the environment that inhibit AChE and cause a buildup of ACh
Myasthenia gravis
- autoimmune disease
- gradual destruction of ACh receptors
- associated with thymus tumor or hyperplasia
- gradual development of weakness from proximal to distal portions of body
myasthenia crisis
respiration is compromised
demyelinations
- Schwann cell disorder - damage to the myelin sheath
- Guillien Barre: caused by virus, starts in the feet which lose neuro function, then moves up to the head and neck…. leaves the opposite way
axonal degeneration
- damage to LMN cell bodies in the spinal cord
- damage to axons in the spinal or peripheral nerves
mononeuropathies
- damage to one nerve
- carpal tunnel
polyneuropathies
- damage to many nerves
- Guillian-Barre syndrome
- Diabetics (sugar is irritating to nerves)
back pain
- one of the most common reasons people abuse pain meds
- often due to compression of nerve root by vertebrae or the vertebral disk
sign of damage to the sciatic nerve
pain shooting down the back of the leg
vestibulocerebellar disorders
difficulty maintaining posture
cerebellar ataxia
movements divide into separate components
How do basal ganglia modulate motor impulses
- upper motor neuron cell bodies are in the the motor cortex
- send their axons down through the internal capsule
- basal ganglia inhibit and modulate movement patters
basal ganglia dysfunction causes…
tremors, tics, hypo and hyperkinetic disorders
chorea
hyperkinetic disorder; jerky movements
athetosis
hyperkinetic disorder; contnuous twisting movements
ballismus
hyperkinetic disorder; violent fighting movements
dystonia
hyperkinetic disorder; rigidity
parkinsonism
- tremor
- rigidity
- bardykinesia (slow movement)*
- loss of postural reflexes
- autonomic system dysfunction
- dementia
Amyotrophic lateral sclerosis (ALS)
- damages both upper and lower motor neurons
- UMN damage causes weakness and lack of motor control (loss of control over spinal reflexes= stiffness and spasticity
- LMN damage: irritation and fasciculations, decreased neuron firing= weakness, denervation atrophy, hyporeflexia)
ALS prognosis
incurable… respiratory failure kills them about 5 years after diagnosis
multiple sclerosis
- destruction of myelin coating on axons
- demyelinated or sclerotic patches develop through white matter of the CNS
- decreased conduction velocity, conduction block
spinal cord injury: spinal shock
temporary complete loss of function below injury
spinal cord injury: primary neurologic injury
irreversible damage to neurons
secondary injury to the spinal cord
neurons and white matter in area of initial damage are affected
possible causes of secondary injury to the spinal cord
- damage to blood vessels supplying the area
- decreased vasomotor tone decreasing blood supply
- local release of substance that cause vasospasm
- release of digestive enzymes from damaged cells
central cord syndrome
partial spinal cord injury;
- central gray or white matter
- arms are more affected than legs
anterior cord syndrome
partial spinal cord injury;
- anterior section of cord
- motor functions affected; touch sense not affected
Brown-Sequard syndrome
partial spinal cord injury;
- one side of cord
- motor function lost on that side; pain/temp sensation lost from the other side
Conus medullaris syndrome
partial spinal cord injury;
- sacral and lumbar
- bowel, bladder, sexual function defects
autonomic dysreflexia
your involuntary nervous system overreacts to external or bodily stimuli
C1 injury
you’re going to die
C7 injury
tells whether you’ll breathe or not… below C7, breathing is affected
spinal cord injury to upper motor neurons (T12 and above)
- spinal reflexes still work
- no longer modulated by the brain
- hypertonia, spastic paralysis
spinal cord injury to lower motor neurons (T12 and below)
- cells in spinal reflex arcs are damaged
- flaccid paralysis
vasogenic brain edema
- extracellular fluid
- BBB has been disrupted and there is leakage of fluid out of the capillaries
- tumor, cancer, coumadin, injury, altitude (a little bit of edema makes you sick!)
problem with brain edema
hypoxia; pressing on brain tissue stop blood flow → ischemia and pain → infarction/stroke
cytotoxic brain edema
- intracellular fluid
- Na+k+ pump… too much sodium in the brain, water join it and you get edema
intracranial pressure (ICP)
increased brain tissue, CSF, or blood in the skull
intracranial pressure compensation
decreased brain tissue, CSF, or blood in the skull
intracranial pressure herniation
- the brain pushes from higher to lower pressure regions
- brain stem can herniate down the spinal tract- causes death instantly
hydrocephalus
progressive enlargement of the ventricular system from increased CSF
primary traumatic brain injuries are due to…
- focal lesions: contusions, hemorrhages
- diffuse injuries: concussions, diffuse axonal injuries
secondary traumatic brain injuries are due to…
- brain swelling
- infection
- ischemia
hematomas in the epidural space
meningeal arteries
rapid bleeding with hematomas
unconsciousness may be followed by brief lucid period
hematomas in the dura mater
- subdural space: bridging veins
- slower bleeding; gradual development over days or weeks
signs of a stroke
- word salad
- one sided muscle weakness
- loss of sight in one eye
ischemic stroke
- transient ischemic attacks (“brain angina”)
- large vessel (thrombotic): carotid
- small vessel (lacunar infarct)
- embolic: air embolus
hemorrhagic stroke
bleeding- an artery or vein has become compromised and there’s a lot of blood
is hemorrhagic or ischemic stroke worse?
hemorrhagic
Aneurysmal Subarachnoid Hemorrhage: aneurysm
sudden-onset headache with nausea, vomiting, dizziness
Aneurysmal Subarachnoid Hemorrhage: hemorrhage
sudden, severe headache, neck stiffness, photophobia, vision and motor problems
complications of Aneurysmal Subarachnoid Hemorrhage
rebleeding, vasospasm and ischemia, hydrocephalus, hypothalamic dysfunction, seizures
primary intracranial tumors of neuroepithelial tissue
neuroglia, neurons
Primary intracranial tumors originating in the cranium
Meninges, primary CNS lymphoma, pituitary gland tumors
Metastatic tumors
become metastatic quickly because the brain serves every part of the body
-low survival rate
focal disturbances
- Dysfunction of particular brain areas
- Seizures, hallucinations, weakness or palsies in specific areas, sensory deficits
generalized disturbances
Increased intracranial pressure: headache, vomiting, visual problems
seizures
abnormal, excessive nerve firing
provoked siezures
fever, metabolic disturbances, brain injury (tumors, drug abuse, vascular lesions)
unprovoked (epileptic) seizures
cause unknown
focal seizures
- without impairment of consciousness or awareness: limited to one hemisphere
- with impairment of consciousness or awareness: one hemisphere to the other
generalized seizures
involve both hemispheres
tonic-clonic seizures
muscle contraction, loss of consciousness
absence seizures
disturbances in consciousness
myoclonic seizures
muscles of the face, trunk, and extremities contract
tonic seizures
voluntary muscles of the legs and arms contract
clonic seizures
bilateral, symmetric, rhythmic muscle contractions
atonic seizures
loss of muscle tone
alzheimer disease brain inclusions
neuritic plaques and neurofibrillary tangles, decreased ACH
pick disease brain inclusions
pick bodies
stages of alzheimers disease
- initial: short-term memory loss
- moderate: global cognitive impairment: language, spatial relationships, problem solving, depression, confusion, disorientation, lack of insight, inability to carry on daily activities
- severe: loss of ability to respond to environment, require total care, bedridden
vascular dementia
ischemic, hemorrhagic
frontotemporal dementia
atrophy
Wernicke-Korsakoff syndrome
vitamin b12 deficiency
huntington disease
autosomal dominant inheritance
