Neuro Flashcards
What is the function of the frontal lobe?
voluntary muscle activation
emotions and judgements
Broca’s area = motor aspects of speech
What is the function of the parital lobe?
integration of sensatinon
touch, proprioception, pain and temp from opposite side of body
What is the function of the temporal lobe?
primary auditory cortex = receives/processes auditory stimuli
associative auditory = processes auditory stimuli
Wernicke’s = language comprehension
What is the function of the occipital lobe?
primary visual cortex = receives/processes visual stimuli
visual association = processes visual stimuli
What is the function of the hypothalamus?
integrates and controls functions of the autonomic NS and neuroendocrine system
**maintains body homeostasis
What is the function of the thalamus?
Aside from sense of smell, all other sensory processes involve a thalamic nucleus receiving a sensory signal which is then directed to the relevant cortical area.
The thalamus plays a role in controlling the motor systems of the brain which are responsible for voluntary bodily movement and coordination.
What does the sympathetic NS do?
prepares body for fight or flight, emergency responses; increases HR and BP, constricts peripheral blood vessels, and redistributes blood; inhibits peristalsis
Thoracolumbar division T1-L2
What does the parasympathetic NS do?
conserves and restores homeostasis; rest and digest; slows HR and reduces BP; increases peristalsis and glandular activity
Craniosacral division CN 3, 7, 10; S2-4
What signs/tests do you use for examination of CNS infection or meningeal irritation?
signs of global, not focal
- neck mobility
- Kernig’s sign - 90/90 HS, bilat pain suggests meninitis
- Brudzinski’s sign - flex neck causes flexion of hips/knees
- irritability
- slowed mental function
- altered vital signs
- generalised weakness
What do you examine for increased intracranial pressure secondary to cranial edema and brain herniation?
Altered level of consciousness Altered vital signs Headache Vomiting Pupillary changes Papilledema at entrance to eye Progressive impairment of motor function Seizure activity
What is homonymous hemianopsia?
loss of half of visual field in each eye, contralateral to cerebral lesion
What is somatognosia?
patient can’t identify body parts
What is visual spatial neglect?
unilateral neglect, ignores one side of body
What is anosognosia?
severe denial, neglect of lack of awareness of severity of conditions
What is agnosia?
inability to recognise familiar object with one sensory modality (ie sight), but can recognise same object with other sensory modality (ie. hearing)
What is apraxia?
inability to perform voluntary, learned movements in absence of loss of sensation, strength, coordination, attention or comprehension
Ideomotor - can’t perform on command, but can do task on their own
Ideational - cannot perform task on command or on their own
What is aphasia? Types?
communication disorder
Nonfluent / expressive aphasia
Fluent / receptive aphasia
What is meningitis? And how do you treat it?
inflammation of membranes of the spinal cord or brain.
bacterial or viral
PT - supportive symptomatic Rx, bed positioning, PROM, skin care to prevent complications of immobility, safety measures if confusion present
What is encephalitis?
severe infection and inlammation of the brain
PT - supportive symptomatic therapy
What is a brain abcess?
infectious process in which there is a collection of pyogenic material in brain parenchyma.
PT - supportive symptomatic therapy
What is AIDS? S&S?
viral syndrome and severe depression of cell-mediated immunity
S&S:
dementia complex
motor deficits - ataxia, weakness, tremor, loss of fine motor
peripheral neuropathy
List the types of spinal cord lesions and their characteristics
complete: bilat motor, bilat sensory loss
central: bilat motor, bilat pain and temp
Brown-sequard: ipsilat motor, ipsilat proprioception, contralat loss pain and temp
anterior: bilat motor loss, bilat pain/temp
posterior: bilat loss of proprioception, vibration, pressure
cauda equina
What types of nerve fibers are there? And what are the functions of each?
A fibers: large, myelinated, fast conducting
- Alpha proprioception, somatic motor
- Beta touch, pressure
- Gamma motor to motor spindles
- Delta pain temp touch
B fibers: small, myelinated, conduct less rapidly
C fibers: smallest, slowest, unmyelinated
What are levels of conciousness?
Alterness - appropriate response
Lethargy - appears drowsy, falls asleep quickly
Obtundation - can open eyes, responds slowly and confused, decreased interest in environment
Stupor - aroused from sleep from painful stimuli, verbal response slow/absent, minimal awareness
Coma - cannot be aroused, no response to stimuli
Unresponsive/vegetative
What is the Glasgow Coma Scale and how is it scored?
measures 3 elements of response - eye opening, motor response, verbal response
Severe scores 1-8
moderate 9-12
minor 13-15
What are the levels of Rancho Los Amigos?
1 - unresponsive 2- general 3 - local 4 - confused agitated 5 - confused inapp 6 - confused app 7 - auto inapp 8 - auto app, purposful 9 - assistance 10 - ind
What are the cranial nerves and what are their functions?
Olfactory - smell
Optic - vision
Oculomotor - move eyes, raise eyelids, regulate pupils
Trochlear - eye movements, proprioception
Trigeminal - sensations of head and face, chewing, muscle sense
Abducens - lateral eye movements
Facial - facial expressions, taste, secretion of saliva
Vestibulochochlear - balance, equilibrium, hearing
Glossopharyngeal - tast and other sensations of tongue, swallowing, saliva
Vagus - muscles for speech, swallowing, smooth muclse of viscera in abdo
Accessory - turning head, movement of shoulders, voice production
Hypoglossal - tongue movements
What is dyssenergia?
impaired ability to associate muscles together for complex movement
What is dysmetria?
impaired ability to judge the distance of range of movement
What is dysdiadochokiesia?
impaired ability to perform rapid alternating movements
What are the types of involuntary movements?
Tics - spasmodic contraction common in face, neck, shoulders
Chorea - quick twitches or dancing movements
athetosis - slow, irregular, twisting, writhing
tremor - continuous quivering movements, rhythmic oscillatory movement obs at rest
myoclonus - single, quick jerk
What are the sensory elements of balance?
visual - acuity, depth perception
somatosensory - proprioception, cutaneous sensation, trunk, feet, ankles
vestibular - changes in head position
What are the 6 recovery stages of a CVA?
1 - initial flaccidity, no voluntary movement
2 - emergence of spasticity, hyperreflexia, synergies
3 - voluntary movement possible, only in synergies, strong spasticity
4 - voluntary control in isolated joint movement
5 - increased voluntary control out of synergy, coordination deficits
6 - control and coordination near normal
What are characteristics of a left and right CVA lesion?
Left:
slow, cautious, hesitant, insecure
use words, gestures
do not underestimate ability to learn
Right: impulsive, quick, indifferent, poor judgement use verbal cues visusospatial deficits, avoid clutter focus on safety do not overestimate ability
What is primary and secondary damage regarding a TBI?
primary: diffuse axonal focal injury coup-contracoup closed/open injury
secondary:
hypoxic ischemic injury
swelling edema
electrolyte imbalance
Describe each ASIA scale level
A - complete, no motor or sensory function
B - incomplete, sensory but no motor
C - incomplete, motor preserved with > MMT 3
D - incomplete, motor >3 MMT
E - normal, motor and sensory normal
What is MS?
chrnoic progressive demyelinating disease of CNS
worsening symptoms with heat, hyperventilation, dehydration, fatigue
S&S = ataxic, spasticity, hyperreflexia, dysarthria, paraesthesia, vestibular involvement, fatigue
What is Parkinson’s disease?
chronic progressive disease of CNS with degeneration of basal ganglia
S&S: rigidity, bradykinesia, resting tremor, impaired postrual reflexes
What is myasthenia gravis?
neuromuscular junction disorder, progressive muscular weakness and fatiguability on exertion
muscular strength worsens with continued contraction, improved with rest
What is epilepsy?
recurrent seizures
What are the types of peripheral nerve diseases?
Poly? Mono? Radic?
polyneuropathy - bilat symmetrical involvement
mononeuropathy - single nerve involvement
radiculopathy - involvement of nerve roots
clinical symptoms of LMN
What is trigeminal neuralgia?
CN V neuralgia
stabbing shooting pain following mandibular and maxillary divisions, one side of the face
exacerbated by stress, cold
What is Bell’s palsy?
LMN lesion to CN VII (facial nerve)
unilateral paralysis
loss of control of salivation
acute onset, max severity in hours-days
What is Bulbar palsy?
weakness or paralysis of muscles innervaated by motor nuclei of lower brainstem (face, tongue, larynx, pharynx)
What is Guillain-Barre syndrome?
polyneuritis with progressive muscular weakness that develops rapidly
demyelination of cranial or peripheral nerves; LMN disease
sensory loss, paresthesia, pain, sensory loss less than motor loss
symmetrical distribution of motor loss
progresses from LE to UE, distal to proximal
What is ALS?
Degenerative disease affecting UMN and LMN
muscular weakness, early onset involves limbs progressing to whole body; atrophy, cramping, muscle fasiculations, twitching (LMN)
spasticity, hyperreflexia (UMN)
pain, cramping, postural stress syndrome, joint hypomobility
What is postpolio syndrome?
slowly progressive muscel weakness in patients with history of polio
abnormal fatigue
pain, myalgia
weakness and atrophy, asymmetrical
What are the anterior and posterior neurons of central gray matter?
anterior/ventral - efferent motor neurons
posterior/dorsal - afferent sensory neurons
What are the ascending and descending systems of the white matter in the spinal cord?
ascending (sensory)
- dorsal - proprioception, vibration, tactile
- spinothalamic - pain and temp, crude touch
- spinocerebellar - proprioception, voluntary movement control from touch and pressure receptors
- spinoreticular - deep and chronic pain
descending (motor)
- corticospinal - voluntary movement
- vestibulospinal - muscle tone, postural reflex
- rubrospinal - motor function
- reticulospinal - modifies transmission of sensation, pain
How do you measure spasticity with the Modified Ashworth Scale?
0 - no increase in muscle tone
1 - slight increase, minimal resistance at end ROM
1+ - slight increase in tone, minimal resistance through less than half of ROM
2 - more marked increase in tone, through most ROM, affected part easily moved
3 - considerable increased tone, passive movement difficult
4 - affected part rigid in flexion and extension
What is the differential diagnosis of UMN and LMN lesions?
UMN - hypertonia, spasticity, hyperreflexia, clonus, disuse atrohpy, impaired voluntary movement
LMN - hypotonia, hyporeflexia, neurogenic atrophy, strength altered along myotome
