Neuro Flashcards
What would a damage to cranial nerve 3 cause?
Complete unilateral ptsosis
Pupil dilated and fixed
eye faces down and lateral
What is the condition where the eye reacts normal to accommodation but not to light?
Argyll robertson pupil
What is the cause of Argyll robertson pupil?
Seen in diabetics but also a characteristic of neurosyphilis
What is Bells palsy?
Damage to the 7th cranial nerve
Lower motor neuron lesion leading unilateral paralysis of the face
If there is a lesion in cranial nerve 12, does the tongue point away or towards the lesion?
Towards
If there is a lesion in cranial nerve 9 or 10, does the uvula point away or towards the lesion?
away
What do you look for in general inspection of cranial nerves?
The face for Asymmetry Atrophy Random eye movement Paralysis of the face
What is horners syndrome?
Results from an interruption of the sympathetic nerve supply to the eye
What is the triad symptoms of Horners syndrome?
Miosis (constricted pupil)
Partial ptsosis
Unilateral anihydrous
What muscle does cranial nerve 4(trochlear ) control?
What movement does that control?
Superior oblique and movement of down
What muscle does cranial nerve 6(abducen) control?
What movement does that control?
Lateral rectus
Movement of the eyes right –> laterally
If there is a jaw jerk reflex is it UMN or LMN lesion?
UMN
What is conductive deafness?
Defect of sound transmission to the spiral ganglion
What is Sensorineural deafness?
Defect of the spiral ganglion and/or cochlear nerve
In Sensorineural deafness will sound be louder in air or via bone in rines test?
Bone
Give two diseases that cause constriction of pupil?
Argyll robertson pupil
Horners syndrome
Give a diseases that cause dilation of the pupil?
holmes adie pupil
What are you looking for in general observation of lower and upper exam?
Scars Wasting of muscles Involuntary movement Fasciculations Tremor
What is a cause of decreased tone
LMN lesion or cerebellar lesion
What is a cause of increased tone?
UMN lesion
What is felt in UMN lesion in tone?
spasticity–> initial increase in resistance then decrease
What is felt in basal gaglia lesion in tone?
Led pipe rigidity
In parkinsons what is the type of tremor?
Cog wheel rigidity which is tremor superimposing led pipe rigidity
What does babinski sign indicate?
UMN lesion if the toes extend
What nerve roots for patella reflex?
L3/4
What nerve roots for ankle jerk reflex?
S1/2
What nerve roots for babinski sign?
S1
What are the end pieces of lower neuro exam?
Romberg and Gait
What does a positive romberg test indicate?
Cerebellar lesion if you wobble when eyes open
In romberg test if positive once eyes closed what is the indication?
Sensory ataxia
What is positive pronator drift sign a indication of?
UMN lesion–> the arm will pronate and fall
What lesion causes lose of rebound phenomenon?
Cerebellar lesion
What does clonus indicate?
UMN lesion
What is the cerebellar symptoms?
Dysdiadochokinesis Ataxia Nystagmus Intentional tremor and past pointing Slurred speech Hypotonic
What causes UMN lesion?
Blunt trauma, stroke and tumour
If you have a UMN lesion is extension or flexion weaker in
a) arm
b) leg
A) Extension weaker than flexion
B) Flexion weaker than extension
Explain the grading power?
5= normal
4= slight weakness of power
3=movement possible against gravity but not resistance
2= movement possible if eliminate gravity
1= slight movement
0= no movement
Describe the reflex ladder?
0= absent \+= present with reinforcement needed 1= present but dappended 2= normal 3= increased 4= clonus
What is the SNOOP mnemonic for red flag of headache symptoms?
Systemic symptoms–> fever , neck stiffness
Neurological symptoms–> ataxia, pralysis
Onset recent or recurrent–> important for <40
Other associated symptoms–> with trauma,
Past headaches –> different or same
What fingers are abducted in the upper neuro examination?
o First dorsal interosseous (FDI) (index)
o Abductor digiti minimi (ADM) (small finge)
What is the finger nose test assessing?
If their is any past pointing or intentional tremors
What is rebound phenomenon testing?
Your antagonist muscle
If you fail to stop your hand then you have a cerebellar disease
What nerves are involved in bicep reflex?
C5/6
What nerves are involved in supinator reflex?
C5/6
What nerves are involved in tricep reflex?
C6/7
What does Proprioception test indicate?
Intact joint position sense is intact
What is the SOCRATES for migraine?
o S: unilateral type of headache o O: Gradual o C: Pulsating/throbbing o R:start one side then spread to whole head and neck o A: Nausea/vomiting, blurred vision o T: 4 to 72 hrs o E: Bright light, loud sound, food triggers o S: moderate to severe
What is the SOCRATES for tension headache?
o S: Generalized o O: gradual o C: tight band o R: arise from the neck o A: stress o T: few hours o E: Stress o S: moderate
What is the SOCRATES for cluster headache?
o S: unilateral
o O: Gradual
o C: specific to one eye feel like you want to gouge your eye out key symptom
o R: Lacrimation flow of tears
o A:
o T: 6 to 12-week period of cluster headaches
Each lasting 30 to 60 minutes
o E: Agitation, they move around and hit there head to try and get rid of the pain
o S: severe
What is the characteristics of syncope?
o Short duration
o Rapid onset
o Spontaneous complete recovery
What questions you ask when patient has lost of consciousness?
o Was LOC complete
o Was LOC transient with rapid onset with short duration
o Did patient recover spontaneously, completely without sequel?
o Did patient loose postural tone
What is the most common syncope?
Vasovagal syncope
What does vasovagal syncope occur?
o Occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress
What is key facts you need to get from a syncope history?
o Position o Activity was it exercise induced, or were you sitting down o Predisposing factors What happened that day o Onset o Eye witness o Background history
What is carotid syncope?
o Massage both carotid bodies on your neck together pass out
o More common in elderly
How do you treat carotid syncope?
Pace maker
What is ictus mean?
period of which seizures occur in
What does Postictal mean?
Period after seizure but before patient has returned to baseline mental state
What is key questions to ask in epileptic seizure history?
- The trigger
- Is it your 1st Seizure
- Response to treatment
- Seizure frequency
- Any warnings or symptoms
- How many times have you visited ED
- What follows the seizure
- What happens during seizure
What are the key associated symptoms for headache?
Fever=meningitis Rash= meningitis Nausea +Vomiting= ICP Worse on lying down or coughing=ICP Neck stiffness =menin Fits/faints Loss of consciousness Blurred vision Jaw in the temporal region/jaw when moving Photophobia Thunderclap= worse after 5 minutes (SAH) Disrupting the sleep= ICP Any weakness in the body or face= stroke
In a headache history what questions do you ask about associated causes of the headache?
Cheese, coffee, bright light
Smack your head
Does sitting in a dark room make it better
In radiation of a headache what do you want to ask?
Spread to the neck
Behind the eye
Unilateral or bilateral
Tight band?
What are the key red flags for acute angle glaucoma with headache history?
Blurred vision
N+V
Eye pain
Red eye
What are the key red flag questions to distinguish ICP in headache history?
Worse when lying down or coughing
wakes you up at night?
Nausea and vomiting
How to identify meningitis headache?
Fever with worsening headahce Neck stiffness Rash Photophobia N+V Altered mental state ( more confused)
What questions do identify temporal arteritis in headahce history?
Temporal pain
Pain with jaw movement
unilateral or bilateral
Key questions for SAH headachce?
Thunder clap Worse headache Occipital region Blurred vision Neck stiffness Vomiting/blurred vision
In all general vague headache history what question should you ask?
MOOD!!!!!!!!1
In what type of lesion do you get fasciculations and atrophy of the muscles?
Lower
