Neuro Flashcards
Frontal lobe
voluntary skeletal, behavioral, visceral functions
Parietal
processing sensory data; proprioception
Occipital
vision
Temporal
Sound and integration of taste, smell, and balance
Speech center is called
Wernicke
Basal ganglia
refine motor movements
Cerebellum
muscle tone, balance, posture; integration of voluntary movement
Thalamus
pain and temperature
Brainstem structures:
medulla oblongata, pons, midbrain, and diencephalon
Two structures of diencephalon
thalamus; hypothalamus
Pons
transmits information between the brainstem and cerebellum
Medulla olbongata is the site where
descending corticospinal tracts decussate
ascending spinal tracts
complex discrimination tasks
posterior (dorsal) column spinal tracts
fine touch, 2-point discrimination, and proprioception
Spinothalamic
light and crude touch; pressure, temp, and pain
How long is the spinal cord
40-50 cm
where does the spinal cord begin and end?
begins at foramen magnum and ends at L1 or L2
The gray matter contains:
the nerve cell bodies associated with sensory pathways and the ANS
The white matter of the spinal cord contains
the ascending and descending spinal tracts
descending spinal tracts
brain to muscles; muscle tone, posture, and precise motor movements
Corticospinal
skilled, delicate movements
vestibulospinal
extensor muscles to contract during fall
UMN
nerve cell bodies for the motor pathways; begin and end within the CNS
UMN role
influencing, directing, and modifying spinal reflex arcs and circuits; can affect movement only through LMN
UMN injury causes
initial paralysis, followed by partial recovery
LMN
originate in anterior horn of spinal cord and extend to PNS; transmit signals directly to muscles
LMN injury
permanent paralysis
motor/efferent go to what horn
anterior
sensory/afferent go to what horn
posterior
how many pairs of spinal nerves?
31
The major portion of the brain growth occurs in the x year of life, along with myelinization of the brain and nervous system?
first
At birth the neurologic impulses are primarily handled by the?
brainstem and spinal cord
The following reflexes are present at birth
sucking, rooting, yawning, sneeze, hiccup, blink at bright light, and withdrawal from pain
Motor maturation proceeds in what direction
cephalocaudal
What change in pregnant patients leads to neurologic changes?
hypothalamic-pituitary neurohormonal changes
Do tendon reflexes increase or decrease in the elderly?
decreased
Three screening questions for fall risk?
have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?
Corneal reflex is associated with what CN?
V (trigeminal)
Palate and uvula movement is associated with what CN?
IX and X
Guttural speech sounds are associated with CN?
IX and X
Tongue movement is associated with CN?
XII
Lingual speech sounds are associated with CN?
XII
The loss of sense of small or an inability to discriminate odors called
anosmia
Anosmia is due to
trauma to the cribriform plate or an olfactory tract lesion
What’s the first thing to lose function in the presence of increased intracranial pressure
sixth cranial nerve
Impaction of sixth cranial nerve can lead to what vision abnormality
absence of lateral (temporal) gaze
When UMN are affected what is paralyzed?
voluntary motor paralyzed, but emotional movements are spared
What is paralyzed in LMN?
all facial movements on the affected side are paralyzed
posterior tongue taste and nerve?
bitter and sour; 1/3; IX
anterior tongue taste and nerve?
sweet and salty; 2/3; VII
enhanced physiologic tremor is seen when?
hands are held extended, disappears when limb at rest
Potential cause of enhanced physiologic tremor
drug or alcohol withdrawal; hyperthyroidsm; hypoglycemia; toxicity
describe tremor of essential tremor
symmetric; worse with stress or fatigue; improved with alcohol
cause of essential tremor:
AD
Intentional tremor describe
seen during intentional movements; does not occur with rest
Cause of intentional tremor
cerebellar disorder like MS or alcohol abuse
Describe resting tremor
seen at rest; slow supination-pronation
Cause of resting tremor
PD
a positive romberg test indicates
cerebellar ataxia, vestibular dysfunction, sensory loss
For all the Romberg tests (standing on foot; bouncing on foot) what is the time frame?
5 seconds
Heel-toe walking is called?
tandem gait
the affected leg is stiff and extended with plantar flexion of the foot ; movement of the foot results from pelvic tilting upward on the involved side; the foot is dragged, often scraping the toe, or it is circled stiffly outward and forward; the affected arm remains flexed and adducted and does not swing
spastic hemiparesis
the patient uses short steps, dragging the ball of the foot across the floor; the legs are extended and the thighs tend to cross forward on each other at each step due to injury to the pyramidal system
spastic diplegia
the hip and knee are elevated excessively high to lift the plantar flexed foot off the ground; the foot is brought down to the floor with a slap; unable to walk on heels
steppage
the patient’s feet are wide-based; staggering and lurching from side to side is often accompanied by swaying of the trunk
cerebellar gait
the patient’s gait is wide-based; the feet are thrown forward and outward, bringing them down first on heels, then on toes; the patient watches the ground to guide his or her steps; positive romberg present
sensory ataxia
the patient limits the time of weight bearing on the affected leg to limit pain
ataxia
the patient’s posture is stooped and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping
parkinsonian gait
loss of position of joints indicates?
peripheral neuropathy
polyneuropathy manifests in what distribution?
glove and stocking
manifestations of complete transverse lesion of the spinal cord
all sensation lost below the level of the lesion; pain/temp/touch sensation lost one or two dermatomes below lesion
partial spinal sensory syndrome aka
brown-sequard
partial spinal sensory syndrome manifestations
pain and temp sensation loss one or two dermatomes below the lesion on the opposite side of the body from the lesion; proprioceptive loss and motorparalysis occur on the lesion side of the body
familiar object test
sterognosis
touch two areas of body and ask how many and where test
extinction phenomenon
upper abdominal reflexes
T8, T9, T10
lower abdominal reflexes
T10, T11, T12
cremasteric reflxes
T12, L1, L2
Plantar reflxes
L5, S1, S2
biceps reflex
C5 C6
brachioradial reflex
C5 C6
triceps reflex
C6 C7 C8
patellar reflex
L2, L3, L4
Achilles reflex
S1 and S2
the babinski sign indicates a
pyramidal tract UMN disorder
Babinski sign is expected in children younger than
2 years old
With abdominal reflex do you stroke toward or away from umbilicus?
away
With abdominal reflex how does the abdomen respond?
slight movement of the umbilicus toward each area of stimulation, bilaterally equal
Diminished abdominal reflex seen in?
obese patients, stretched abdominal muscles (pregnancy); absent on side of corticospinal tract lesion
absent reflexes may indicate
neuropathy or LMN disorder
Hyperactive reflexes may indicate
UMN disorder
UMN muscle tone
increased tone, muscle spasticity, risk for contractures
LMN muscle tone
decreased tone, muscle flaccidity
UMN muscle atrophy
little or none, but decreased strength
LMN muscle atrophy
loss of muscle strength; muscle atrophy or wasting
UMN sensation
sensation loss may affect entire limb
LMN sensation
sensory loss follows the distribution of dermatome or peripheral nerves
UMN reflexes
hyperactive deep tendon and abdominal reflexes; + babinski
LMN reflexes
weak or absent deep tendon, plantar, and abdominal reflexes, negative plantar reflex, no pathologic reflexes
UMN fasiculations
none
LMN fasiculations
present
UMN motor effect
paralysis of voluntary movements
LMN motor effect
paralysis of muscles
uMN location of insult
damage above level of brainstem affects opposite side of body; damage below the brainstem affects the same side of body
LMN location of insult
damage affects muscle on same side of body
grade 0 reflex
no response
grade 1+ reflex
sluggish or diminished
grade 2+ reflex
active or expected response
grade 3+ reflex
more brisk than expected, slightly hyperactive
grade 4+ reflex
brisk, hyperactive, with intermittent or transient clonus
brachioradial reflex results in what action?
pronation
sustained clonus indicate?
UMN disease
diabetic foot exam filament?
5.07
monofilament should be applied for x time
1.5 seconds
how to test for nuchal rigidity?
with patient supine, slip hand under head and raise it, flexing neck. Try to make patient’s chin touch sternum. Placing hand under shoulders and raising will help relax the neck. Pain and resistance is positive.
Brudzinski sign
involuntary flexion of the hips and knees when flexing the neck
Kernig sign
flexing the leg at the knee and hip when patient is supine, then attempting to straighten the leg. positive is present when the patient has pain in the lower back and resistance to straightening the leg at the knee.
jolt accentuation of HA
ask pt to move head horizontally at a rate of 2-3 rotations per second. Positive is increased HA over the baseline.
decorticate is associated with
corticospinal tracts injury above the brainstem
decerebrate is associated with injury to
the brainstem
coordinated sucking and swallowing is a function of the
cerebellum
hands are usually held in fists for first
3 months
Purposeful movements begin at about
2 months
taking objects with one hand at
6 months
transferring objects between hands at
7 months
purposefully releasing objects by
10 months
which reflex is present at birth?
patellar
achilles and brachioradial reflex appear at age
6 months
Ankle clonus in an infant?
one or two beats
positive babinski normal until
16-24 months
rooting reflex
touch corner of infant’s mouth, when hungry will move head and open mouth on side of stimulation
rooting reflex disappears by
3-4 months
palmar grasp
touch palm of infant’s hand from ulnar side, note strong grasp of finger
palmar grasp strongest between
1-2 months
palmar grasp disappears by
3 months
plantar grasp
touch plantar surface of infant’s feet at base of toes; toes should curl downard
plantar grasp strong up to
8 months
moro
with infant supported in semisitting position, allow the head and trunk to drop back to 30 degree, observe symmetric abduction and extension of arms, fingers fan out and thumb and index finger form a C; the arms then adduct in an embracing motion followed by relaxed flexion; legs follow a similar pattern
moro diminishes by
3-4 and disapears by 6 months
placing reflex
hold infant upright under arms next to table or chair; touch the dorsal side of the foot to table/chair; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table
stepping reflex
hold infant upright under arms and allow soles of feet to touch the surface; observe for alternate flexion and extension of the legs; simulating walking
Asymmetric tonic neck or “fencing”
with infant lying supine and relaxed, turn his or her head to one side so jaw is over shoulder; observe for extension of arm and leg on the side to which the head is turned and for flexion of the opposite arm and leg
asymmetric tonic neck or “fencing” diminishes by
3-4 months and disappears by six
what four baby reflexes are present at birth?
rooting, palmar grasp, plantar grasp, moro
placing is present by
4 days of age
stepping present by
birth to 8 weeks
asymmetric tonic neck or “fencing” present by
2-3 months
In a child, delaying in sitting or walking may be sign of
cerebellar disorder
the child beginning to walk has what type of gait?
wide-based
what type of taste is lost with aging?
salty
gait of advancing age
shorter steps with less lifting; shuffling; arms are more flexed and legs may be flexed at hips and knees
Screening test of balance, strength and cerebellar function
The Timed Up and GO Test
Timed Up and Go Test
stand up from chair without using arms; walk 10 feet to mark on floor, turn around, walk 10 feet, and sit down without using chair arms; assistive devices ok
How long does it take to complete Timed Up and Go test
10 seconds
Fall risk tool
Performance Oriented Mobility Assessment Tool AKA Tinetti Balance and Gait tool
are lower extremities or upper extremities reflexes diminished first in elderly
lower first
What reflexes may be absent in the elderly?
achilles and plantar
