Neuro Flashcards
Stages of ALS
Stage III
- Severe weakness of specific muscles
- Increasing fatigue
- Mild to moderate functional limitations
- Ambulatory
Neurotmesis
- Class 3
- Cutting of the nerve w/ severance of all structures and complete loss of function
- Reinnervation typically fails w/o surgical intervention because of aberrant regeneration
- Failure of regenerating axon to find its terminal end
LE Extension Synergy Components
Strong Components:
- Hip Abduction
- Knee Extension
- Ankle Plantarflexion
Other Components:
- Hip extension
- IR
- Ankle Inversion
Temororal Lobe Area
- Contains:
- Primary Auditory Cortex
- Associative Auditory Cortex
- Wernicke’s Area
Patients w/ T12-L3 Lesions
- Can be independent ambulator on all surfaces/stairs
- Swing-Through/Four-Point Gait
- Bilateral KAFOs/Crutches
- Household Ambulators
- WC Community Ambulator
Fibrillation
- Spontaneous independent contractions of individual muscle fibers
- Evident w/ denervation for 1-3 weeks after losing nerve
Anterior Cord Syndrome: UMN Lesion
Loss of anterior cord:
- Loss of Lateral Corticospinal Tracts
- Bilateral loss of motor function, spastic paralysis below level of lesion
- Loss of Spinothalamic Tracts
- Bilateral loss of pain and temperature
- Preservation of Dorsal Columns
- Proprioception, kinesthesia, and vibratory sense
Glasgow Coma Scale
Score 13-15
Minor Brain Injury
Hoehn and Yahr Classification
Stage II
- Minimal bilateral or midline involvement
- No balance involvement
Stages of AD
Moderate AD
- Noticable memory, thinking, and behavioral symptoms that impair a person’s ability to function in daily life
Spinothalamic Tracts
- Lateral
- Sensations of Pain and Temperature
- Anterior
- Crude Touch
Occipital Lobe Area
- Primary Visual Cortex
- Visual Association Cortex
Most Common Lumbar SCI Injury
Flexion
ACA Blood Supply
Anterior two-thirds of the medial cerebral cortex
Functional Balance Grade: Fair
- Patient is able to maintain steady balance with hand-hold support; may require occasional minimal assistance (static).
- Patient accepts minimal challenge; able to maintain balance while turning head/trunk (dynamic).
Stages of ALS
Stage II
- Moderate weakness in groups of muscles
- Some wasting (atrophy) of muscles
- Modified independence w/ assistive devices
Fasciculations
- Spontaneous contractions of all or most of the fiber in a motor unit
- Muscle twitches that can be observed or palpated
- Present w/ LMN disorders and denervation
Posterior Cord Syndrome: UMN Lesion
Loss of dorsal columns:
- Bilateral Loss of Proprioception, Vibration, Pressure,
- Epicritic Sensation (Stereognosis/Point Discrimination)
- Preservation of Motor Function, Pain, and Light Touch
Reticulospinal System
Modifies Transmission of Sensation, Especially Pain
Brudzinski’s Sign
- Patient is positioned in supine; flex neck to chest
- Positive sign: causes flexion of hips and knees
- Suggests meningeal irritation
Patients w/ C5 Lesions
- Have Shoulder/Elbow Function
- Can use manual chair w/ propulsion aids
- Independent for short distances on smooth/flat surfaces
- May choose electric WC for distances/energy conservation
Figure-Ground Discrimination
Ability to pick out an object from an array of objects
Ex: brakes from a WC
Typical Neurological Gait Deficits
Ankle
- Equinus Gait
- Varus Foot
- Equinovarus Position
Medial Medullary Syndrome
Ipsilateral to lesion:
- Paralysis of Half of Tongue
Contralateral to lesion:
- Hemiplegia UE/LE
- Impaired Sensation
Stages of ALS
Stage IV
- Severe weakness and wasting of LEs
- Mild weakness of UEs
- Moderate assistance and assistive devices required
- Uses WC
Segmental Demyelination
- Axons are preserved (no wallerian degeneration)
- Remyelination restores function
- ex: Guillain-Barre
Cheyne-Stoke Respiration
- A period of apnea lasting 10-60 seconds
- Gradually increasing depth/frequency of respirations
- Accompanies depression of frontal lobe/diencephalic dysfunction
Depth and Distance Imperceptions
Determine whether a patient can judge depth and distance
Stages of ALS
Stage V
- Progressive weakness w/ deterioration of mobility/endurance
- Increased fatigue
- Moderate to severe weakness of whole limbs/trunk
- Spasticity
- Hyperreflexia
- Loss of head control
- Max assist
Opisthotonos
- Prolonged, severe spasm of muscles, causing head, back, andheels to arch backward
- Arms and hands are held regidly flexed
- Seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning
Patients w/ C8-T1 Lesions
- Have Hand Function
- Manual WC w/ standard hand rims
Midbrain Lesion
- Contralateral Hemiplegia
- Contralateral CN III palsy
Stages of AD
Mild AD
- Mild by measurable changes in cofnitive abilities noticeable to person affected and family members
- Able to carry out everyday activities
Spinoreticular Tracts
Convey Deep and Chronic Pain
Stages of AD
Preclincal AD
- Individuals have measureable changes in brain CSF/blood biomarkers w/out noticeable symptoms
Axonal Degeneration
- Degeneration of axon cylinder and myelin
- Progressing from distal to proximal
- Dying back of nerves
- ex: peripheral neuropathy
Typical Neurological Gait Deficits
Hip
- Retracted/Flexed
- Trendeleburg Limp (Weak Abductors)
- Scisoring (Spastic Adductors)
- Insufficient Pelvic Rotation during Swing
Lesions of Neocerebellum (Hemisphere, Posterior Lobe)
- Intention Tremor
- Irregular/Oscillatory Voluntary Movements
- Dysdiadochokinesia
- Dysmetria
- Hypermetria
- Errors or Force, Direction, Amplitude, Rebound Phenonmenon
- Dyssynergia
Rancho Los Amigos Levels of Cognitive Function
Level IV, V, and VI
Confused
Parietal Lobe Area
- Contains:
- Postcentral Gyrus (Primary Sensory Cortex)
Neck Mobility Test for Meningeal Irritation
- Patient is positioned in supine, flex neck to check
- Positive sign: neck pain w/ limitation/guarding of head flexion due to spasm of posterior neck muscles
- Can result from meningeal inflammation, arthritis, or neck injury
Guidelines to Promote Learning
W/ Right Hemisphere Lesions
- Use verbal cues
- Demonstrations or gestures may confuse patients w/ visuospatial deficits
- Give frequent feedback
- focus on slowing down and controlling movement
- Focus on safety
- Avoid environmental (spatial) clutter
- Do not overestimate ability to learn
MCA Bloody Supply
Lateral cerebral cortex, basal ganglia, and large portions of the internal capsule
UE Extension Synergy Components
Strong Components:
- Shoulder Adduction
Other Components:
- Scapular Protraction
- IR,
- Elbow Extension,
- Forearm Pronation
- Wrist and Finger Flexion
Gross Motor Classification for CP
Level II
- Walks w/o assistive devices
- Limitations walking outdoors/community
Dorsal Columns/Medial Lemniscal System
- Convey sensations of:
- Proprioception
- Vibration
- Tactile Discrimination
Functional Balance Grade: Poor
- Patient requires hand-hold support and moder to maximal assistance to maintain position (static).
- Patient unable to accept challenge or move without loss of balance (dynamic).
Functional Balance Grade: Good
- Patient is able to maintain steady balance without hand-hold support, limited postural sway (static).
- Patient accepts moderate challenge; able to maintain balance while picking object off floor (dynamic).
Tectospinal Tract
Assists in Head-Turning Responses to Visual Stimuli
LE Flexion Synergy Components
- Hip flexion
- Abduction
- ER
- Knee Flexion
- Ankle Dorsiflexion/Inversion
Agnosia
- Inability to recognize familar objects w/ one sensory modality
- Retain ability to recognize same object w/ other sensory modalities
- Ex: Subject doesn’t recognize a clock by sight but can recognize by ticking
Vertebrobasilar Artery Blood Supply
Ventral surface of the medulla and the posterior inferior aspect of the cerebellum
Rancho Los Amigos Levels of Cognitive Function
Level II-III
Decreased Response
Vertical Disorientation
Determine whether patient can accurately identify when something is upright
Patients w/ L4-L5 Lesions
- Bilateral AFOs w/ Crutches or Canes
- Independent Community Ambulators
- May still use WC for high-endurance activities
Lateral Inferior Pontine Syndrome
Ipsilateral to lesion:
- Cerebellar: Ataxia, Nystagmus, Vertigo
- Facial Paralysis/Impaired Facial Sensation
- Paralysis of Conjugate Gaze
- Deafness
- Tinnitus
Contralateral to lesion:
- Impaired Pain and Temperature Sensation
Vestibulospinal Tracts
Controls:
- Muscle Tone
- Antigravity Muscles
- Postural Reflexes
Spatial Relations
Ability to duplicate a pattern of two or three blocks
Patients w/ T6-T9 Lesions
- Require KAFOs, Crutches, Swing-to Gait Pattern
- Supervised ambulation for short distances
- May prefer standing devices/standing WC
Lesions of Paleocerebellum (Spinocerebellum; Rostral Cerebellum/Anterior Lobe)
- Hypotonia
- Truncal Ataxia
- Dysequilibruim
- Static Postural Tremor
- Increased Sway
- Wide BOS
- High Guard Arm Position
- Posture worse w/ EO
- Ataxic Gait
- Unsteady/Increased Falls
- Uneven/Decreased Step Length
- Increased Step Width
CRPS: Dystrophic or Middle Stage
- Think/Pale/Cynotic Skin
- Cessation of Hair/Nail Growth
- Hyperhidrosis
- Muscle Astrophy
- Osteoporosis
Most Common Cervical SCI Injuries
Flexion-Rotation
CRPS: Acute or Early Stage
- Diffuse/Severe Burning/Aching Pain
- Increases w/ Emotional Stress
- Allodynia
- Hyperpathia
- Increased sensitivity to normal stimuli
- Vasomotor Instability
- Dusky Molting/Cool Sking
- Swelling
- Edema
CATSIB
Patients Unstable in Conditions 4, 5, and 6
Dependent on Surface/Somatosensory Inputs
Anterior Cerebral Artery (ACA) Syndrome
- UE more spared
- Apraxia
- Akinetic Mutism
Basilar Artery Blood Supply
Ventral portion of the pons
Gross Motor Classification for CP
Level III
- Walks w/ assistive mobility device
- Limitations walking outdoors/community
CATSIB
Patients Unstable in Conditions 3, 4, 5, and 6
Patients with Sensory Selection Problems
Lateral Medullary (Wallenberg’s) Syndrome
Ipsilateral to lesion:
- Cerebellar: Ataxia, Nystagmus, Vertigo
- Loss of Pain and Temperature to Face
- Sensory Loss UE, Trunk, or LE
Contralateral to lesion:
- Impaired Pain and Temperature Sensation to Body/Face
- Horner’s Syndrome (Miosis, Ptosis, Decreased Sweating)
- Dysphagia
- Impaired Speech
CATSIB
Patients Unstable in Conditions 2, 3, 5, and 6
Dependent on Vision
Ideomotor Apraxia
Patient cannot perform task on command but can do task when left alone
Lacunar (pure motor) Stroke
- Contralateral Hemiplegia
- UE/LE
- No Aphasia
- Visual Field Deficit Rare
Hoehn and Yahr Classification
Stage V
- Confined to bed or WC
Rancho Los Amigos Levels of Cognitive Function
Level VII and VIII
Appropriate (Automatic and Purposeful)
Stages of ALS
Stage I
- Early disease
- Mild focal weakness
- Asymmetrical distribution
- Symptoms of hand cramping and fasciculations
Medial Inferior Pontine Syndrome
Ipsilateral to lesion:
- Cerebellar Ataxia
- Nystagmus
- Paralysis of Conjugate Gaze
- Diplopia
Contralateral to lesion:
- UE/LE Hemiparesis
- Impaired Sensation
Glasgow Coma Scale
Score 1-8
Severe Brain Injury
Topographical Disorientation
Determine whether patient can navigate a familiar route on their own
Ex: travel from room to clinic
Middle Cerebral Artery (MCA) Syndrome
- LE more spared
- Nonfluent Aphasia
- Perceptual Deficit
- Loss of Conjugate Gaze to Opposite Side
- Sensory Ataxia
Hoehn and Yahr Classification
Stage III
- Impaired Balance
- Some restrictions in activities
Apraxia
Inability to perform voluntary, learned movements in the absence of loss of sensation, strength, coordination, attention, or comprehension
Stages of ALS
Stage VI
- Bedridden
- Dependent ADS/FMS
- Progressive respiratory distress
Locked-in Syndrome
- Tetraplegia
- Lower Bulbar Paralysis (CN V-XII)
- Mutism (Anarthria)
- Preserved Consciousness
- Preserved Vertical Eye Movements/Blinking
Glasgow Coma Scale
Score 9-12
Moderate Brain Injury
Ideational Apraxia
Patient cannot perform the task at all
Functional Balance Grade: Absent
- Patient unable to maintain balance.
CATSIB
Patients Unstable in Conditions 5 and 6
Patients with Vestibular Loss
Hoehn and Yahr Classification
Stage IV
- All symptoms present and severe
- Stand and walks only w/ assistance
Guidelines to Promote Learning
W/ Left Hemisphere Lesions
- Develop an appropriate communication base
- Words, Gestures, Pantomimes
- Assess Level of Understanding
- Give frequent feedback and support
- Do not underestimate ability to learn
Gross Motor Classification for CP
Level V
- Self-mobility is severely limited, even w/ assistive technology
Typical Neurological Gait Deficits
Knee
- Weak Knee Extensors
- Knee Flexes during Stance
- Compensatory Locking of Knee in Hyperextension
- Spastic Quadriceps
- May Also Hyperextend Knee
Patients w/ Left Hemisphere Lesions
Typically slow, cautious, hesitant, and insecure
Cauda Equina Injury: LMN Lesion
- Loss of long nerve roots at or below L1
- Variable nerve root damage (motor and sensory signs)
- Incomplete lesions common
- Flaccid paralysis with no spinal reflex activitiy
- Flaccid paralysis of bladder and bowel
- Potential for nerve regeneration
- Regeneration often incomplete, slows and stops after about 1 year
Neurapraxia
- Class 1
- Injury to nerve that causes transient loss of function (conduction block ischemia)
- Nerve dysfunction may be rapidly reserves or persist a few weeks
- ex: compression
Wallerian Degeneration
- Transection (neurotmesis) results in degeneration of the axon/myelin sheath distal to site of axonal interuption
Posterior Cerebral Artery (PCA) Syndrome
- Contralateral Sensory Loss
- Choreoathetosis, Tremor, Hemiballismus
- Transient Contralateral Hemiparesis
- Homonymous Hemianopsia
- Visual Agnosia
- Memory Defect
- Dyslexia
- Central Pain
- Weber’s Syndrome
- Oculomotor N. palsy
Stages of AD
Severe AD
- Loss of ability to communicate, recognize others, and complete dependence
Position in Space
Have patient demonstrate different limb positions
Spinocerebellar Tracts
Convey proprioception information from:
- Muscle Spindles
- Golgi Tendon Organs
- Touch/Pressure Receptors
Frontal Lobe Area
- Contains:
- Precentral Gyrus
- Prefrontal Cortex
- Broca’s Area
Rubrospinal Tracts
Assists Motor Function
Gross Motor Classification for CP
Level I
- Walks w/o restrictions
- Limitations in more advanced gross motor skills
Kernig’s Sign
- Patient is positioned in supine, flex hip and knee fully to chest, and then extend knee.
- Positive sign: causes pain and increased resistance to extending the knee due to spasm of hamstring
- When bilateral, suggests meningeal irritation
Corticospinal Tracts
Arise from Primary Motor Cortex
Hoehn and Yahr Classification
Stage I
- Minimal or absent disability
- Unilateral symptoms
Brown-Sequard Syndrome: UMN Lesion
Hemisection of Spinal Cord:
- Ipsilateral Loss of Dorsal Columns
- Loss of tactile discrimination, pressure, vibration, and proprioception
- Ipsilateral Loss of Corticospinal Tracts
- Loss of motor function and spastic paralysis below lesion
- Contralateral Loss of Spinothalamic Tract
- Loss of pain and temperature below level of lesion
- Bilateral loss of pain and temperature at level of lesion
Patients w/ C7 Lesions
- Have Triceps Function
- Same as C6 but w/ increased propulsion
Patients w/ C6 Lesions
- Have Radial Wrist Extensors
- Manual WC w/ friction surface hand rims
- Independent
Patients w/ Right Hemisphere Lesions
- Typically impulsive, quick, indefferent
- Often exhibit poor judgement/safety
- Overestimate their abilities while underestimating their problems
UE Flexion Synergy Components
Strong Components:
- Elbow, Wrist, Finger Flexion
Other Components:
- Scapular Retraction/Elevation
- Shoulder Abduction, ER,
- Supination
Form Constancy
Ability to pick out an object from an array of similarly shaped but different sized objects
Axonotmesis
- Class 2
- Injury to nerve interrupting the axon and causing loss of function and wallerian degeneration distal to lesion
- No disruption of the endoneurium
- Regeneration is possible
- ex: crush injury
Gross Motor Classification for CP
Level IV
- Self-mobility w/ limitations
- Children are transported or use power mobility outdoors/community
Most Common SCI Injury Levels
- C5
- C7
- T12
- L1
Lisions of the Archicerebellum (Flocculonodular Lobe)
- Central vestibular symptoms
- Ocular Dysmetria
- Poor Eye Pursuit
- Dysfunctional VOR
- Impaired Hand-Eye
- Gait/Trunk Ataxia
- Poor Postural Control/Orientation
- Wide-Based Gait
- Little change in tone or dyssenergia of extremities
Rancho Los Amigos Levels of Cognitive Function
Level I
No Response
Functional Balance Grade: Normal
- Patient is able to maintain steady balance without hand-hold support (static).
- Patient accepts maximal challenge and can shift weight easily at full range in all directions (dynamic).
CRPS: Atrophic or Late Stage
- Decreased Hypersensitivity
- Normal Blood Flow/Temperature
- Smooth/Glossy Skin
- Severe Muscle Atrophy
- Periscapular Fibrosis
- Diffuse Osteoporosis
- Development of Claw Hand
Central Cord Lesion: UMN Lesion
Cavitation of central cord in cervical section:
- Loss of Spinothalamic Tracts
- Bilateral loss of pain/temperature
- Loss of Ventral Horn
- Bilateral loss of motor function: primarily UE
- Preservation of proprioception and discriminatory sensation
