Neuro Flashcards
what are the primary functions of the frontal lobe? (3)
(1) PRIMARY MOTOR CORTEX
(2) executive function
(3) attention
what are the primary functions of the parietal lobe? (2)
(1) PRIMARY SENSORY CORTEX
(2) pain, temp, touch, proprioception
what is Broca’s aphasia? what lobe is this area of the brain located?
(1) expressive, non-fluent aphasia; these patients know what they want to say, but can’t say it
(2) frontal lobe (think frontal because they have MOTOR issues with speaking)
BEN = Broca, Expressive, Non-Fluent
what is Wernicke’s aphasia? what lobe is this area of the brain located?
(1) fluent aphasia where the patient can’t comprehend (they can put together smooth sentences but they make no sense)
(2) temporal lobe
what are the primary functions of the temporal lobe? (2)
(1) PRIMARY AUDITORY CORTEX
(2) memory and learning
what are the primary functions of the occipital lobe? (3)
(1) PRIMARY VISUAL CORTEX
(2) perceptual deficits (visual agnosia)
(3) C/L homonymous hemianopia
what artery supplies blood to Broca’s region of the brain? what artery supplies Wernicke’s region?
(1) Broca’s: upper division of MCA
(2) Wernicke’s: lower division of MCA
where are the 12 cranial nerves located within the brain?
CE MI PONS MEDU Cerebrum: 1,2 Midbrain: 3,4 Pons, 5,6,7,8 Medulla: 9,10,11,12
what is CN 1 and what is it’s function?
(1) olfactory
(2) smell
what is CN 2 and what is it’s function?
(1) optic
(2) vision
what is CN 3 and what is it’s function?
(1) oculomotor
(2) turns eye up, down, medial; elevates eyelid, constricts pupil
what is CN 4 and what is it’s function?
(1) trochlear
2) turns adducted eye down (intorsion
what is CN 5 and what is it’s function?
(1) trigeminal
(2) FACIAL SENSATION, ANTERIOR TONGUE SENSATION, muscles of mastication, dampens sound
what is CN 6 and what is it’s function?
(1) abducens
(2) abducts eye
what is CN 7 and what is it’s function?
(1) facial
(2) TASTE ANTERIOR TONGUE, muscles of facial expression. tears / salivation (two sub glands), dampens sound
what is CN 8 and what is it’s function?
(1) vestibulocochlear
(2) balance and hearing
what is CN 9 and what is it’s function?
(1) glossopharyngeal
2) TASTE POSTERIOR TONGUE, SENSATION POSTERIOR TONGUE, sensation from oropharynx, salivation (parotid
what is CN 10 and what is it’s function?
(1) vagus
(2) decreases HR, increases GI motility, muscles of larynx / pharynx, thoracic and abdominal viscera
what is CN 11 and what is it’s function?
(1) accessory (spinal)
2) trap and SCOM innervation (head movements
what is CN 12 and what is it’s function?
(1) hypoglossal
(2) tongue movements
a lesion to CN 12 will result in a deviation of the tongue to which side?
the tongue will deviate to the SAME side of the lesion (atrophy will be present on lesion side)
a lesion to CN 10 will result in a deviation of the uvula to which side?
the uvula will deviate to the OPPOSITE side of the lesion
what CNs is ALS more likely to affect? least likely to affect?
motor and mixed nerves; sensory nerves are not usually affected by ALS
what CNs is ALS more likely to affect? least likely to affect?
motor and mixed nerves; sensory nerves are not usually affected by ALS
how is the Rinne test performed and what do positive tests indicate?
(1) place tuning fork on mastoid process (bone conduction) and then right beside ear (air conduction)
(2) if the pt. can’t hear it stronger outside of ear but can hear it on mastoid process, it’s positive for conductive hearing loss
how is the Weber test performed and what do positive tests indicate?
(1) place tuning fork on bridge of forehead, nose or teeth
(2) Laterilzation to GOOD side = sensorineural loss
(3) Laterilzation to AFFECTED side = conductive loss
what score on the BERG indicates an increased risk for falls?
<45
what score on the TUG indicates independence? what score indicates HIGH risk for falls?
(1) <10 seconds indicates independence
(2) >30 seconds indicates high fall risk
what score on the dynamic gait index (DGI) indicates an increased fall risk?
<19
what score on the functional reach test indicates an increased risk for falls?
<10 inches
what is the underlying physiological cause of PD?
progressive disease that depletes dopamine from substantia nigra in the basal ganglia
what are the hallmark signs of PD?
TRAP
Tremors, Rigidity, Akinesia, Postural Instability
what are some early signs of PD? (3)
loss of sense of smell, constipation, and sleep disorders
what are the 5 stages of Hoehn & Yahr for PD?
I - UNILATERAL involvement
II - BILATERAL involvement (no balance impairment)
III - BALANCE impaired (can still live independently)
IV - REQUIRES ASSISTANCE (needs AD to ambulate)
V - bed bound or w/c bound
what is the gold standard drug therapy for PD?
Sinemet (Levodopa / Carbidopa)
what is the underlying physiological cause of Huntington’s disease?
neurodegenerative GENETIC disease; degeneration of basal ganglia and cerebral cortex
what are the hallmark signs of Huntington’s disease?
(1) chorea: involuntary jerking or writhing
(2) dystonia
(3) leads to cognitive decline
what is the most common form of MS?
relapsing-remitting (70% of cases)
what are the 4 types of MS and how is each presentation?
(1) relapsing-remitting: attacks followed by periods of remission
(2) primary progressive: steady decrease in disability without any attacks
(3) secondary progressive: initially is relapsing-remitting then switches to progressive disability without attacks
(4) progressive-relapsing: steady decline with attacks (no periods of remission)
what are usually the first symptoms of MS?
visual impairments (such as optic neuritis, nystagmus, diplopia)
how do you determine if pupillary light reflexes are intact? what are posititve tests and what do they indicate?
if you shine a light in one eye, both should constrict (contralateral consensual response causes opposite eye to constrict)
(1) if light is shined in R eye, but it dilates the R oculomotor nerve is affected (and vice versa)
(2) if you shine a light in the R eye and both eyes dilate the optic nerve is affected
what is the most commonly reported symptom of MS? what should be avoided in patients with MS?
(1) fatigue
(2) exposure to excessive heat (can increase neurological s/s) as these patients are often heat sensitive
what time of day should a patient with MS exercise? why?
in the morning; decreased core body temperature and less fatigued
what is the underlying physiological cause of GBS?
demyelinating of spinal and peripheral nerves with rapid onset; LOWER motor neuron disorder
what is the clinical presentation of a patient with GBS?
symmetrical, bilateral, ascending muscle (distal to proximal) muscle weakness and sensory symptoms (pain, aches, tingling, numbness)
is ALS an upper motor neuron or lower motor neuron disorder?
BOTH
what is a common clinical feature of ALS?
cervical extensor weakness
when a CVA occurs to the anterior cerebral artery, what impairments might you expect to find? what region of the body is more affected?
(1) LOWER extremity
(2) CONTRALATERAL motor and sensory loss (LE > UE)
(3) memory and behavioral impairments due to frontal lobe involvement
(4) urinary incontinence
when a CVA occurs to the middle cerebral artery, what impairments might you expect to find? what region of the body is more affected?
(1) UPPER extremity
(2) CONTRALATERAL motor and senosry loss (UE and Face > LE)
(3) Aphasia (left stroke)
(4) Perceptual problems (right stroke)
how would homonymous hemianopsia present with a RIGHT sided stroke?
(1) Loss of vision on LEFT side of BOTH right and left eyes
(2) loss of nasal field on RIGHT
(3) loss of temporal field on LEFT
what is agnosia?
inability to recognize an object by sight, touch or sound
what is apraxia?
inability to perform learning sequential movements on command
when a CVA occurs to the posterior cerebral artery, what impairments might you expect to find?
(1) C/L homonymous hemianopsia
(2) memory deficits
(3) visual agnosia
(4) Prosopagnosia (difficulty naming people on site)
what can happen with a vertebrobasilar artery infarct?
locked in syndrome; no speech or movement, but the patient is alert and oriented
what is figure ground discrimination?
inability to separate the elements of a visual image on the basis of contrast (ex: button from the shirt)
what is form discrimination?
unable to recognize object in an unusual position (difference between letters m and n)
what is space impairment?
inability to perceive spatial concepts (ex: up/down, under/over)
what is the UE flexor synergy pattern?
(1) scapular: elevation / retraction
(2) shoulder: ABD, ER
(3) elbow: flexion, supination
(4) wrist: flexion
(5) finger: flexion
what is the LE extensor synergy pattern?
(1) hip: extension, ADD, IR
(2) knee: extension
(3) ankle: PF, INV
(4) toe: extension
what are the 7 stages of Brunnstrom’s Stages of Recovery?
Stage 1: flaccidity
Stage 2: spasticity begins (no voluntary movement)
Stage 3: voluntary movement (in synergy)
Stage 4: start of movement outside of synergy (spasticity declines)
Stage 5: complex movements, less synergy (spasticity continues to decline)
Stage 6: individual joint and coordinated
Stage 7: normal function
what is decorticate rigidity?
(1) UE flexion
(2) LE extension
what is decerebrate rigidity?
(1) UE extension
(2) LE extension
what are the stages of the modified ashworth scale?
0 - no increase in tone (normal)
1 - slight increase in tone (at end range)
1+ - slight increase in tone <50% of range
2 - marked increased through most of range (still moves easily)
3 - passive movement difficult
4 - rigid (no movement)
with pusher syndrome, which side do these patients push towards?
push towards the WEAKER side
for pusher syndrome, what should most of your treatments be?
ACTIVE movements; active movements are much more effective than passive movements
how is a PNF chop performed?
(1) WEAK arm starts in D1 Flexion and moves into D1 extension
(2) STRONG arm holds top of weak wrist and moves into D2 extension
how is a PNF lift performed?
(1) WEAK arm starts in D2 extension and moves into D2 flexion
(2) STRONG arm holds the weak arm from underneath and moves into D1 flexion
what is the D1 flexion pattern for the LE?
think kicking a soccer ball (follow through) Hip: flexion, adduction, ER Knee: flex or ext ankle: dorsiflexion, inversion toe: extension
what is the D1 extension pattern for the LE?
think winding up to kick a soccer ball
hip: extension, abd, IR
knee: flex or ext
ankle: PF, eversion
toe: flexion
what LE PNF pattern is ideal for pre-gait training?
D1 flexion and extension
how are the Glascow coma scale scores interpreted?
3-8 severely abnormal
9-12 moderately abnormal
13-14 mildly abnormal
15 - normal
what are the 8 levels of the RLA cognitive functioning?
I - no response II - general response III - localized response IV - confused, agitated V - confused, inappropriate VI - confused, appropriate VII - automatic, appropriate VIII - purposeful, appropriate
are the DCML tracts ascending or descending? what are they responsible for?
(1) ascending (sensory)
(2) fine touch, vibration, two-point descrimination, proprioception, light pressure
what are the two parts of the DCML? which one is lateral and which one is medial? where do each transmit information from?
(1) fasciculus gracilis: medial; gathers information from lower limbs
(2) fasciculus cuneatus: lateral; gathers information from upper limbs
is the lateral spinothalamic tract ascending or descending? what is it responsible for?
(1) ascending (sensory)
(2) pain and temperature
is the anterior spinothalamic tract ascending or descending? what is it responsible for?
(1) ascending (sensory)
(2) crude touch
what is the function of the spinocerebellar tracts?
ascending (sensory) tract that is responsible for the unconscious transmission of information from muscles to the cerebellum
are the anterior corticospinal tracts and lateral corticospinal tracts ascending or descending? what is it responsible for?
(1) descending (motor)
(2) lateral: motor control of contralateral limbs (DECUSSATES)
(3) anterior: postural control of head, neck, and trunk (DOESN’T DECUSSATE)
what is the function of the vestibulospinal tract?
balance and posture (maintain head and neck muscle tone)
what is the function of the medial and lateral reticulospinal tracts?
(1) medial: facilitates voluntary movements, and increases muscle tone
(2) lateral: inhibits voluntary movements, and reduces muscle tone
what is the function of the tectospinal tract
coordinates movements of the head in relation to vision stimuli
what does an ASIA A spinal cord injury imply?
no motor or sensory function preserved in the sacral segments S4-S5
what does an ASIA B spinal cord injury imply?
SENSORY but not motor is preserved below the neurological level; no motor function preserved more than 3 levels below motor level
what does an ASIA C spinal cord injury imply?
LESS than half of the key muscles below the neurological level of injury have an MMT score of at least 3
what does an ASIA D spinal cord injury imply?
MORE than half of the key muscles (half or more) below the neurological level of injury have an MMT score of at least 3
how is the neurological level determined?
(1) sensory: lowest level where normal sensory function is present bilaterally
(2) motor: lowest key muscle that has a grade of at least 3 (AND the muscle above is a 5/5)
- Neurological level is the lowest segment with normal sensory and motor as described above
what occurs with anterior cord syndrome? (2)
(1) motor function loss bilaterally (spastic paresis below level of injury)
(2) loss of pain and temperature below level of injury)
what occurs with posterior cord syndrome?
sensory loss bilaterally (proprioception, vibration, fine touch)
what occurs with central cord syndrome? (2)
(1) loss of pain and temperature
(2) motor loss to bilateral UEs
what occurs with brown sequard syndrome? (2)
(1) IPSILATERAL: motor and sensory loss below level of injury
(2) CONTRALATERAL: loss of pain and temp below and at level of injury
what typically causes anterior cord syndrome?
flexion injury of the cervical spine
what most commonly causes central cord syndrome?
hyper extension of the neck
how is the Tardieu scale graded?
3 Velocities: V1: slow as possible V2: normal V3: fast as possible Scoring 0 - no resistance 1 - slight resistance throughout 2 - clear catch and release 3 - fatiguable clonus (LESS than 10 sec) 4 - non-fatiguable clonus (> 10 sec) 5 - joint immovable
in a patient with cauda equina syndrome, will the patient have a non-reflexive or reflexive bowel and bladder? why?
NON-REFLEXIVE (it’s a LMN condition); DTR would also be hypo
an injury to what levels of the spinal cord would lead to difficulty breathing?
(1) AT or ABOVE C3-C5 spinal segments (2) phrenic nerve (C3-C5) innervates the diaphragm)
* *Remember C three, four, five keeps the diaphragm alive**
what is the FIRST thing you do when a patient is experiencing autonomic dysreflexia?
sit the patient up and lower their legs (this decreases BP)
what should be done to remove the noxious stimulus in a patient experiencing autonomic dysreflexia? (3)
(1) loosen clothing
(2) catherize bladder)
(3) check for fecal impaction
at what level of SCI does autonomic dysreflexia typically occur?
injuries ABOVE T6
what is considered orthostatic hypotension?
decrease in BP >20 mmHg with positional changes
at what level would a spinal cord injury present with a spastic bladder? what level would patients present with flaccid bladder? what is the treatment for both?
(1) Spastic bladder: T12 AND ABOVE
(2) Flaccid bladder: BELOW T12
(3) intermittent catheterization is required every 3-6 hours
if a dix hallpike is performed and a torsional upbeating nystagmus is present what does that indicate? what is it’s a torsional downbeating nystagmus?
(1) torsional upbeating: posterior canal involvement
(2) torsional downbeating: anterior canal involvement
how many degrees of extension should the head be placed in for the dix hallpike test?
20-30 degrees off the table
when performing the supine roll test, what do geotropic nystagmus and a-geotropic nystagmus indicate? which ear is the INVOLVED ear for each condition?
(1) geotropic: canalithiasis
- involved ear is the side with STRONGER nystagmus
(2) a-geotropic: cupulolithiasis
- -involved ear is the side with WEAKER nystagmus
what is the purpose of the liberator (Sermont) maneuver?
to treat cupulolithiasis for posterior canal BPPV; attempt to dislodge otoconia from cupula
what treatment can be performed in patients who can’t tolerate canal respositioning manuevers?
Brandt-Daroff Exercises; it’s a habituation exercise that desensitize your nervous system
how can you differentiate between canalithiasis and cupulolithiasis?
if the s/s or nystagmus last longer than 60 seconds, it’s considered cupulolithiasis; anything less is a canalithiasis
what abnormal testing might indicate a CNS lesion in regards to oculomotor testing?
(1) smooth pursuit
(2) saccades
if a person with BPPV is otherwise healthy, would their VOR be intact?
yes; VOR is intact in BPPV
what are the 6 conditions for the CTSIB?
1 - eyes open - firm surface 2 - eyes closed - firm surface 3 - eyes sway - firm surface 4 - eyes open - foam surface 5 - eyes closed - foam surface 6 - eyes sway - foam surface
there are 3 systems that maintain balance, when two systems are affected, which is the primary?
VISION is the most dominant system
SOMATOSENSORY is 2nd most dominant
VESTIBULAR is 3rd most dominant
-If 2 systems are affected, the MORE dominant system is the main one affected
what score on the Tinetti (POMA) indicate a high fall risk?
<19
what are neuropraxia, axonotmesis, neurotmesis?
(1) neuropraxia: segmental demyelination; temporary sensation loss
(2) axonotmesis: loss of axonal continuity; wallerian degeneration distal to lesion
(3) neurotmesis: complete severance of nerve; muscle atrophy and sensory loss
