Neuro Flashcards
Neurological Assessment (5)
- LOC
- CN Function
- Motor Function: muscle strength; cerebellar function; gait and balance
- Peripheral Nerves/ Sensation
- Reflexes (Babinski, DTRs)
Assessment LOC and mental Stat
alert
not alert
other
- Q4: person, place, time, situation
- Glasgow Coma Scale (GCS)
- ABCT: appearence, behavior, cognition, thought process
GCS
Glasgow Coma Scale
- eye opening
- verbal responce
- motor responce
This is a type of flexed posturing and can indicate damage to the cerebral hemispheres.
There will be adduction and flexion of the arms and the hands will be closed shut (flexed). The legs will be rotated internally and feet flexed.
Decorticate
This is a type of extended posturing and can indicate damage to the brain stem. Severe.
There will be adduction and extension of the arms and pronation of the hands and the fingers will be flexed along with extended legs and plantar flexion of the feet.
Decerebrate
Assessment of CN I - XII, and abnormal finding CN I- olfactory II- optic III- ocularmotor IV- Trochlear V- Trigeminal VI- Abducens VII- Facial VIII- Vestibulocochlear IX- Glossopharyngeal X- Vagus XI- Accessory XII- Hypoglossal
CN I- olfactory: Smell test. Abnormal- anosmia.
II- optic: Sullen eye chart, confrontation, ophthalmoscopic. Abnormal- visual field loss, papilledema.
III- ocularmotor, IV- Trochlear, VI- Abducens: EOMs, PERRLA. Abnormal- ptosis, nystagmus, strabismus, absence of PERRLA.
V- Trigeminal: muscles of mastication, light touch.
VII- Facial: facial symmetry, sweet/ salty taste.
VIII- Vestibulocochlear: whispered voice test.
IX- Glossopharyngeal: gag, sour/ bitter.
X- Vagus: gag “ahhhh”.
XI- Accessory: shoulder shrug, turn head against resistance.
XII- Hypoglossal: midline protrusion of tongue.
Examine Muscles (4)
- Size
- Strength
- Tone (assess via passive ROM)
- ROM
Muscle tone, 3 movements to note:
flaccidity
spasticity
rigidity
paresis
weakness, eg: 1/5 strength
Cerebellar Function Test (5)
- RAMs
- Finger-nose-finger
- Heel-to-shin
- Tandem walking
- Romberg
- RAMs
- Finger-nose-finger
- Heel-to-shin
- Tandem walking
- Romberg
RAMs: Rapid alternating movements (pronation/ supination on thighs; touching each finger to thumb)
- Finger-nose-finger: look for Dysmetira (tremmor or overshooting)
- Heel-to-shin: tests lower extremity coordination
- Tandem walking: Ataxia (uncoordinated unstready gait)
- Romberg: pt stands with feet together, ares at sides, eyes closed for 20 seconds
Assess Peripheral Sensation tests (5)
- sharp vs dull
- light touch
- vibration
- position (with pt eyes closed, move a finger or the big toe up or down and have the pt tell you which way it is moved)
- Monofilament Test: platar side of foot, test 7 sites at random, have pt tell you when they feel the filament (test for neropothy associated with DM)
Tactile Discrimination: Stereognosis Graphesthesia 2 point discrimination Point location
Abnormalities
Stereognosis: key in hand
Graphesthesia: number drawn on hand
2 point discrimination: 2-8mm on fingers
Point location: “put your finger where I touch you”
any abnormalities occur with parietal cortex lesions; or dermatome (spinal cord)
DTRs
where is each reflex, what movement is triggered
Deep Tendon Reflex Bicep: flexion Tricep- extension Brachioradialis: supination and flexion Quadriceps (patellar): extension Achelles: plantar flexion
DTRs
hyper/hyopflexion meaning
Clonus
Babinski
-Hyperflexion: LMN lesion
-Hypoflexion: UMN lesion
-Clonus: raipd rhythmic contractions of the same muscle (briskly dorsiflex the foot and hold; + = rapid tapping motion)
-Babinski: “J” drawn from heel across ball of foot. Toe curling= plantar reflex present, normal
Toe fanning= + Babinski, abnormal (unless <24 months old)
Developmental Competence: Infants shrill cry When should the following stop? Rooting Sucking Palmar grasp Babinski Tonic Neck Moro Placing and stepping
- shrill cry: CNS damage
- Rooting: baby turns head towards touch; 4mo
- Sucking: 12mo
- Palmar grasp: 4mo
- Babinski: 24 mo
- Tonic Neck: fencing position; 6mo
- Moro: startle; 4mo
- Placing and stepping: tries to place foot on table and step; 4 days walking
Cushing’s Triad
increased SBP, widening PP, decreased HR
Neuro Checks (4)
when is it used
normal vs abnormal
-Used when doing frequent checks on pt with CVA or brain trauma (usually q1-q2). Assess neuro decline and ICP
- LOC/ GCS
- Motor function (upper and lower strength; facial movement; pronator drift- pt holds arms out w/ eyes closed)
- PERRLA
- Vitals (crushing’s triad)
Motor System Dysfunction
what is this
causes
s/s
UMN/ LMN lesions resulting in paresis or paralyzation.
- UMN Lesions: problems in CNS; eg: CVA, cerebral palsy. MS
- LMN Lesions: problems in the PNS; eg: spinal cord injury, herniated disk, polio, Guillain-Barre
-muscle weakness, paralyzation, site of transection will affect the site bellow the injury (quadriplegia: LMN at cervical vert., paraplegia: LMN at lumbar vert., hemiplegia/ hemiparesis: UMN: stroke)
MS what it is cause s/s average age of diagnosis
Multiple Sclerosis
-Autoimmune disorder
- Progressive demyelination of brain and spinal cord
- vary depending on location of demyelination: nystagmus, diplopia, fatigue, weakness, spasticity, loss of balance, hyperreflexia, +Babinski
-average age of diagnosis is 32
Parkinson’s Disease
what it is
cause
s/s
- A disorder of the CNS that affects movement can causes tremors.
- Degeneration of dopamine producing neurons in the basal ganglia causing over activation of ATP
-Findings: Rest tremor, rigidity, flat affect, shuffling gait
CVA
what it is (types)
cause
s/s
Cerebral Vascular Accident
- ischemia to the brain
- HTN, smoking, obesity, DM
-Findings: relates to what part of the brain is affected and the extent of the ischemia
AD
what it is
cause
s/s
Alzheimer’s Disease
- incurable degenerative neurologic disorder
- unknown (poss: toxins, autoimmune, virus, hx of CVA)
-Findings: *recent memory loss, personality changes, getting lost in familiar places
Guillain-Barre Syndrome
what it is
cause
s/s
-widespread demyelination of PNS
-unknown
-Findings: Ascending Paralysis (weakness in the lower extremities; ascends to upper extremities and face)
DTRs absent
ischemia
an inadequate blood supply to an organ or part of the body
BE FAST
Balance decrease, Eye (blurred vision), Facial drooping, Arm weakness, Speech different, Time to call 911
Types of CVA: Transient Ischemic Hemorrhagic Embolic Thrombotic
Transient Ischemic: loss of blood a portion of the brain symptoms lasting <1hr
Hemorrhagic: ruptured blood vessel
Embolic: a clot that travels to the brain a blocks blood flow
Thrombotic: clot formed in the blood vessels of the brain leading to a blockage
