Neuro Flashcards
Loss of voice that accompanies disease affecting the larynx or its nerve supply
Aphonia
Impairment in the volume, quality or pitch of the voice. Example- hoarse or only speak in a whisper. Caused by laryngitis, tumors, unilateral cord paralysis (CN X)
Dysphonia
Defect in the muscular control of the speech apparatus (lips,, tongue, palate, pharynx). Worse may be nasal, slurred, or indistinct but central symbolic aspect of language remains intact. Causes include motor lesions of CNS or PNS, parkinsonism, cerebellar disease.
Dysarthria
Disorder in producing or understanding language. Often caused by lesion in the dominant cerebral hemisphere (left)
Aphasia
In which type of aphasia is speech fluent, rapid, effortless but sentences lack meaning and words are malformed or inverted.
Wernicke’s Aphasia
In which type of aphasia is word comprehension good, and reading comprehension fair to good?
Broca’s aphasia
In which type of aphasia are word and reading comprehension, repetition, naming, and writing all impaired?
Wernicke’s aphasia
IN which type of aphasia is speech nonfluent, slow and laborious. Words are meaningful with nouns and transitive verbs with important adverbs.
Broca’s aphasia
What type aphasia is there a lesion in the posterior superior temporal lobe?
Wernicke’s
In which type aphasia is there a lesion in the posterior inferior frontal lobe?
Broca’s
This type of disorder is characterized by distrust and suspiciousness.
Paranoid
Characterized by Detachment from social relations with a restricted emotional range
Schizoid
Eccentricities in behavior and cognitive distortions; acute discomfort in close relationships
Schizotypal
Disregard for the law and rights of others; a defect in the experience of compunction or remorse for harming others
Antisocial
Instability in interpersonal relationships, self-image and affective regulation; impulsivity
Borderline
Emotional overreactivity, theatrical behavior, and seductiveness; attention-seeking behavior
HIstrionic
Persisting grandiosity, need for admiration and lack of empathy for others
Narcissistic
Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Avoidant
Submissive and clinging behavior; psychological dependence on others
Dependent
Rigid, detail-oriented behavior, often associated w/ compulsions to perform tasks repetitively and unnecessarily and rigid conformity to rules
Obsessive-compulsive
Speech characterized by indirection and delay in reaching the point because of unnecessary detail. Occurs in people with obsessions.
Circumstantiality
Speech in which a person shifts from one subject to others w/o realizing the subjects aren’t meaningfully connects. Seen in schizophrenia, manic episodes,
Derailment (loosening of associations)
An almost continuous flow of accelerated speech in which a person changes abruptly from topic to topic. Changes are usually based on understandable associations and play on words but ideas don’t produce a sensible conversations. Most often seen in manic episodes
Flight of ideas
Invented or distorted words, or words w/ new and highly idiosyncratic meanings. Often seen in schizophrenia, psychotic disorders, aphasia
Neologisms
Speech that is largely incomprehensible because of illogic, lack of meaningful connections, abrupt changes in topic, disordered grammar or word use. Seen in severe psychotic disturbances (usually schizophrenia)
Incoherence
Sudden interruption of speech in mid sentence or before completion of an idea. Person attributes this to losing the though. Also occurs in normal people, but may be striking in schizophrenia.
Blocking
Fabrication of facts or events in response to questions to fill in the gaps of invalid memory. Often seen in Korsakoff’s syndrome from alcoholism.
Confabulation
Persistent repetition or words or ideas. Seen in schizophrenia and other psychotic disorders
Preseveration
Repetition of the words and phrases of others. Occurs in manic episodes and schizophrenia
Echolalia
Speech in which a person chooses a word on the basis of sound rather than meaning, as in rhyming and punning speech. Seen in schizophrenia and manic episodes
Clanging
Repetitive behaviors or mental acts that a person feels driven to perform in order to produce or prevent some future state of affairs, although such expectations are unrealistic.
Compulsions
Recurrent, uncontrollable thoughts, images, or impulses that a person considers unacceptable and alien. Intrusive thoughts.
Obsessions
Persistent, irrational fears, accompanied by a compelling desire to avoid that stimulus.
Phobias
Apprehensions, fears, tensions or uneasiness that may be focused (phobia) or free-floating ( a general sense of ill-defined dread or impending doom)
Anxieties
A sense that one’s self is different, changed or unreal or has lost identity or become detached from one’s mind or body.
Feelings of Depersonalization
False, fixed personal beliefs that are not shared by other members of the person’s culture.
Delusions
Misinterpretations of a real external stimuli. Seen in greif, PTSD< schizophrenia, delirium
Illusions
Subjective sensory perceptions in the absence of relevant external stimuli.
Hallucinations
3 tests for attention
Digit Span
Serial 7s
Spelling Backwards
Memory about birthdays, anniversaries, social security number, names of schools attended, historical events.
Remote Memory
Events of the day (weather, appointment time, medications)
Recent memory
A delusion where people are getting thoughts from other sources- television, PC, etc.
Delusions of reference
People keep adding on symptoms and have a very elaborate amount of symptoms.
systematized delusions
What are the 3 “d’s” to screen for?
Delirium
Depression
Dementia
Cranial Never for lateral deviation of the eye.
CN VI Abducens
CN for downward, internal rotation of the eye.
Trochlear, IV
CN for facial movements and taste on anterior 2/3 of tongue.
Facial VII
CN for temporal, masseter, lateral pterygoids movements and sensory from face.
Trigeminal, V
CN for hearing and balance
VIII, Acoustic (vestibulocochlear)
CN for motor of parynx, sensory from posterior parts of earn and ear drum, pharynx, posterior taste of tongue
IX, Glossopharyngeal
CN for motor of the palate, pharynx, larynx. Sensory from pharynx and larynx
X, Vagus
CN for movement of SCM, upper part of trapezius
XI, Spinal accessory
CN for movement of the tongue
XII, Hypoglossal
CN for vision, ocular fundi
II, Optic
CN for pupillary constriction, opening of the eye, EOM
III, Oculomotor
CN for sense of smell
I, Olfactory
What cranial nerves are involved in pupillary reactions?
II, III (optic, oculomotor)
WHat CN are involved in EOMs?
III, IV, VI (Oculomotor, trochlear, abducens)
What CN are involved in voice and speech?
V, VII, X, XII (Trigeminal, Facial, Vagus, Hypoglossal)
What CN are involved in swallowing and risk of the palate, gag reflex
CN IX, X (glossopharyngeal, Vagus)
In what condition will the eyes not close and forehead not wrinkle on the affected side.
Peripheral lesion of facial nerve i.e. Bell’s Palsy
In what condition will the forehead wrinkle but there is paralysis of the lower face?
Central lesion involving UPN between cortex and pons
What is the rhythmic oscillation of the eyes, analogous to a tremor ins other parts of the body?
Nystagmus
What are some causes of nystagmus?
Impairment of vision early in life
Disorders of the labyrinth and cerebellar system
Drug toxicity
When does nystagmus occur normally?
When a person watching a rapidly moving object (ex- passing train)
What tract mediates voluntary movement, and integrates skilled, complicated or delicate movements. Also carry impulses that inhibit muscle tone.
Corticospinal (pyramidal) tract
What are tracts that synapse in the brainstem with motor nuclei of the cranial nerves called?
Corticobulbar
What is a system that helps maintain muscle tone and control body movements, especially gross automatic movements such as walking?
Basal ganglia system
This system maintains equilibrium, helps to control posture.
Cerebellar system
Ankle reflex stimulates what?
Sacral 1
Knee reflex stimulates…
Lumbar 2,3,4
Supinator (brachioradialis) reflex stimulates
Cervical 5,6
Biceps reflex stimulates
cervical 5,6
Triceps reflex stimulates
cervical 6,7
What is the rhythmic oscillations b/w flexion and extension . Is normal if there is less than 5.
Clonus
What is a DTR classified as very brisk, hyperactive with clonus.
4+
What is the DTR classified as average, normal?
2+
What is a DTR that is somewhat diminished, a low normal?
1+
What is a DTR that is brisker than average. Possibly indicative of disease.
3+
What are fine flickering irregular movements in small groups of muscle fibers?
Fasciculations
Muscle strength is graded on a ___ to ___ scale.
0 to 5
What is the grade for an active movement of the body part with gravity eliminated?
2
What is the grade for a barely detectable flicker or trace of contraction?
1
What is the grade for active movement against full resistance without evident fatigue. Normal
5
What is the rating for active movement against gravity.
3
What is the rating for active movement against gravity and some resistance.
4
What type lesion is spasticity associated with?
Upper motor neuron or corticospinal tract system
With spasticity there is _______ that is rate dependent.
Hypertonia
With spasticity during rapid passive movement, initial hypertonia may give way suddenly as the limb relaxes. This catch and relaxation is know as….
Clasp-knife resistance
Rigidity is due to a lesion where?
Basal ganglia system
WIth rigidity there is increased resistance that persists throughout the movement arch, independent of rate of movement. This is know as what?
Lead- pipe rigidity
With rigidity there is a superimposed racketlike jerkiness with flexion and extension called….
Cogwheel rigidity
What is a common cause of rigidity?
Parkinsonism
Flaccidity is associated with a lesion where?
Lowe motor neuron system. ANy point from the anterior horn cell to the peripheral nerves
Flacidity is associated with loss of muscle tone causing the limb to be loose or floppy. This is called….
hypotonia
In flacidity, the limbs affected may be _____ or ever flail-like.
hyperextensible
What is a common cause of flacidity?
Guillain-Barre syndrome. Initial phase of spinal cord injury
With paratonia, where is the lesion?
Both hemispheres, usually frontal lobes
What is associated with sudden change in tone with passive range of motion?
Paratonia
What is a sudden loss of tone that increases the ease of motion in paratonia?
Mitgehen
In paratonia, a sudden increase in tone making motion more difficult is called what?
Gegenhalten (holding against)
What is a common cause of paratonia?
Dementia
This gait abnormality is seen in corticospinal tract lesion and causes the affected arm to be flexed, immobile and held to the side. The affected leg extensors are spastic. Patient may drag toe, circle leg stiffly outward and forward or lean towards contralateral side during walk.
Spastic hemiparesis
This gait abnormality is seen in spinal cord disease and causes bilateral lower extremity spasticity. Gait is stiff, steps are short. Thighs tend to cross forward on each other. Often with cerebral palsy.
Scissors Gait
This gait abnormality is usually secondary to peripheral motor disease. Seen in foot drop- patients drag their feet or lift them high with knees flexed and bring them down with a thud.
Steppage Gait
This gait abnormality is seen in basal-ganglia defects. Posture is stooped with flexion fo heads, arm, hips knees. Patients are slow initiating movement, there is festination and retropulsion.
Parkinsonian gait
In this abnormality, gait is staggering, unsteady, wide based. Patients can’t stand steadily with feet together. There is also dysmetria, nystagmus, intention tremor.
Cerebellar ataxia
This abnormality is seen in loss of position sense in the legs, gait is unsteady and wide based, patients throw their feet forward and outward then bring them down with a double tapping sound. Watch ground for guidance when walking. Positive Rhomberg.
Sensory ataxia
This is an abnormal posture seen in comatose patients. Upper arms are flexed tight to the sides with joints flexed. Legs are extended and internally rotated. Feet are plant flexed. Implies a destructive lesion of the corticospinal tracts within or near cerebral hemispheres.
Decorticate rigidity (abnormal flexor response)
In this abnormal posture seen in comatose patients, jaw is clenched, neck is extended. Arms are adducted and stiffly extended at the elbows. Forearms pronated, wrists and fingers flexed. Legs are extended, feet are planter flexed. Caused by a lesion in the midbrain, pons, or metabolic disorder.
Decerebrate rigidity (abnormal extensor resposne)
What is the tests where the patient stands for 30 sec with both arms extended forward with palms up and eyes closed. The examiner taps the arms briskly.
Pronator Drift
This type of vertigo is sudden, on rolling onto affected side or tilting head up. and lasts a few second to less than a minute. Sometimes naseau, vomiting, nystagmus accompany it.
Benign positional vertigo
This type of vertigo is sudden and can lasts hours up to 2 weeks. Also have N/V, nystagmus
Vestibular neuronitis (acute labyrinthitis)
This type of vertigo has a sudden onset and can last several hours or equal to one day. There is sensorineural hearing loss, loss recurs and eventually progresses. Tinnitus is present and there may be pressure or fullness in the affected ear along with N/V, nystagmus.
Meniere’s Disease
This type of vertigo is insidious from CN VIII compression of the vestibular branch. Variable course, hear is impaired on one side. May also involve CN V and VII.
Acoustic Neuroma
If an individual can’t feel light touch, what 2 locations could the lesion be?
Spinothalamic tracts and posterior columns
If an individual can’t feel pain, where is the lesion?
Spinothalamic tracts
If a person can’t determine vibration and proprioception, where is the lesion?
Posterior columns
If a person can’t determine the where one or two points is touching their skin (discrimination) where is the lesion?
Spinothalamic tracts
Posterior columns
Cortex
What are two signs that can determine meningeal irritation?
Brudzinski’s
Kernig’s
If this sign is positive, when the neck is flexed the hips and knees will also flex.
Brudzinski’s Sign
If this sign is positive, when the patient’s leg is flexed at both the hip and the knee, when extended there is pain and increased resistance.
Kernig’s Sign
In this test, the patient is supine and the leg is lifted and ankle is flipped. If the person has radiculopathy this will reproduce the pain.
Straight leg raise
In this test, when the opposite leg is raised the pain on the affected side is reproduced.
Crossed straight leg raise
This helps to identify metabolic encephalopathy. When patient puts their hand up as if to signal “stop” there is sudden, brief, nonrhythmic flexion of the hands and fingers. This is seen in liver disease, uremia, and hypercapnia.
Asterixis
This is caused by weakened shoulder muscles (especially serratus anterior) and is seen in muscular dystrophy or injury to the long thoracic nerve.
Winging of the scapula
For this LOC you apply repeated painful stimuli to wake the patient.
Coma
In this LOC you apply a painful stimulus (ex- pinch a tendon, rub the sternum) to wake the patient.
Stupor
In this LOC you shake the patient gently as if awakening a sleeper to have the patient come to.
Obtundation
In this LOC you speak to the patient in a loud voice to awake the patient.
Lethargy
In this LOC you speak to the patient in a normal tone of voice and the patient will respond.
Arousal
This type patient appears drowsy but opens their eyes to respond then falls back asleep.
Lethargic patient
This type patient opens their eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.
Obtunded patient
This patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. When stimuli ceases, the patient lapses into an unresponsive sate.
Stuporous patient
This patient remains unarousable with eyes closed. No evident response to inner need or external stimuli.
Comatose patient.
This reflex helps to asses brainstem function in a comatose patient.
Oculocephalic reflex (doll’s eye movements)
If there is contralateral leg weakness, where is the stroke?
Anterior circulation (Anterior cerebral artery)
If there is contralateral face, arm > leg weakness, sensory loss, field cut, aphasia where is the stroke?
Anterior circulation- middle cerebral artery (MCA)
If there is contralateral motor or sensory deficit without cortical signs where is the stroke?
Subcortical circulation- lenticulostriate deep penetrating branches of MCA
If there is a contralateral field cut where is the stroke?
Posterior circulation- posterior cerebral artery (PCA)
If there is dysphagia, dysarthria, tongue/palate deviation and/or with crossed sensory/motor defects where is the stroke?
Posterior circulation- brainstem, vertebral, basilar artery branches
If there are oculomotor deficit and/or ataxia with crossed sensory/motor defects where is the stroke?
Posterior circulation- basilar artery
If an individual has “locked-in” syndrome with intact consciousness but with inability to speak and quadriplegia where is the stroke?
Complete basilar artery occlusion
Define the vertigo: Sudden onset; lasts a few weeks and may recur, hearing is not affected, tinnitus is absent, possible N/V and nystagmus
Vestibular neuronitis (acute labyrinth itis)
Define the vertigo: insidious onset due to compression of CN VIII; variable duration; hearing is impaired on one side; tinnitus is present; involves CN V and VII
Acoustic Neuroma
Define the vertigo: Sudden onset, recurrent course, sensorineural hearing loss; tinnitus is present and fluctuating, pressure or fullness of affected ear; N/V, nystagmus
Meniere’s Disease
Define the syncope: Stressful situation, symbolic expression of an unacceptable idea through body language, hysterical personality traits, slump to the floor
hysterical fainting from conversion reaction
Define the syncope: sudden peripheral vasodilation w/o compensatory rise in CO; strong emotion; standing; fatigue/hunger, prompt return of consciousness
vasodepressor or vasovagal syncope
Define the syncope: constriction of cerebral blood vessels; hyperventilation; anxiety; dyspnea, palpitation, numbness of hands; slow improvement; any position
hypocapnia due to hyperventilation
Define the syncope: insufficient glucose; insulin therapy or metabolic disorders; tremor, hunger, HA, confusion, abnormal behavior; any position
Hypoglycemia
Define the seizure: tonic/clonic movements; start unilaterally in hand/foot/face, spread to other body parts on same side; normal consciousness in postictal state
Jacksonian
Define the seizure: brief lapse in consciousness with blinking, staring, or lip/hand movements; Postictal- no aura
absence seizure
What is the time frame in a typical absence seizure?
< 10 seconds
What is the time frame in an atypical absence seizure?
> 10 seconds
What is the difference between petit mal absence and atypical absence?
petit mal= prompt return to normal consciousness
atypical= some postictal confusion
Define the seizure: sudden loss of consciousness; body stiffens; breathing stops (cyanosis); rhythmic muscle contractions follow; injury, tongue biting, and urinary incontinence occur; following seizure: confusion/drowsiness/fatigue/HA; amnesia and no aura
Tonic Clonic seizure
Define the tremor:
absent at rest
appear with movement
Intention Tremors
What diseases intention tremors associated with?
disorders of cerebellar pathways (Multiple Sclerosis)
Define tremor:
occur when actively maintaining a posture
Postural tremor
What diseases Postural tremor associated with?
hyperthyroidism
anxiety, fatigue
benign essential tremor
Define tremor:
at rest
decrease/disappear with voluntary movement
Resting (Static) tremor
What is the main disease associated with Resting tremor?
Parkinson’s
T/F: In oral-facial dysinesias, the limbs and trunk are involved.
False
What is a common cause of athetosis?
cerebral palsy
What are 2 common causes of chorea?
Sydenham’s chorea (with rheumatic fever)
Huntington’s disease
