Neuro Flashcards
MSE (4) (ORAL)
Orientation
Recall
Attention
Language
UMN S/S
Atrophy of disuse, arms flexed, legs extended. Stronger flexors > extensors upper Stronger extensors > flexors lower Increased/spastic tone Coordination limited Reflexes Plantar: up (dorsi flex) Deep: increased clonus Superficial: absent
LMN S/S
Atrophy, fasciculations
Weak Decreased tone Coordination limited Reflexes Plantar: down (plantar flex) Deep: decreased Superficial: absent
asterixis
brief jerky downward mvts of the wrist when patient extends both arms with wrist dorsiflexed, palms forwards, eyes closed
Tics
non-voluntary contractions of single muscles or groups of muscles, suppressive, associated with a sense of relief
Myoclonus
sudden rapid muscle jerk, may be focal
athetosis
repetitive, involuntary, slow, sinuous, writhing, especially severe in hands
dystonia
prolonged/sustained muscle contraction
Tremor
rhythmic semi-rhythmic oscillating movements, can be fast or slow. Both against and antagonist muscles simultaneously activated. Coarse = insignificant (cold/fatigue). Fine = UMN lesion, or other
Chorea
“Dance” = fleeting random involuntary movements that affect multiple joints may be fluid or jerky and carrying in quality
Hemiballismus
Violent flinging movement of half the body
seizure automatisms
stereotyped semi-purposeful movements, repeated eye blinking, tonic or clonic motor activity
Location of lesion for:
Spasticity
Flaccidity
Rigidity
Spasticity = UMN Flaccidity = LMN Rigidity = extrapyramidal
Rhyme song to recall myotomes… ‘___ pick up sticks…’
C5, C6 pick up sticks (biceps)
C6, 7, 8, lay them straight (triceps)
L3, L4, kick the door (quad)
S1, S2, buckle my shoe (ankle plantar flexion)
What are the 4 lobes of the cerebral cortex and what do they control
• Frontal Personality, behaviour, emotion Broca’s – motor speech Precentral gyrus (primary motor)
• Parietal
Sensation
Postcentral gyrus (primary sensory)
• Temporal
Hearing taste smell
Wernicke’s
• Occipital
Visual
Function of cerebellum
- Motor coordination
- Equilibrium
- Balance
- Voluntary movement and muscle tone
- Does not initiate movement, but coordinates and smooths it
What does the extrapyramidal system control? What are the structures (general)?
- Basal ganglia
- Subcortical motor system
- Brain stem and spinal cord
- All movement outside of pyramids
- Gross automatic movements like: arm swinging, walking
What does the thalamus do?
relay station
Hypothalamus neuro function?
- Temperature, HR, BP, sleep
- Pituitary gland
- Coordinates ANS and emotional status
What are the components of the brainstem?
- Midbrain: most anterior of the brain stem, merges into thalamus hypothalamus
- Pons: enlarged area containing ascending and descending fibre tracts
- Medulla: continuation of spinal cord. CN XIII to XII. Pyramidal decussation.
What does the posterior (dorsal) column transmit?
vibration
fine touch (stereognosis)
proprioception (position)
What does the spinothalamic tract do? lateral vs anterior
- Pain and temperature – lateral thalamic tract
* Crude touch – anterior spinothalamic tract
What are the UMN?
corticospinal, corticobulbar, extra pyramidal tracts. (MS, CVA)
What are the LMN?
PNS, cell body in grey matter of spinal cord then extends to muscle (ALS, polio)
DTR has 5 components to function. What are they?
Afferent limb Efferent limb Synapse in the cord Neuromuscular junction Competent muscle
Where do CN I and II originate form?
cerebrum
Where do CN III to XII originate from?
diencephalon and brainstem
Movement disorders (8)
- Paralysis
- Fasciculations
- Tic
- Myoclonus
- Intention tremor
- Rest tremor
- Chorea: sudden, rapid, jerky, purposeless
- Athetosis: slow, twisting, writhing, continuous movement resembling a snake
Spastic hemiparesis gait
o arm stuck, leg extended, circumducts to walk
o UML, CVA, trauma
cerebellar ataxia gait
o Wide-based gait, staggering.
o Positive Romberg sign
o ETOH, cerebellar tumour, MS
parkinsonian (festinating) gait
o Stooped posture, trunk pitched forwards
o Short shuffling steps
o Hesitates to initiate walking and has difficulty stopping
scissors gait
o Knees crossed, or are in contact
o MS
steppage or foot drop
o Slapping quality
o Weakness of tibia, LMN lesions
o Charcot, Polio
waddling gait
o Weak hips
o Muscular dystrophy, hip dislocation
short leg gait
o Discrepancy > 2.5 cm
o Congenital dislocated hip
What is cerebral palsy?
- Mixed group of neuromotor disorders of infancy and childhood
- Results from damage to cerebral cortex caused by a developmental defect
What is muscular dystrophy?
- Chronic progressive wasting of skeletal musculature
* Duchenne’s
What is hemiplegia?
- Damage to corticospinal tract, above pyramids, UML, contralateral
- CVA
Parkinsonism
- EPS tract defect in the Basal Ganglia
- Loss of dopamine
- Triad: tremor, rigidity, akinesia
- Slow monotonous speech, diminutive writing, flat affect, excessive saliva, less eyelid blinking
Paraplegia
- LMN damage
* First DTR absent, then reappear gradually, then spastic prevailing extensor tone
What sensory loss does spinal cord hemisection (brown squared) result in?
- Loss of pain and temperature sensation on the contralateral side, starting one to two segments below the level of the lesion
- Loss of vibration sensation and positive discrimination on the ipsilateral side below the level of the lesion
- Meningioma, neurofibroma, MS, cervical spondylitis
What loss of function does thalamus or cortex lesion result in?
- ALL modalities, contralateral side, head to toe
- Vascular occlusion
- Cortex: also loss of graphesthesia, stereognosis, recognition of shapes and weights, finger finding…
Speech disorders:
Dysphonia
Dysarthria
Aphasia
Dysphonia – hoarse/whisper
Dysarthria – distorted, poor articulation
Aphasia – defect in comprehension
- Global – spontaneous speech absent or reduced to stereotypical words
- Broca’s – expressive – speech mostly nouns and verbs – word searching. Auditory and reading intact.
- Wernicke’s – receptive aphasia
