Neuro (complete) Flashcards
Central nervous system made up of:
Brain
Spinal cord
Peripheral nervous system made up of..
Everything else!
* “All nerve fibers outside
the brain and spinal cord”
* Includes autonomic
nervous system
Cerebral cortex (location, function)
cerebrum’s outer layer of nerve cells; controls most conscious processes
Cerebral cortex is center of functions governing thought, memory, reasoning, sensation, and voluntary movement
LOBES OF THE CEREBRAL CORTEX
Parietal
occipital
frontal
temporal
Parietal lobe (location/function)
Sensation/ Top back
Frontal lobe (Location/function)
“Personality”
* Behavior
* Emotions
* Intellectual
function
* Broca’s area
**Front lobe
Occipital lobe (Location/function)
Vision- back of head
Temporal lobe (Location/function)
Auditory
* Hearing
* Taste
* Smell
* Wernicke’s area
**Side of head
Cerebellum
The “auto pilot”
* Voluntary movement
* Equilibrium
* Muscle tone
* Coordination of movement
**below occipital
Brain stem
basic functions of life
Autonomic nervous system (Sympathetic)
“Fight or flight” response
* Increased HR, BP, RR
* Decreased Peristalsis
* Secretion of epinephrine and
norepinephrine
* Bronchiole dilation
Autonomic nervous system (parasympathetic)
Maintaining normal body
functions
* Maintains (“normalizes”) BP,
HR, RR
* Increased Peristalsis
* Bronchiole constriction
Brain stem is made up of…
Midbrain/Pons/Medulla
Midbrain controls…
thalamus/hypothalamus
Pons controls…
respiratory centers
Medulla controls…
- Ascending & descending tracts
- Autonomic centers
- Respiration, heart, GI
- CN VII to XII
Cerebellum
Complex motor coordination for
* Movement
* Equilibrium
* Posture
* Receives information about muscle/joint position
How to assess for cerebellar functin?
Romberg Test
* Finger-to-finger
* Finger-to-nose
* Heel-to-shin
* Rapid alternating
movements
Pathways- sensory and motor direction
sensory-ascending
motor-descending
Corticospinal (pyramidal) tract
MOTOR PATHWAY OF THE CENTRAL NERVOUS SYSTEM
Motor fibers travel from
motor cortex to
brainstem, where they
cross and go down the
opposite (contralateral)
side
Describing Motor Function
Spinothalamic tract
Sensory fibers: transmit
pain, temperature,
touch
Posterior column
- Position
- Vibration
- Fine touch
DESCRIBING SENSORY FUNCTION
- Touch, pain, temperature
* Light/dull (Sternal rub) - Vibration (tuning fork)
- Proprioception
- Romberg
- Stereognosis (Put object in persons hands)
- Graphesthesia (use pen to draw on their hands)
4 types of reflexes
- Deep tendon (DTR)
- Superficial
- Visceral
- Pathologic
Deep tendon reflex types
Biceps
* Triceps
* Brachioradialis
* Patellar
* Achilles tendon
* quadriceps
Deep tendon reflex grading
superficial reflex grading
- 0 = Absent
- 1 = Weak
- 2 = Normal
- 3 = exaggerated
- ## 4 = Hyperreflexia+- Present
0-absent
HISTORY: PERTINENT TO
NEUROLOGICAL ISSUES
SIGNS AND SYMPTOMS (5)
Headache
* Mental status change- confusion, lethargy,
agitation, restlessness
* Dizziness, vertigo, syncope
* Numbness or loss of sensation
* Deficits of the 5 senses
Tools for assessing (5)
- Flashlight
- Cotton
- Object with sharp and dull sides
- Vibration (tuning) fork
- Reflex hammer
CEREBRAL FUNCTION
- Behavior
- Level of consciousness: time, place, person
- Glasgow Coma Scale
- Memory: immediate, recent, remote
- Mathematical ability
- Thought process
- Judgment
- General knowledge
- Communication
CRANIAL NERVES (CNS)
- I: Olfactory
- II: Optic
- III: Oculomotor
- IV: Trochlear
- V: Trigeminal
- VI: Abducens
- VII: Facial
- VIII: Acoustic
- IX: Glossopharyngeal
- X: Vagus
- XI: Spinal Accessory
- XII: Hypoglossal
oh, oh, oh, to, touch, a, female, ass. Great, vag, soft, hands
Sensory nerves
which cranial nerves are sensory
- I: Olfactory
- II: Optic
- VIII: Acoustic
Motor
- IV: Trochlear
- VI: Abducens
- XI: Spinal Accessory
- XII: Hypoglossal
Sensory and motor
which cranial nerves
- III: Oculomotor
- V: Trigeminal
- VII: Facial
- IX: Glossopharyngeal
- X: Vagus
Cranial Nerves I,II
- I: Olfactory
- Smell
- Non-noxious smells
- Sensory
- II: Optic
- Vision
- Requires ophthalmoscope
- Sensory
CRANIAL NERVES: III, IV, VI
- III: Oculomotor (Motor)
* Pupil dilation and constriction
* PERRLA - IV: Trochlear (Motor)
- VI: Abducens: Eye movement (Motor)
* EOMs of cardinal gaze
* Nystagmus? (back and forth eye movement)
* Unilateral or bilateral?
* Frequency?
* Plane of movement? - Strabismus? (one eye wonky, lazy eye
- Ptosis? Droopy eye lid
PERRLA
- P = Pupils
- E = equal (as in size)
- R = Round
- R = Reactive to
- L = Light, and
- A = Accommodation
- Can only be assessed in an alert individual
CRANIAL NERVE: V (TRIGEMINAL)
Motor and Sensory
* Motor function: Chewing
* Have patient clench teeth clench, then palpate temporal and masseter muscles
* Sensory function
* Facial sensation
* Taste at anterior tongue
CRANIAL NERVES: VII (FACIAL)
- Facial muscles for expression
* Have client “smile, frown, close eyes tight, lift brows, show teeth, puff cheeks”
Sensory
* Taste on anterior tongue
* Tested only if injury occurs or is suspected
* Salt, lemon juice, sugar
CRANIAL NERVES: VIII, IX
- VIII: Vestibulocochlear or Acoustic
* Sensory for hearing and equilibrium
* Requires special equipment to fully assess
* Bedside assessment with conversation
* Balance (vestibulocochlear) - IX: Glossopharyngeal
* Sensory: taste (post tongue)
* Motor: pharyngeal muscles (swallowing)
CRANIAL NERVE: X (VAGUS)
Motor
* Pharyngeal muscles (swallowing)
* Consider the patient with stroke
* Assess gag
Sensory
* Viscera of thorax and abdomen
Why else is the Vagus nerve
important?
The heart rate can drop so low that people will pass out if they “bear down” too much.
CRANIAL NERVES: XI, XII (MOTOR)
- XI: Spinal accessory (turning head right and left)
* Trapezius and sternomastoid movement
* Have patient turn head and apply resistance
* Assess shoulder shrug - XII: Hypoglossal
* Tongue movement
DEVELOPMENTAL CONSIDERATIONS: INFANTS
Sensory Assessment (Superficial and Deep)
- Superficial:
- Pain
- Temperature
- Light touch
- Deep Sensation
* Vibration
* Position (kinesthesia)- Tactile discrimination
* Stereognosis - Graphesthesia
- Tactile discrimination
SPINAL NERVES
Cervical- C1-C7
Thoracic T1-T12
Lumbar L1-L5
Sacral S1-S5
Coccyx
Types of sensations (4)
- Anesthesia: no sensation
- Hyperesthesia: increased sensitivity
- Hypoesthesia: loss of sensation
- Paresthesia: pins and needles
NEUROLOGIC ASSESSMENT
DEVELOPMENTAL CONSIDERATIONS:
THE ELDERLY PATIENT
Physiologic changes
General atrophy of neurons
* Brain actually decreases in weight
* Cerebral cortex thins
* Leads to decreased Cognitive brain function (CBF), Cerebral spinal fluid (csf),
* Neural connections slower
* Loss of muscle mass and tone
* Decrease in sensory abilities
Consequences
* Dizziness
* Syncope
* Tremors develop
* Strength (grip) less strong
**High risk for falls
NEUROLOGIC CHANGES R/T AGING
- Probable decline in cranial nerve function
- Senile tremors
- Benign: intention
* Dyskinesia: no rigidity
- Benign: intention
- Grip remains intact
- Rapid alternating movements more difficult to perform
- DTRs less brisk (Deep tendon reflexes)
- In general, stronger stimuli may be necessary to elicit response
ASSESSING MENTAL STATUS
- Is change acute or gradual
- Orientation
* Person, place, time - Response to pain (Sternal rub)
- Speech patterns
- Person’s appearance
- Coordination
- Thought process
- Level of consciousness (LOC)
* Awake & alert
* Lethargic
* Stuporous (really have to shake the pt to rouse them)
* Comatose - Speech patterns
* Ability to communicate?- Appropriate response?
- Speech rhythm
- Memory
* Cerebral function
* Recent vs. remote memory
* Immediate memory test (3 words) - Intellectual
* Learning
* Computation
* Ability to read
* Insight
* Judgment
MINI MENTAL STATUS Test
- Max score 30
- < 23 = cognitive impairment
Orientation?
Registration? (Repeat words back to me)
Naming (what is this object?)
Reading (Can you read this and do what it says?)
Superficial reflexes
- Plantar
- Abdominal
- Anal
- Cremasteric: males, stroke the inner aspect of upper thigh (testes will contract)
- Bulbocavernosus: contraction of the anal sphincter
ABNORMAL FINDINGS (Muscle tone and reflexes)
Tone
* Flaccidity
* Spasticity
* Rigidity
* Cogwheel rigidity (like a watch hand/arm ticking)
Movement
* Paresis
* Paralysis
* Myoclonus
* Fasciculation/Tic/Tremor
* Resting
* Intention
* Chorea (Tourette’s)
* Athetoid (cerebral palsy)
Abnormal pathological reflexes
- Babinski
- Brudzinski: flex the neck
- Kernig: extension of
the knee
Abnormal postures
*Decorticate rigidity
* Decerebrate rigidity
* Flaccid quadriplegia
* Opisthotonus (Back/neck arches back)
NEUROLOGIC INJURY: STROKE
- “3rd most common cause of death in US”
- Men > women
- Thrombotic/embolic (clot)
- Hemorrhagic (pressure build up)
- Poor control of modifiable risk factors
NEUROLOGIC INJURY:
PARKINSON DISEASE
- Damage to extrapyramidal tracts
* Dopamine loss - Classic symptom triad
- Tremor
* Rigidity - Bradykinesia (slow walking)
- Tremor
- Flat facial expression
- Increased Salivation (Drooling)
- Decreased Eye blink (Dry eyes)
- Ambulation problems (shuffling feet)
ASSESSING THE HOSPITALIZED PATIENT
NEURO EXAM SCREENING CHECKLIST (4)
- Mental status
- Cranial nerves
- Motor function
- Sensory function
Glasgow coma scale
Used for TBI patients
NIH stroke scale
15- item neurological examination stroke scale used to evaluate the effect of acute cerebral infarction on the LOC, language, motor strength, ataxia, dysarthria, and sensory loss.
