Neuro Exam Flashcards
What does A&O x3 mean
- Patient is alert and orientated to person, place, and time
Define the levels of alertness
- Alertness: pt responds appropriately, opens eyes, respond fully/appropriately to stimuli
- Lethargy: pt appears drowsy, can open eyes, respond to examiner but falls asleep easily
- Obtundation: pt can open eyes/look at examiner but responds slowly & is confused
- Stupor: pt can be aroused from sleep only with painful stimuli, verbal responses are slow or absent
- Coma: state of unconsciousness from which can not be aroused; no response to external stimuli
- Unresponsive wakefulness syndrome (AKA vegetative state): return of sleep/wake cycles, normalization of HR/BP/respiration/digestion, & lack of cognitive responsiveness
- Minimally conscious state (MCS): severely altered consciousness with minimal but definite evidence of self or environmental awareness
Define persistent vegetative state
- State lasting >1 yr for traumatic brain injury (TBI) and >3 mo for anoxic brain injury
Describe the Glascow Coma Scale (GCS)
- Relates consciousness to 3 elements of response: eye opening, motor response, & verbal response
- Score ranges from 3-15: severe brain injury = 1-8; moderate brain injury = 9-12; minor brain injury = 13-15
Describe the coma recovery scale-revised
- Examines multiple domains including auditory, visual, motor, verbal, communication, & arousal
- Includes brain stem reflexes such as pupillary light reflex, corneal blink reflex, spontaneous eye movements, oculocephalic reflex, & postural response
- Recommended for moderate to sever TBI and stroke
How would you assess memory
- Immediate recall: name 3 items previously presented after a brief interval (5 mins)
- Recent memory: recall of recent event (what did you have for breakfast)
- Remote memory: recall of past events (where were you born)
What are the different kinds of attention and how to assess them
- Attention span: ability to recall 7 digits in order presented
- Sustained attention: ability to attend to task without redirection
- Divided attention: ability to shift attention from one task to another
- Focused attention: ability to stay on task in presence of distractors
- Ability to follow commands
Describe the mini-mental state examination (MMSE)
- Screening for cognitive dysfunction
- Looks at orientation, registration, attention & calculation, recall and language
- Max score of 30; 21-24 = mild; 16-20 =-4 moderate; ≤15 = severe impairment
Describe the scoring of Rancho Los Amigos levels of cognitive function (LOCF)
- Assess cognitive recovery from TBI
- (1) no response
- (2/3) decreased response levels
- (4/5/6) confused levels
- (7/8) appropriate
Define nonfluent aphasia/Broca’s aphasia/expressive aphasia
- Central language disorder in which speech is typically awkward, restricted, interrupted, and produced with effort
- Result of lesion in 3rd frontal convolution of left hemisphere
Define verbal apraxia
- Impairment of volitional articulatory control secondary to a cortical, dominant hemisphere lesion
Define dysarthria
- Impairment of speech production resulting from damage to the central or peripheral nervous system
- Causes weakness, paralysis, or incoordination of the motor-speech system
Define fluent aphasia/Wernicke’s/receptive aphasia
- Examines comprehension
- Central language disorder in which spontaneous speech is preserved & flows smoothly while auditory comprehension is impaired
- Result of lesion in posterior 1st temporal gyrus of left hemisphere
Define global aphasia
- Examine for marked impairments in comprehension and production of language
Define conduction/association aphasia
- Result of damage to the arcuate fasciculus that connect Wernicke’s and Broca’s areas
- Causes word finding issues & problems with repeating phrases
Normal vital responses to exercise
- HR increases in direct proportion to intensity of exercise
- SBP increases while DBP remains the same or slightly decreases
Define Cheyne-Strokes respiration
- Period of apnea lasting 10-60 secs followed by gradually increasing depth and frequency of respirations
- Accompanies depression of frontal lobe and diencephalic dysfunction
Define hyperventilation
- Increased rate and depth of respirations
- Accompanies dysfunction of lower midbrain & pons
Define apneustic breathing
- Abnormal respiration marked by prolonged inspiration
- Accompanies damage to upper pons
What might an elevation in temperature indicate
- May indicate infection, damage to hypothalamus or brainstem
Signs and symptoms of meningeal irritation/brain infection
- Impaired neck mobility: Kernig’s sign and Brudzinski’s sign
- Irritability, visual discomfort with bright light
- Altered level of consciousness
- Severe HA, nausea, and vomiting
- Altered vital signs, high fever
- Generalized weakness
Signs and symptoms of increased intracranial pressure (ICP)/cerebral edema and brain herniation
- Altered level of consciousness
- Altered vital signs: increased SBP, widening pulse pressure & bradycardia, irregular respirations (bradypnea = <12 breaths per min), elevated temperature
- HA
- Vomiting secondary to irritation of vagal nuclei (CN X)
- Pupillary changes (CN III signs)
- Papilledema at entrance to eye
- Progressive impairment of motor function
- seizure activity
How to assess sensation
- Test superficial and proprioceptive sensations first: pain, discriminate touch, vibration, & proprioception
- Test combined sensations after determining superficial & proprioceptive touch is intact: apply stimulus in random/unpredictable order and avoid summation
What are the combined cortical sensations
- Stereognosis: ability to identify familiar objects placed in hand
- Tactile localization: ability to identify location of a touch stimulus on the body
- Two-point discrimination: ability to recognize one or two blunt points applied to the skin simultaneously
- Barognosis: ability to identify similar size/shaped objects placed in hand with different gradations of weight
- Graphesthesia: ability to identify numbers, letters, or symbols traced on skin
- Bilateral simultaneous stimulation: ability to identify simultaneous touch on the two sides/segments of the body