Neuro Exam Flashcards
Dysequilibrium
Impaired walking due to difficulties with balance. it sometimes describes as dizziness “in the feet”. Formally speaking, this does not occur in the non-ambulatory patient.
Light-headedness
Dizziness that is not vertigo, syncope, or disequilibrium; this form is also called undifferentiated dizziness
Presyncope
The feeling that one is about to faint or lose consciousness, but actual loss of consciousness is averted. Syncope is defined as sudden, transient loss of consciousness.
Vertigo
An illusion or hallucination of movement, usually rotation, either of oneself or the environment
4 most common causes of dizziness
- Peripheral vestibulopathy (44%); BBPV 16%
- Nonvestibular, nonpyschiatric (24%); medication-related 14%
- Psychiatric (16%); Psych disorder 11%
Alarm Symptoms: Dizziness
- Chest discomfort or presyncope/syncope
Serious Cause (SC): MI, PE, arrhythmia
- Acute on-set vertigo plus neurologic deficits
SC: VBI, brainstem mass, meningoencephalitis
- Acute-onset vertigo plus neck or occiptal pain plus neurologic deficits
SC: VBI
- Acute vertigo (lasting > 1 day), nausea, vomiting, severe imbalance
SC: Cerebellar stroke/mass
- Sudden onset severe vertigo, facial paralysis, otalgia, external ear vesicular eruption, hearing loss
SC: Ramsay Hunt Syndrome
- Hx of DM (insulin and/or oral hypoglycemic use)
SC: Hypoglycemia
S4 Model
Predictive of psych disorder. >2 of 4 = psych evaluation
- Symptom count
- Stress
- Severity
- Self-rated health
Primary Headache
A chronic, benign, recurring headache without known cause. Examples include migraine and tension-like headache
Secondary Headache
Headache due to underlying pathology
New Headache
A headache of recent onset or a chronic headache that has changed in character. Such headaches are more than likely to be pathologic than unchanged chronic headaches.
Aura
Complex neurologic phenomena that precede a headache. Example includes scotoma, aphasia, and hemiparesis
Thunderclap Headache
A headache that occurs instantaneously with maximal intensity at its onset.
Cervicogenic Headache
Referred headache pain that originates from the neck, often due to muscle tension or cervical degenerative arthritis. Also referred to as occipital neuralgia.
2 common causes of primary headaches
- Tension-type headache 12-19%
2. Migraine with or without aura 3-5%
2 common causes of secondary headaches
- Viral syndrome - 39%
2. Sinusitis - 1%
Serious Dx of headache
- Posttraumatic headache
- HTN emergency
- Subarachnoid hemorrhage
- Brain tumor
- Mengitis
- Giant cell arteritis
- Benign intracranial HTN
- Brain abcess
- Carotid or vertebral artery dissection
- Stroke
- Arteriovenous malformation
- Carbon monoxide poisoning
SSNOOP
S: systemic symptoms - fever or weight loss
S: Systemic disease - HIV infection, malignancy
N: Neurologic symptoms or signs
O: Onset sudden
O: Onset > 40 yrs
P: previous headache history (first, worst, different headache)
Ascending Paralysis
Motor weakness that begins in the feet and progressively moves up the body
Bulbar symptoms
Weakness in the muscles of the face and tongue, resulting in difficulty speaking, swallowing, and smiling
Descending paralysis
Motor weakness that begins in the face and progressively moves down the body
Distal weakness
Weakness in the distal extremeities. Example: foot drop
Hemiparesis
Weakness on one side of the body
monoparesis
Weakness of one limb
Paraparesis
Weakness of both legs
Proximal weakness
Weakness in proximal muscles (shoulder girdle, quadriceps) resulting in difficulty standing up from a seated position or raising arms above head
Tetraparesis
Weakness of all 4 limbs
Upper motor neuron lesions
Abnormalities of motor pathways that descend from the central nervous system to the alpha motor neurons, resulting in spasticity, hyperreflexia, and increased muscle tone
Lower motor neuron lesions
Abnormalities of the alpha motor neuron in the brainstem or spinal gray matter, resulting in muscle atrophy, hyporeflexia, and fasciulations
Most common causes of muscle weakness
- CNS disorders: Stroke or TIA
- Motor neuron disease
- Radiculopathies
- Peripheral neuropathies: Polyneuropathies
- Neuromuscular junction disorders
- Myopathies
Dementia
Acute impairment in attention or disorganized thinking, with a fluctuating course and altered level of consciousness
Delirium
Chronic progressive degenerative condition affecting memory, behavior, and cognition
Attention
The ability to focus on specific stimuli and change from one stimulus to another when salient
Alertness
The level of arousal or responsiveness to external cues
Coherence
The ability to maintain selective attention over time
Asterixis
Failure to maintain continuous voluntary tone in the limbs resulting in very brief loss of strength
Meningismus
Neck stiffness and pain on neck flexion and extension, a sign of meningitis
Alarm Symptoms of Confusion
- Fever or hypothermia
SC: Meningitis, sepsis
- Abnormal motor activity or Hx of epilepsy
SC: Seizures (status epilepticus) or postictal state
- Headache
SC: Stroke, meningitis, mass lesion/truama
- Shortness of breath
SC: Hypoxia (CHF, Pneumonia
- Diaphoresis, tremors
SC: Hypoglycemia
- Negelect (inattention to one side of space) or visual field loss
SC: stroke
- Ataxia, nystagmus
SC: Wernicke encephalopathy
Major causes of Memory Loss
- MCI
- Alzheimer’s
- Vascular dementia
- Mixed dementia
- Parkinson’s
- Diffuse Lewy body
- Frontaltemporal dementia
Diplopia
Seeing a duplicate copy of an image, colloquailly referred to as double vision
Monocular diplopia
Diplopia with only one eye viewing
Binocular diplopia
Diplopia present only when both eyes are open
Polyopia
Seeing multiple copies of an image
Comitant
diplopia that does not vary with gaze direction
Esotropia
Crossed eyes; eyes pointing medially with respect to each other
Exotropia
Eye that are pointing laterally with respect to each other
Hypertropia
One eye elevated with respect to the other
Phoria
A tendency for the eyes to be misaligned when one eye is covered; with both eyes open, the subject’s ocular motor control system can use vision to align the eyes so that there is no diplopia
Common cause of diplopia
- Ocular myopathy
Dx: Graves opthalmyopathy
- Neuromuscular junction
Dx: Myasthenia gravis
- Cranial Neuropathy
Dx: Diabetes, tumor, infection, inflammation
- Supranuclear (brainstem) disorders
Dx: Stroke, tumor, demyelination, infection
Alarm symptoms of diplopia
- Eye pain or headache
SC: Cerebral aneurysm, mengitis
- Facial numbness
SC: cavernous sinus mass
- Facial weakness, limb weakness, limb numbness, imbalance, drowsiness
SC: Brainstem lesion, meningitis
Ataxia
unbalanced or uncoordinated ambulation
Cerebellar ataxia
Ataxia due to impaired cerebellar function
Sensory ataxia
Ataxia due to impaired proprioceptive or sensory feedback from the lower extremeities
Spastic paraplegia
Tonic muscular contraction leading to an inability to relax the muscles. The increased tone is due to damage of the inhibitory neurons in the spinal cord or brain
Peripheral neuropathy
Abnormal sensory or motor nerve function leading to weakness, altered sensory perception, or both
Serious Dx of gait abnormalities
- Spinal cord impingement by tumor or infection
- Stroke
- Normal-pressure hydrocephalus
- Aortic dissection causing spinal cord ischemia
Action Tremor
An oscillation that occurs or increases during voluntary movement, generally, of midrange frequency. Also called kinetic tremor.
Postural tremor
An oscillation that occurs while maintaining a fixed posture against gravity or during other fixed postures (clenched fist, standing), generally at a lower frequency
Rest tremor
An oscillation that occurs with the affected body at rest, during no action (voluntary contraction of muscles) and without resisting gravity, generally at a lower frequency
Intention tremor
A type of action tremor in which oscillation orthogonal to the direction of movement and increases in amplitude as the target is approached. usually denotes disease of the cerebellum and/ or its connections
Physiologic tremor
Irregular oscillations of 8-10 Hz occurring during maintenance of a posture, which usually disappear when the eyes are closed or a gravity load is placed on the muscles. By definition, mild physiologic tremor may be a normal finding and is common in the general population.
enhanced physiologic tremor
Physiologic tremor is increased in amplitude due to fatigue, sleep deprivation, treatment with certain drugs, some endocrine disorders, caffeine use, or stress
essential tremor
Isolated postural or action tremor involving the hands and sometimes the head and voice without other neurologic findings. Genetically determined with a positive family Hx (familial tremor) in approx. 50% of cases
Parkinsonian tremor
Rest tremor that usually has a very regular “pill-rolling” quality and is frequently, but not always, associated with other symptoms of Parkinson’s disease (stiffness, slowness, gait changes).
Task-specific tremor
A tremor elicited by a specific task, such as speaking or writing
