Neuro Exam Flashcards
What type of deficits are produced by brainstem lesions?
Ipsilateral loss in face, contralateral loss in body
Explain the scale for grading muscle strength
0/5= no muscle contraction 1/5= slight contractive but no joint movement 2/5= active movement with gravity eliminated 3/5= complete ROM against gravity but not resistance 4/5= complete ROM against gravity with some resistance, movement at joint with some effort 5/5= complete ROM against gravity with full resistance, no movement at joint
Why are CN VI lesions the most common isolated CN palsy? When is it often seen?
D/t long peripheral course
Often seen in pts with subarachnoid hemorrhage, late syphilis and trauma
How is the cerebellum tested? What specifically is being tested?
–Finger-to-nose: dysmetria/dystaxia of voluntary movements
–Finger-to-finger: position sense, labyrinth and cerebellum function
–Heel-to-shin: tap heel on opposite patella and glide slowly along shin, look for accuracy and smoothness
–Rapid alternating movements: rapid pronation and supination of hand, deficit seen in frontal and cerebellar damage
–Saccades: tests contralateral cerebral hemisphere
What is the Romberg test?
Generally evaluated with gait and station but tests proprioception
What type of deficits are produced with thalamic lesions?
Hemisensory loss of all modalities
Differentiate between Bell’s Palsy, bilateral facial palsies and supra nuclear (central) facial palsy
Bell’s palsy: peripheral facial paralysis, caused by trauma or infection, but in most cases is idiopathic
Bilateral facial palsies: can occur in Miller:Fisher variant of Guillain-Barre syndrome
Supranuclear (central) facial palsy): spares upper face, usually associated with hemiplegia, important in determining if weakness is central or peripheral
What can lesions in CN X result in?
Dysphonia, dysphagia, dyspnea, loss of gag or cough reflex
How do you test CN I? How might CN I be affected?
Test via: with eyes closed, have patient depress each nostril and sniff to identify non-irritating, familiar odors on each side
Loss of smell can occur with smoking, chronic sinus dz, head trauma, aging, Parkinson’s dz, cocaine use
Loss of smell can indicate an ipsilateral lesion
What can CN III lesions cause?
Ptosis, pupillary dilation or asymmetry, position change of the eye (i.e. down and out)
What is clonus?
UMN sign, abnormal pattern involving rapidly alternating involuntary contractions and relaxations of skeletal muscle; test if reflexes are hyperactive
Differentiate between myopia and presbyopia
Myopia: nearsightedness (loss of distance vision)
Presbyopia: farsightedness (loss of nearby vision)
Which motor dermatomes are tested with wrist flexion? Extension?
Wrist flexion: C6-7
Wrist extension: C6-7
What are the motor dermatomes relevant to the quadriceps?
L2-4
Which muscles and motor dermatomes are tested with knee flexion? Extension?
Knee flexion: hamstrings, L4-S2
Knee extension: quadriceps: L2-L4
How is temperature tested?
Often omitted if pain is intact, test tube with hot and cold water
Which muscles and motor dermatomes are tested with hip flexion? Extension?
Hip flexion: psoas and iliaques, L2-4
Hip extension: gluteus maximus, S1
What type of deficits are produced with cortical lesions?
Intact primary sensations but loss of cortical sensations
What four umbrella sensations is the sensory system tested for?
–pain and temperature
–proprioception, 2-point tactile discrimination and vibration
–light touch
–discriminative sensations
Explain the DTR grading scale
0: no response
1: diminished, low normal
2: average, normal
2+: more brisk tha normal but no spread
3: brisk, spread to involve moments across more than 1 joint
4: hyperactive with clonus
What are the motor dermatomes relevant to the triceps?
C6-8
What sensory dermatome corresponds to the nipple? Umbilicus? Inguinal?
Nipple: T4
Umbilicus: T10
Inguinal: L1
What are the four discriminative (cortical) senses?
Stereognosis: ability to ID shapes of objects or recognize objects place in the hand
Graphesthesia: ability to ID #s written on the palm
2-point discrimination: ability to distinguish being touched by one or two points
Double simultaneous stimulation (extinction): ability to feel two locations being touched simultaneously
How do you test CN IX?
Afferent limb of the gag reflex: touch posterior pharynx with cotton applicator