NEURO Exam Flashcards
Sense that does not go to THALAMUS
SMELL
• Spinothalamic Tracts
________order _________, then _________to ______
@thalamus, synapse to ______
- Pain/Temp/Light Touch/Crude Touch
- 2nd orders cross to opposite side, then ascend to Thalamus
- @ Thalamus, synapse to 3rd order
Posterior Dorsal Columns
1st order enter ______and ______on which sidee?
@ Medullla, synapse to _______then cross over and ascend to ________
@ thalamus, synapse to 3rd order
ascend to cortex
• Proprioception/Vibration/2 pt discrim/Stereognosis
• 1st orders enter SC and ascend same side
• @ medulla, synapse to 2nd order then cross over
and ascend to Thalamus
• @ Thalamus, synapse to 3rd order
• Ascend to cortex
OUTSIDE
LOWR MOTOR NEURON
Inside
UPPER MOTOR NEURON (Stroke)
Dermatome have
1/3 OVERLAP
To get dermatome numbing
both dermatomes above and below
• 4 types of Reflexes:
•
DTR
Superficial
Visceral
Pathologic
• Deep Tendon (DTR)
• ex. Patellar
• Superficial
• ex. Corneal (blink), abdominal
• Visceral
• ex. Pupillary response to light
Pathologic
• ex. Babinski’s sign
Example of Lower MN disease
- SC lesions
- Polio
- ALS
Examples of Upper MN disease
- CVA
- CP
- MS
Extrapyramidal Tracts
• Gross automatic movement
(ie. Walking)
Only test in anosmia pt.s with:
- Head trauma
- Abnormal mental status
- Suspected intracranial lesion
Ophthalmoscope – fundoscopy
• Optic disc LOOK FOR
- Papilledema
* Optic atrophy
Optic disc is
most prominent landmark (nasal side)
Pallor indicated
CN 2 atrophy
Hyperemia indicates
methanol poisoning
Irregular shape indicates
Glaucoma
Margins Blurred =_________ = _________
Blurred margins = papilledema = ↑ ICP
CN III is the
OCULOMOTOR NERVE
• Asymmetric response indicated
CN 3 damage
Asymmetry in Corneal Light REFLEX
What to do next?
Asymmetry indicates deviation 2o to muscle weakness or paralysis – if present, do Cover Test
• Phoria =
mild weakness when fusion is blocked
• Tropia =
severe weakness that is constant
Ptosis occurs with:
• Myasthenia Gravis
MG is a ________
- Autoimmune cause
* One or both eyes affected
Horner’s Syndrome (PIAC)
- Pupil constriction
- Ipsilateral sympathetic n. paresis
- anhydrosis
- CN III damage
CN IV is the
TROCHLEAR NERVE
CN V is the
Abducens
Uneven eye movement, Strabismus or failure to follow =
EOM weakness or CN dysfunction
EOM weakness or CN dysfunction
Uneven eye movement, Strabismus or failure to follow =
• Nystagmus indicates (2) SPM
semicircular canal ds.
paretic eye m.,
MS or brain lesion
Lid lag =
hyperthyroidism
CN V is the
Trigeminal nerve
EOM testing
Hold finger ~12” back, Move through the 6 cardinal positions of gaze, “H” pattern
Motor function of Nerve V trigeminal
Mastication
Note: WAP weakness, asymmetry, pain
Sensory testing of CN V trigeminal
• Forehead (ophthalmic branch)
• Cheeks (maxillary branch)
• Chin (mandibular branch)
Test light touch with cotton wisp or brush
Sensory testing of CN V trigeminal (FO)
• Forehead
(ophthalmic branch)
Sensory testing of CN V trigeminal (CheekMax)
• Cheeks
(maxillary branch)
Sensory testing of CN V trigeminal (TRIMAN)
• Chin
(mandibular branch)
If there’s no Blink means
damaged CN V and/or CN 7
2 typs
Circular (sympathetic)
radial (
Facial Nerve
motor test CN 7
CN 7 dseases
CVA
• Bell’s Palsy
MG looking up makes eyelid
droop
CN 8 is the___________
•
Vestibulocochlear N.
Vestibulocochlear
Test Hearing acuity w/
• normal conversation & whispered voice
• Weber & Rinne tuning fork tests
Weber test
normal, both ears hear equally
weber test sound lateralizes to POORER with
conductive loss
weber test sound lateralizes to BETTER with
SENSONEURINAL loss
Normal Rinne test
AC>BC
Conductive loss in Rinne Test
AC =BC
AC < BC
Sensorineural loss is
AC> BC BUT POOR EAR IN BOTH OVERALL REDUCED
CN IX IS
Glossopharyngeal N.
CN X IS
Vagus N.
MOTOR Function tests IX and X (AATU)
• Note : absence asymmetry of soft palate tonsil pillar movement, uvula deviation
• Hoarse/brassy voice =
vocal cord dysfunction (CN X)
Spinal Accessory N is CN
XI
Test motor function
- Instruct pt. to rotate head against resistance
* Shrug shoulders against resistance
CN XII is
• Hypoglossal N.
Inspect tongue for (FAT)
- Fasciculations
- Atrophy
- Tongue deviates toward paralyzed side
When do you use atrophy? (DIL PD)
Disuse
injury
LMN ds. (Polio, Diabetic neuropathy)
Paresis means
diminished strength
Paralysis/plegia =
absence of strength
Decorticate rigidity where is the lesions (decorCORTEX)
Lesion in Cerebral Cortex
DECEBRATE RIGIDITY where is the lesion
Lesion in brain stem @ midbrain or pons
in Decorticate there is
FLEXION
Decerebrate there is
EXTENDED
Staggering, loss of balance =
Seen UMN lesion such as
Ataxia
ie. MS
FLACCID
Lower
Romberg test
Sways/falls/widens feet
• (+) Romberg sign (CEM)
- Cerebellar ataxia
- MS
- Etoh intoxication
(+) Romberg sign (CEM)
- Cerebellar ataxia
- MS
- Etoh intoxication
Slow, clumsy, lack of coord. indicates______For _______
dysdiadochokinesia; cerebellar ds.
There is dysymmetry means
cerebellar disorder
Finger to nose test multiple misses
Cerebellar ds.
Heel to shin test : lack of coordination
= cerebellar ds.
For pt.s with neurologic symptoms
pain, numbness, tingling, motor deficits
full work up s/b done (all sensory modalities, most dermatomes)
For pt.s without neurologic symptoms, screening includes:
SLVS
- Superficial pain (sharp/dull discrimination)
- Light touch
- Vibration
- Stereognosis
Spinothalamic Tract Testing
PAIN (SHARP/DULL)
Temp Test
May omit since fibers follow same path as pain, or use side of metal tuning fork (cold)
Spinothalamic Tract Testing: Light touch
Test w/ hammer brush
• Brush over skin in random order of sites at irreg. intervals
• Ask pt. eyes closed; say “now” or “yes” when they feel it
Vibration Test
• Vibration sense usually first lost in______
In 2 conditions_______
Peripheral Neuropathy
(DM, Etoh abuse
Posterior column tract testing
Position (Kinesthesia) Test
• Tests ability to perceive passive movement of extremities
Posterior Column Tract Testing
2 tests
• Position (Kinesthesia) Test
- Tactile Discrimination (Fine Touch)
Posterior Column tract testing (GSTEP)
- Graphesthesia
- Stereognosis
- Two-point discrimination
- Extinction
- Point location
Stereognosis Test
Tests ability to recognize object by feel, size, shape
Stereognosis test steps
- Pt. eyes closed
- Place a familiar object in one hand, ask them to identify it
- Left hand assess Right parietal lobe function; Right hand assess Left lobe
Graphesthesia –
tests ability to “read” a number traced on skin
Graphestesia Steps
- Pt. eyes closed
- Using blunt instrument trace a single digit or letter on palm
- Useful test for pt.s with limited hand ROM (ie. Arthritis)
Failure of either test GRAPHESTESA/ STEREOGNOSIS indicates
sensory cortex lesion (ie. CVA)
Two-point Discrimination
- Pt. eyes closed
- Lightly touch two points of opened paper clip to skin in ever-closing distances.
- Note distance pt. no longer perceives two separate points.
- Level of perception varies with region tested)
Two-point Discrimination• Most sensitive =
Fingertips (2 – 8 mm)
Two-point Discrimination• Least sensitive =
Back, Thigh, Upper Arms (40 – 75 mm
Extinction Failure one side indicates
a contralateral sensory cortex lesion
Point Location TEST
• Failure indicates___________
sensory cortex lesion
DTRs
Clonus ____________ indicates
repeated jerking contractions; UMN lesion (MS)
DTRs Hyperreflexia indicates
UMN lesion (CVA)
Hyporeflexia indicates
LMN or Cord damage S
Biceps Reflex
• Tests_______
C5 – C6
Normal for biceps reflex is
flexion
Triceps Reflex
• Tests
C7 – C8
Normal for Triceps is
extension
Brachioradialis Reflex
• Tests_______
C5 – C6
Brachioradialis Reflex
Gently strike 2 to 3 cm above radial styloid process
Normal Brachioradialis refex
Flexion & supination of forearm
Quadriceps Reflex
• Tests_______
L2 – L4
Quadriceps normal
extension
Achilles
• Tests______
L5 – S2
AChilles is Normal =
plantar flexion
Clonus is
Jerky Repeated muscle contractions
Clonus is seen in
UMN
Clonus normal test is
no movement
Superficial reflex
Abdominal
• Upper _______
Upper T8-T10
Superficial reflex
Abdominal
Lower________
T10 – T12
Plantar Reflex test is
Babinski Sign
Babinski plantar test
• Test L4 – S2
Abnormal in babinski is dorsiflexion and it is
Indicates Lesion in corticospinal (“pyramidal”) tract
Babinski is normal up to
18 months
Neurologic recheck
These pts. need close monitoring to chk. for improvement/deterioration/ ↑ICP
______can push brain stem down (uncal herniation)
↑ICP
Pressure on CN III causes
pupil dilation
Cushing reflex can indicates
↑ICP
Pain and temp monitor
LaTeral SPINOTHALAMIC tract
• Light/Crude Touch monitor
ANTERIOR spino-thalamic tract
Space spinothalamic tract testing
2 seconds apart
