Neuro Exam Flashcards
LL Myotomes
- Hip flexion [iliopsoas L1/2]
- Hip adduction[adductors L2/3]
- Knee extension [quadriceps L3/4]
position, “kick your leg out” - Ankle dorsiflexion [tibialisanterior L4]
- Great toe dorsiflexion [extensor hallucis longus L5]
- Ankle plantarflexion [gastrocnemius S1/2]
Define the terms 1. hemiplegia 2. diplegia 3. paraplegia 4. quadriplegia
- Hemiplegia: Paralysis on one side of the body
- Diplegia: paralysis of corresponding parts on both sides of the body, typically affecting the legs more severely than the arms
- Paraplegia: Complete or incomplete paralysis affecting the legs and possibly also the trunk, but not the arms.
- Quadriplegia: Paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso
Cause of pyramidal gait?
UMN lesion leading to increased tone of leg
MRC scale of muscle strength
- No movement
- Flicker is perceptible in the muscle
- Movement only if gravity eliminated
- Can move limb against gravity
- Can move against gravity and some resistance exerted by examiner
- Normal power
LL reflexes
Knee jerk = L3/4
Ankle jerk = S1/2
Define the term clonus. In what conditions might you be able to elicit clonus?
- Clonus definition: muscular spasm involving repeated, often rhythmic, contractions. Sign of UMN lesions
- Causes: MS, Huntington disease, damage to the spinal cord, meningitis
Reflex grading system
0: Absent 1+: Hypoactive 2+: normal 3+: Hyperactive, without clonus 4+ : Hyperactive, with clonus
Babinski’s sign
The reflex is normal in infants when the sole of the foot is firmly stroked and the hallux moves upwards whilst the remaining toes fan out
2 main sensory pathways
Dorsal column: Vibration and proprioception
Spinothalamic tract: Pain and temp
Name 2 conditions which would give a mixture of upper motor neurone and lower motor neurone signs.
- ALS (amyotrophic lateral sclerosis)
- Paralytic Poliomyelitis
Gait problems??
Ataxic: Trendelenburg: Arthralgic: Pyramidal: Extrapyramidal: Foot drop: Apraxic:
Ataxic: Poor control (due to peripheral nerve injury, cerebellar injury, vestibular apparatus injury)
Trendelenburg: Dropping hip / waddling (due to weak proximal muscle
Arthralgic:
Pyramidal:
Extrapyramidal:
Foot drop:
Apraxic:
Gait problems??
Ataxic: Trendelenburg: Arthralgic: Pyramidal: Extrapyramidal: Foot drop: Apraxic:
Ataxic: Poor control (due to peripheral nerve injury, cerebellar injury, vestibular apparatus injury)
Trendelenburg: Dropping hip / waddling (due to weak proximal muscle
Arthralgic: Painful
Pyramidal: Circumduction of the legs (due to UMN lesion)
Extrapyramidal: Shuffling, unstable (due to basal ganglia lesion)
Foot drop: High stepping gait due to LMN lesion (i.e. common peroneal nerve)
Apraxic: Unable to perform purposeful tasks (due to frontal lobe lesions in e.g. hydrocephalus, stroke)
Myotomes of UL
Shoulder - C5 Elbow flexion - C6 Elbow ext - C7 Wrist flex - C6 Wrist flexion - C7 Finger flexion - C8 Finger abduction/ adduction - T1 Thumb abduction - T1
Dermatomes of UL
Deltoid - C5 Thumb - C6 Middle finger - C7 little finger - C8 Inner arm - T1
Dermatomes of LL
Groin - L1 Thigh - L2 Inner knee - L3 Medial malleolus - L4 Web space of big toe - L5
Reflexes of UL
Biceps - C5/6
Triceps - C7-8
Brachioradialis - C6
Absolute contraindications to thrombolysis
Haemorrhage stroke on CT S/S of SAH Neurosurgery, head trauma or stroke in past 3 months LP in last week GI bleed in last 3 weeks Uncontrolled HTN >185/110 Hx of intracranial haemorrhage Known intracranial AV malformation, neoplasm or aneurysm Active internal bleeding Suspected or confirmed endocarditis Known bleeding diathesis BM <5
Contraindications of LP
signs suggesting raised intracranial pressure or reduced or fluctuating level of
consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 points or more)
relative bradycardia and hypertension
focal neurological signs
abnormal posture or posturing
unequal, dilated or poorly responsive pupils
papilloedema
abnormal ‘doll’s eye’ movements
shock
extensive or spreading purpura
after convulsions until stabilised
coagulation abnormalities or coagulation results outside the normal range or platelet
count below 100x109/litre or receiving anticoagulant therapy
local superficial infection at the lumbar puncture site
respiratory insufficiency in children.
Signs of RICP
headache drowsiness anorexia visual disturbances e.g. - blurred vision: often the first manifestation noted by patients - visual field loss: early finding - visual acuity is usually preserved - double vision - "greying out of vision" a.k.a. transient visual obscurations. Commonly occur with changes in posture - papilloedema neck/back pain nausea and/or vomiting convulsions pulsatile tinnitus blackouts decreased GCS/coma
Signs of cerebellar dysfunction
Dysdiadochokinesia Ataxia Nystagmus Intension tremor Slurred speech Hypotonia
DDx for cerebellar disorder
STEAM
Stroke Trauma Ethanol Anti-epileptics MS
Name the cranial nerves
I - Olfactory II- Optic III- Occulomotor IV- Trochlear V- Trigeminal VI- abducens VII - Facial VIII - Vestibulocochlear IX - Glossopharyngeal X - Vagus XI - Spinal accessory XII - Hypoglossal
Signs of horners syndrome
Miosis (Small pupil)
Ptosis
Anhydrosis
Enophthalmos (eyeball recession)
Meaning of 6/x vision?
6/x vision means what patient can see at 6m what a person with normal vision can see at x metres.
Function of MLF?
MLF (medial longitudinal fasciculus) connect abducens nucleus to contralateral oculomotor nucleus to perform horizontal CONJUGATE LATERAL GAZE
Extraoccular muscles innervation and signs of palsy
CN III: Levator palpebrae superioris, Medial + superior and inferior rectus and inferior oblique
CN IV: Superior oblique
CN VI: Lateral rectus
PALSY:
CN III: Ptosis, “down and out”, pupil dilated and unresponsive
CN IV: “up and in” Impaired depression to adducted eye, contralateral head tilt
CN VI: Impaired abduction
Control of taste and salvation?
CN VII (Sensory and PS efferent)
Light reflex
Afferent: CN II
Efferent: CN III
Speech innervation
CN X (Vagus) and CN XII (hypoglossal)
Nerve control of pharynx, and larynx motor, sensory and PS function
CN IX (glossopharyngeal) CN X (vagus)
Corneal reflex
Afferent: CN V
Efferent: CN VII
