Neuro exam abnormal Flashcards
Altered mental status stage: sleppy but will open eyes and respond before falling back to sleep
lethargy
Altered mental status stage: harder to arose with verbal stimuli; may need to shake patient; responses are slower and tend to be confused
Obtundation
Altered mental status stage: often need painful stimuli (voice and shaking ineffective) to arouse patient; lapse into unresponsiveness when stimuli cease
stupor
Altered mental status stage: no response to verbal or painful stimuli; unarousable
coma
dysarthria
problem with motor speech or articulation
dysphonia
(weak) breathy voice
Broca’s (expressive) aphasia
- comprehension intact
- unable to speak to varying degrees
Wernicke’s (receptive) aphasia
- comprehension not intact
- fluent, but nonsensical speech
global aphasia
combination of receptive and expressive aphasia
apraxia
inability to perform a learned motor act
agnosia
- inability to recongize sensory stimuli
**associated with large parieto-occipital-posterior temporal lesion
clinical presentation
- acute onset
- duration: hours-weeks
- alertness: abnormally high or low
- orientation: impaired for time
- memory: recent and immediate impaired
- speech: incoherent
- perception: visual illusions and hallucination
delirium
impaired attention and incoherent thought
confusion
pyshomotor disturbances seen in schizoprenia characterized by periods of either muscular rigidity, excitement, or stupor
cataonia
glascow coma scale: eye opening
- none
- to pain
- to voice
- spontaneous
glascow coma scale: motor response
- none
- extensor posturing
- flexor posturing
- withdraws to pain
- localizes to pain
- obeys commands
glascow coma scale: verbal response
- none
- makes incomprehensible sounds
- uses inappropriate words
- conversant and disoriented
- conversant and oriented
type of coma: patients “act awake,” usually following a deep coma. eyes are open, they may cough, yawn, and swallow and meaninglessly use thier extremities, but still essentially brain dead
coma vigil
decorticate posturing
flexion with adduction of arms and extension of legs
- reflects destructive lesion in corticospinal tract from cortex to upper midbrain

Decerebrate posturing
extension, adduction, and internal rotation of the arms and extension of the legs
- associated with damage to corticospinal tract at levels of pons or upper medulla

What are the three common sites of hernation due to increased intracranial pressure
- under falx
- through tentorium
- foramen magnum

signs of third nerve palsy
- unilateral, fixed, and dilated pupil with ptosis
*seen with uncal herniation or aneursym compressing CNIII
This pupillary response is associated with what condition:
- midposition (2-5 mm) and fixed
midbrain lesion
This pupillary response is associated with what condition: pinpoint and reactive
Pontine lesion
This pupillary response is associated with what condition:
- unilateral dilated and fixed
CNIII lesion/uncal herniation
This pupillary response is associated with what condition:
- bilateral dilated and fixed
central herniation, hypoxia
Oculocephalic reflex (doll’s eyes)
- hold eyes open and rotate head side to side
- if intact, eyes roll to side opposite of head movement
- if eyes remain fixed and move in the same direction of the head movement, suggests lesion in midbrain or pons (CN III- CN VIII) lesion: “doll’s eyes absent”
vestibulocochlear reflex
- hold head at 30 degrees; lavage ear with ice-cold water (30-60cc)
-
normal response is tonic (slow) toward ear (stimulus); fast nystagmus away
- COWS
- cold water opposite
- warm water same
- if impaired response, suggests brainstem lesion (CN III-CN VI)
- COWS
metabolic encephalopathy or bihemispheric lesions present with what respiratory patterns in coma
cheyne-stokes

metabolic acidosis or hernation present with what respiratory patterns in coma
Hyperventilation (Kussmaul’s)
pontine damage present with what respiratory patterns in coma
apneustic

early medullary damage present with what respiratory patterns in coma
cluster
Medullary damage present with what respiratory patterns in coma
ataxic (biot’s)

clinical presentation
- visual field defect and HA
- acromegaly
- infertility, galactorrhea, amenorrhea
- cushing’s disease
pituitary adenoma
- increased growth hormone, prolactin, and ACTH
lesion to optic chiasm
bitemporal hemianopsia
lesion to (right) optic nerve
blind right eye
Central VII lesion presentation
contralateral paralysis of lower face; sparing of forehead
*upper motor neuron lesion
Peripheral VII lesion presentation
ipsilateral paralysis of the entire side of the face
presentation of glossopharyngeal lesion
- deviation of palate AWAY from side of lesion
- loss of gag reflex
presentation of hypoglossal lesion
deviation of the tongue TOWARD the side of the lesion
spasticity
- increased tone, worse with rapid movement
- due to UMN disease; loss of inhibition
rigidity
increased tone and resistance to movement, independent of rate of movement
- seen with basal ganglia disease
flaccidity
decreased tone
- due to Lower motor neuron disease
clinical presentation
- weakness in affected distribution
- spasticity
- hyperactive DTR
- clonus
- babinski sign
upper motor neuron
clinical presentation
- weakness in segmental distribution
- muscle atrophy
- flaccidity
- fasciculations
- reduced or absent DTR
lower motor neuron
nerve root affected: sensory loss to lateral upper arm and shoulder
C5
nerve root affected: sensory loss to dorsolateral arm, forearm, and thumb
C6
nerve root affected: sensory loss to mid-dorsal forearm and middle finger
C7
nerve root affected: sensory loss to medial forearm, ring and small finger
C8
nerve root affected: motor loss to deltoid, some biceps (shoulder abduction)
C5
nerve root affected: motor loss to biceps, brachioradialis (forearm extension); wrist extension
C6
nerve root affected: motor loss to triceps (forearm extension) wrist flexors and finger extensors
C7
nerve root affected: motor loss to thenar eminence and interossei of hand
C8
nerve root affected: sensory loss to anterior thigh
L3
nerve root affected: sensory loss to antero-medial thigh and medial leg
L4
nerve root affected: sensory loss to lateral thigh and anterior calf
L5
nerve root affected: sensory loss to posterior calf and heel
S1
nerve root affected: motor loss to iliopsoas
L3
nerve root affected: motor loss to quadriceps
L4
nerve root affected: motor loss to foot dorsiflexion
L5
nerve root affected: motor loss to gastrocnemius (plantar flexion of foot)
S1
DTR: knee jerk
L3 and L4
Upper motor neuron weakness
- neurons arising from motor cortex; pass through brainstem and down spinal cord
- weakness will be present below the level of the lesion
- unilateral lesions above medulla -> contralateral weakness
- unilateral lesions below medulla -> ipsilateral weakness
resting tremor
most prominent at rest; disappears with movement
*seen with parkinson’s disease
postural tremor
appears with actively maintaining posture (head or extremity)
*seen with benign familiar tremor and hypothyroidism
intention tremor
abesnt at rest; appears when reaching for target
*seen with aging, cerebellar disease and MS
rhythmic, repetitive bizarre movements of the face, mouth, jaw and tongue
oral facial dyskinesias
*due to psychotropic medication
rapid, jerky movements (unpredictable) of face, trunk and extermities
chorea
*seen with huntington’s
writhing, twisting movement of face, trunk and extremities, slower than chorea
athetosis
*seen with cerebral palsy
sudden and rapid jerks, faster than chorea
myoclonus
*seen in infections, strokes, anoxia
spastic hemiparesis
- associated with corticospinal disease
- UE flexed
- LE extended
- drags or draws foot around
steppage gait
- associated with foot drop, usually due to LMN disease
sensory ataxia
- loss of proprioception in the legs
- unsteady, wide based gait
- watch the ground while walking
- associated with + romberg
cerebellar ataxia
- associated with cerebellar disease
- staggering, unsteady and wide-based gait
- increased difficulty with turns
- unable to stand with eyes open or closed
clinical presentation
- bradykinesia
- rigidity (“cog-wheel)
- resting tremor (pill rolling)
parkinson’s disease
- idiopathic degeneration of dopaminergic neurons in substantia nigra
parkinson’s gait
- stooped posture
- slow to get started
- shortm shuffling step
- decreased arm swing
- arms flexed