Neuro Exam II: Motor, Sensory Reflexes Flashcards

Question

Abnormalities of the Motot System atophy involuntary movements dyskinesia tics dystonia

Answer 1

Atrophy = muscle wasting Involuntary movements - Dyskinesia: involuntary, repeitive & bizzare facial movements (example is tartive dyskinesia) - dyskinesia can be a result of antipsychotic use, prolonged levodopa or stimulants (cocain, ampehtamines) - Tics: involuntary, sudden, rapid movemetns or sounds (Tourettes or drugs) - muscle tics = one muscle group (blinking, head tilting) - vocal tics = nose, mouth or throat Dystonia = muscle contrations which are uncontrollable making a body part twist = abnormal posturing - can be due to abnormal **basal gangliaor cerebellum** - can be from medications (antipsychotics) or infections (lead positon, meningitis, trauma)

Answer 2

Chorea: nearly continuous rapid dance-like fluiditiy movements of the face, tongue or limbs - a key sign in Huntington's disease (start of these signals the decline) as the straitum and caudate are atrophied Athetosis - **SLOW** writithering movements of the extremities due to abnormal muscle contractions - pt. often unable to keep the limb still when ased to - **cerebral palasy (lack of O2 ot basal ganglia)** Hemiballismus - the most dramatic of moveents due to a basal ganglia disorder, where there is **Irregula, wild fialing of the arm and leg on one side of the body ONLY** - often seen in those after a stroke to the basal ganglia

Answer 3

Resting Tremor - fine or coarse movements - worse at rest - goes away with activity - **parkinsons** Postural Tremor - affected area held in a specific postion (like outright arms) brings on the tremor - aneixty, bening essential, etc. Intention Tremor - **absent at rest** - exacerbated when the pt. is doing activities (cerebellar or MS) Fasiculation: spontaneous fine movemnets due to involuntary contraction of the fine motor muscle fiebrs - appears as small, fine muscle twitches - can be associated with late stage ALS - can also be benign, anxiety, caffeine, medications (stimualants, sympathomimics, anticholenergics)

Answer 4

Spacticity: sudden catch follwed by resistance - spacticity seen in UMN lesions Rigidity: resistance during ROM - seen in Parkinsonism Flaccidity: decreased tone - seen in LMN lesiosns (and spinal shock!)

Answer 5

Postive: heightened excitability at a peripheral or central pathway - pain - paraesthesias (tingling) - dysethesia (abnormal sesanation) Negative: lossed or dimisehd sensory function or feeling - numbness - anesthesia **alwasy differentiate between the disturbution of the sensation & how it changes during activity** Numbeness - ask pt. to explain exactly what is "numb" - parasthesias (tingling, pins/needles) - or dysthesia (painful burning) - or is gone (anesthesias) - bilateral? proximal? distal? - assess if its a single nerve pattern - or is it stocking-glove mutliple?

Answer 6

- Light Touch: compare bilateral and distal to proximally - Pain: sharp & dull test: compated bilaterally and distal to proximal - Temperature: only done if abnormal pain/light touch sensation: hot and cold - Vibration: starting on the DIP of fingers and then toes; start distal and move proximla if not left (feel it and when you feel it stop) (compare bilateral) - Proprioception: identify if it is "up" or "down": if cant at teh DIP move proximal and comapre bialterally

Answer 7

Stereogenesis: identify object in hand with eyes closed Graphesthesia: feel the number drawn in the hand Two Point: touch two places simultaneouly and deicde if they can identify where, and two separte touches Point Localization: eyes closed, poke in a spot and have they show you wher you poked Extinction: touch two sides of the body & have them point (should be able to feel that its two different points)

Answer 8

**deficts in the sensory system: identify the pattern, dermatome? cortical? or peripheral nerve/cutaneous** Mononeuropathy: a single nerve distrubution is deficit - can have associated muslce deficts - ex. carpel tunnel, axillary nerve palsay, inflmmation, etc. Polyneuropathy: mutleipl nerves lost modalitiy - sx. numbness, tingling, burning, pain, etc. - think stocking/glove example for diabetic neruopathy (multiple nerves in the same area) Diabetic Neuropathy - stocking/slove distrubtion - monofilamanet testing - vibration sensation test

Answer 9

**loss of the posterior tract** only sensory loss - lost position sense & vibration below lesion - in tact pain and temperature - rare; not common due to - trauma - B12 def. - demyleinating conditions (syphilis, MS) - infarct of posterior spinal artery

Answer 10

Cerebral Cortex - all the modalities on the contralater side will be effected - loss fo sensation, two point discrimination - extinction (sensory inattention) to the other side - causes: stroke, hemorrage, tumor Thalmaic Lesions - **contralateral loss of all sensory modalities** - because at this point the fibers should be crossed or crossing at the medulla so if they cant, you lose everything - Causes: infarct, trauma, tumor, hemorrahge (HTN bleed) Brainstem Lesions - variable motor/sensory loss depends on the location - commonly: ipsilateral loss of facial sesnetion and contralatera body sensation - **if it is the basal ganglia, cerebellum or frontal lobe = no sensory loss, only motor**

Answer 11

- radicular symptoms within that spinal nerve distrubution - sensory loss (all modes) - +/- motor loss - radicular pain (shooting, sharp) - abnormal reflexes: hyporeflexia,hyperreflexia causes - herniated disc - degenertive spinal disease - abcessess - spinal cord tumor - cyst

Answer 12

- symotoms due to a spinal nerve root compression at the lumbosacral region Causes - a **LARGE** herniation of a disc in the lumbar region - trauma to lumbar - tumor, abcess or hematma in lumbar Symptoms - back pain - radicular pain bilaterally to the legs: siatcia on both - urinary retention that leads to loss of bladder/bowel function (overflow incont.) - lower extremitiy weakness (absent reflexes) - saddle anesthesia (groin)

Answer 13

Central Cord - loss of upper pain/temperature sensation bilaterally at the level of the lesion (usually shoulders and arms) - posterior column preserved - decreased motor strength in the upper extremities - **MC incomplete spinal cord injury** - "cap or shawl" sign - usually due to a fall or trauma Anterior Cord Syndrome - sensory: loss of pain and temperature below the lesion - preserve vibration/proprioception below - complete parlysis below the lesion & bladder dysfunction - due to throbosis of teh snterior spinal artery or compression

Answer 14

Brown-Sequard: hemisection - loss of pain and temperature on the contralateral side below the lesion - loss of vibration & proprioception on the ipsilateral side below - loss of motor function below ipslaterally - caused: transverse myleitis (infection) Complete Severed - lost all function motor and sensory belwo

Answer 15

Median Nerve - "Carpel Tunnel" syndrome **most common** - compression of median nerve in the canal - weakness/atrophy of thenar space - pain/parastehisas in forearm, wrsit and digits 1-3 Ulnar Nerve - cubital tunnel syndrome **elbow: MC** - pain, numbness/burning of 1/2 digit 3, then 4 & 5 = worse with elbow flexion - tender at the elbow cubital tunnel Radial Neuropathy - saturday night palsay: tramatic injury to the upper arm @ shaft of humerus - prolonged compression: wrist drop because weakness to the extenors - compression = parasthesia's

Answer 16

Sciatia (L4-S3): pain in the gluteal, hip and posterior thigh region - can be due to lumbar radiculopathy - periphearl causes (mucles compression on the nerve) Femoral Neuopathy - compression and ischemic injury from surgery att he hip or pelvis Peroneal Neruopathy - trauma to the **fibular head** (crossed legs) Tibial Neruopathy - **tarsal tunnel syndrome** from shoes or boots too tight, or a twisted angkle/fracture

Answer 17

What is a DTR - invluntary sterotypical reflex due to two neurons (monosynamtic arch) - connection from afferernt to effernt neruon in the SC Grading 0 = no response 1 = slightly dimished 2 = normal 3 = slightly brisk 4 = hyperactive with clonus Biceps (C5,6) Tricepts (C6,C7) Brachioradialis (C5,C6) Patellar (L2,L3,L4) Achilles (S1) Abdominal : (T8,9,10) & (T10,11,12) umbulicus toward stimuli Clonus: rhymic occilation of ankle back and forth when provoked (CNS injury) Plantar Reflex: shoule curl in (flexion of toes) Hoffmans: flick middle finger downard: if it hyperrelfex in the finger (UMN lesion) -could benormal bilateral; concenring if unilateral ;think cord compression Cutaneous Anal reflex: stroke skin outward in four quadrants from anus - should contract - lost reflex: thinkg S2, S3, S4 reflex arc issue (cauda equina)