Neuro exam PNS Flashcards
If a patient comes in with motor signs what are the 4 main pathologies?
UMN lesion (pyramidal tract and spinal chord)
LMN lesion (spinal chord nerves)
Cerebellar pathology
Basal ganglia pathology (ie Parkinsons)
Damage to which nerve causes carpal tunnel?
Median
What position should the patient be in for a upper limb exam?
45 degrees on couch or sitting with their legs off the couch
What position should the patient be in for a lower limb exam?
Lying on the couch 45 degrees
What may you see on general inspection for an upper limb exam?
Wheelchair Catheter (could be due to neurological cause) Muscle wasting Neurofibromas Ptosis
What acronym is used to remember how should should inspect a patient for an upper limb exam and what does it mean?
SWIFT
Scars
Wasting of muscles
Involuntary movements (chorea, myoclonus, tardive dyskinesia)
Fasciculations
Tremor (resting, intention tremor, postural tremor)
Also look for specific signs eg neurofibromas
Look at the face for hypomimia, ptosis, ophthalmoplegia
What is hypomimia and when is it seen?
Reduced facial expression often seen in Parkinson’s
How do you test for pronator drift?
Ask the patient to put their arm out in front of you with the palm up, close their eyes and get them to hold it there for 30 secs/ as long as they can
If a patients arm goes down slightly and pronates when testing for pronator drift where may their lesion be?
Right side (UMN lesion causing pronator drift)
What happens to upper limb and lower limb flexors and extensors in UMN lesion?
Upper limb: flexors are stronger than extensors (resulting in pronation of the arm)
Lower limb: extensors are stronger than flexors
What does pronator drift test for?
Upper motor neurone lesion
Where do you test for tone in the upper limb? How?
Shoulder
Elbow
Wrist
Ask them to be floppy, circumduction of shoulder, flexion/extension of elbow and flexion/extension of the wrist
What is the difference between spasticity and rigidity?
Spasticity is velocity dependant ie if you do the movement faster the hypertonia will reduce but rigidity is not velocity dependant so the hypertonia will remain
What type of rigidity is seen in the upper limb in Parkinsonism? Describe what it means
Cogwheel rigidity= everytime you attempt a movement it doesn’t work/ gets stuck
What are the ways to test for power in the upper limb?
Shoulder abduction Shoulder adduction Elbow flexion Elbow extension Wrist flexion Wrist extension Finger abduction Thumb abduction
How should you apply resistance when testing for power in the upper limb?
Use the same part of the arm the patient is using eg when testing for shoulder abduction use your whole arm as they are too but when testing for finger abduction only use your fingers as thats what they will use
How is power reported?
MRC= muscle power scale
Describe the MRC and what trick can be used to remember it?
0= no movement 1= flicker of movement 2= active movement (not against gravity) 3= active movement against gravity 4= active movement against gravity and resistance 5= normal power
If you remember that 3 is movement against gravity then you can work up and down to figure out the rest
What reflexes do you test for in the upper limb?
Biceps
Triceps
Supinator
How do you test for the biceps reflex?
Find the biceps tendon
Strike the tendon hammer onto YOUR finger
How do you test for the triceps reflex?
Find the triceps tendon
Strike the tendon hammer on the patients skin directly
How do you test for the patient’s supinator reflex?
Find the tendon and strike the tendon hammer onto YOUR finger
Observe the brachioradialis muscle
What track is responsible for light touch?
Mainly dorsal column
What track is responsible for pin prick/ pain?
Spinothalamic tract
What track is responsible for vibration?
Dorsal column
What track is responsible for proprioception?
Dorsal column
What signs are seen in Brown sequard syndrome and explain them? What is it?
Damage to half the spinal chord
You will see ipsilateral motor weakness and loss of vibration and proprioception
Contralateral loss of pain and temp
This is because the spinothalamic tract crosses at the level of the vertebra (so lesion in the spinal cord causes contralateral signs) but the dorsal column crosses at the level of the medulla (so lesion in the spinal cord has ipsilateral effects)
What is mononeuropathy?
Loss of sensation in the area a nerve applies eg radial nerve
What is radiculopathy?
Sensory loss in area supplied by the nerve root eg C5 dermatome
What sensory loss will occur when there is spinal cord damage?
Sensory loss at and below the level of involvement
What type of sensory loss will occur if there is a thalamic lesion?
Contralateral sensory loss