Neuro Examination Flashcards
Main brain==
Cerebrum
2 lobes– R & L
SMALL brain–>
Cerebellum
Human NS
- UMN?
Brain + SC
Human NS
- LMN?
N. roots
P. nerves
UMN vs LMN picture
see pics
Red==Brain + SC–UMN
Green== N roots and P nerves–LMN
Orange== cerebellum (small brain)
Cerebrum==R & L hemis
4 lobes
- Frontal (A.CEO)
- Parietal
- Temporal
- Occipital
Function of Lobes:
Frontal lobe lesion: “on top of” everything
Remember Frontal lobe is “A.CEO”—-EXECUTIVE DECISIONS
A:Apraxia and Aphasia: Broca’s (remember FB, Frontal, Brocas)
C:Controls plan, programming, mvmt
E:Emotional, behavior, personality affected
O:Olfactory (smell)
NOTE: A. CEO is in CHARGE!–> EXECUTIVE DECISIONS
APraxia?
Think P for Planning problem!!!
Inability to perform LEARNED, PURPOSEFUL motor task
esp when commanded to do it
Function of Lobes:
Temporal lobe lesion:
Remember Temporal lobe right above EAR
- HEARING (bc Temporal lobe rt above EAR)
- Language comprehension (aka understanding WHAT we hear)
- Aphasia: Wernicke’s (comprehension prob bc is its Temporal lobe) rememer TW: Temporal, Wernickes
Note on Broca’s vs Wernickes
- UPPER MCA= Frontal=Broca’s
- LOWER MCA= Temporal=Wernicke’s
- STEM of MCA=Global aphasia (you’ll see BOTH)– give pt gestures**
- L. sided MCA-> Aphasias bc speech areas here (mostly)
EASY way to memorize Broca’s
*Frontal lesion
BEN has Broca’s
B: Broca’s
E: Expressive (trouble Expressing)
N: NON-fluent (broken speech)
Broca’s/Expressive/Non-Fluent: BEN has Broca’s
- Slow, hesitant speech, broken, trouble Expressing
- Tx: Yes/No questions, make it easy!
Wernicke’s aphasia–Temporal lesion
*remember Temporal is hearing and understanding WHAT we hear—–that’s why makes sense its Temporal!!!
COMPREHENSION PROB!!!
- Pt cannot comprehend
- Word salad–“wowsome”, “fantabulous”
- Tx: Gestures and demonstration, aka Don’t SAY it, DEMO it!!!
Wernicke’s aphasia–Temporal lesion
*remember Temporal is hearing and understanding WHAT we hear—–that’s why makes sense its Temporal!!!
COMPREHENSION PROB!!!
- Pt cannot comprehend
- Word salad–“wowsome”, “fantabulous”
- Tx: Gestures and demonstration, aka Don’t SAY it, DEMO it!!!
Practice!
65yo pt and ask “how doing?”. Response is “sun is yellow and water is cold.” most approp dx?
Did not comprehend what you were asking!!!!
Wernicke’s aphasia–temporal lobe–Inf MCA
Trouble understanding you/comprehending
Function of Lobes:
Parietal lobe lesion
Think P in Parietal and P in Perception
- Perceptual disorders
- Sensory loss
*RIGHT sided region
here you will see U/L Neglect
L vs R side clarity
- Lang defs–> Left
- Parietal (Perception)–> Right, the P is IN the R (see notes) but this is how you memorize that Perception is Right side
Function of Lobes:
Occipital lobe lesion
*think VISION
O-SEE-PITAL LOBE
- Vision loss
- C/L homonymous hemianopsia
- Inability to ID prev known objs
Cranial Nerves Mnemonic
Oh: Olfactory
Oh: Optic
Oh: Oculomotor
To: Trochlear
Touch: Trigeminal
And: Abducens
Feel: Facial
Virgin: Vestibulocochlear
Girls: Glossopharyngeal
Vaginas: Vagus
And: Accessory (spinal accessory)
Hymens: Hypoglossal
Cranial N mnemonic to remember S, M, B
Some Say Marry Money But My Brother Says Big Boobs Matter More
How do you remember LOCATION of CN’s???
MNEMONIC
CI MI PONS MEDU
(2 letters= 2 nerves) CI– I, II
(2 letters= 2 nerves) MI–III, IV
(4 letters= 4 nerves) PONS– V, VI, VII, VIII
(4 letters= 4 nerves) MEDU– IX, X, XI, XII
CN I: Olfactory
Type: Sensory
Function: Sense of smell
Affected: Anosmia (lose smell)
CN II: Optic (2 for 2 eyes)
Type: Sensory
Function: Vision (all)- color, acuity, peripheral vision
Pupillary Light Reflex (the messenger)
Affected: Blindness, myopia (shortsight), presbyopia (long sight)
Pupillary Light Reflex
what two CNs and whats NORMAL?
CN II (sensory afferent, senses it, messenger)
CN III (motor efferent)
- NORMAL== BOTH pupils constrict, think DANGER–too much light==DANGER!
- CN II senses it, then messages CN III L & R
Normal vs Abnormal Pupillary Light Reflex
CN II (sensory)/III (motor)
Normal= Light IN, BOTH constrict- CN II/III normal (NOTE you are only testing CN II on side you shine light!)
Abnormal-R CN III= shine light L, R does not constrict
Abnormal- L CN III= shine light L, L does not constrict
Abnormal- L CN II= shine light L, NEITHER constricts (CN II not sending message)
must shine light into side you want to check for CN II
Practice!
PT assessing CN integrity. On shining light in pts R EYE NONE of pupils constrict (messenger prob, CN II PUP LIGHT REFLEX), however shining light in L EYE BOTH CONSTRICT. What is finding?
RIGHT CN II PROB! Messenger prob, R CN II not sending message to CN III to constrict pupils!
A: R optic N (CN II) affected
3 CN’s withmotor function of eyes
CN III, IV, VI
- Oculomotor, Trochlear, Abducens
CN III: Oculomotor
its in the name!!!
Type: Motor
Function: Moves eyeballs UP/IN, opens eyelids, constricts pupils (Pup. Light Reflex)
Affected: Strabismus (Lateral) (abnorm eye pos.), ptosis, DILATION of pupils (bc Pup Lt Reflex)
CN IV: Trochlear
Type: Motor
Function: Look DOWN/IN (aka look @ nose (4 letter word=CN IV)
CN VI: Abducens
think ABducens ABDucts
Type: Motor
Function: ABDucts eye, ABducens ABDucts
Affects: opp of ABD’s=== Medial strabismus
CN VIII: VestibuloCochlear
Vestibulo= balance
Cochlear= hearing
Type: Sensory
Function: Balance, Hearing
Affected: Hearing loss
- 1. Conduction Loss vs. 2. Sensorineural Loss
- 1. Conduction= EXTERNAL PROB Ex. noise cancel headphones
- 2. Sensorineural= INTERNAL PROB
2 Tests associated w/ CN VIII: VestibuloCochlear
- Weber
- Rinne’s
ALWAYS DO BOTH!
Rinne’s vs Weber Tests
R before W–> Do RINNE’S FIRST!
- Rinne’s–> What TYPE-Conduction or Sensorineural
- Weber–> What SIDE (based on loudness)
Rinne’s Test for TYPE
sensorineural vs conduction
Air conduction vs Bone conduction w/ Tuning Fork
- Air conduction»_space; Bone conduction==> Norm OR Sensorineural loss aka pt can hear fork @ ear
- Bone conduction»_space; Air conduction==> Conduction loss aka pt will not hear fork @ ear
How can you remember Weber’s Test for SIDE?
CANS
- Conduction= Sound Louder in Affected side
- Sensorineural= Sound Louder in Normal side
Practice!
Pt c/o of sudden onset mild hear loss on RIGHT SIDE. Rinne (type) was consistent w/ AC»_space; BC (norm or SN) on both sides. Webers (side) findings show Louder in L. ear (normal side). Which is most likely?
AC» BC= norm or SN, louder in L ear
CANS= Sensorneural louder in Normal
Sensorineural hearing loss R side
REMEMBER
Weber= SIDE – CANS
Rinne= Type
- AC» BC= SN or norm
- BC»_space; AC= Conduction
CN V: Trigeminal
Type: Both
Function:
- Sensation to face
- MM’s of mastication (think Tri-chewminal)
- Corneal reflex–afferent sensory (messenger)– touch cornea, BOTH eyes close=normal
- Sensation to ANT tongue
- Dampens sounds (affeced= hyperacusis)
CN VII: Facial
Type: Both
- mm’s of face- smile, frown, eyebrows Exceptions: CN III- eyelids open, CN V: mastication
- Corneal reflex-efferent motor (receives message from CN V)
- TASTE to Ant tongue
- also dampens sounds
Corneal Reflex
works same as Pup Lt Reflex
CN V, VII
- CN V== sensory afferent, sends message
- CN VII== motor efferent, receives message
- WORKS SAME AS PUP LT REFLEX!!!
Eyelids OPEN/CLOSE help
CN III and CN VII
Restaurants OPEN @ 3 (CN III) and CLOSE @ 7 (CN VII)
More about the tongue
Think SENSORY: 5, 7 (Anterior 2/3), 9 (Posterior 1/3)
Tongue
- Sensory= 5, 7, 9
- Movement= 12
Anterior 2/3–> CN V, VII (BEST FRIENDS)
- Sensory- CN V (S-5) S and 5 shaped like S!
- Taste- CN VII (T-7) 7 looks like T!
Posterior 1/3 –> CN IX (P-9) 9 is backwards P!
- also does Sensory and Taste of post 1/3 tongue
CN XII: Hypoglossal
“Lick your Lesion”
Type: Motor
Function: Mm’s of tongue
Affected: I/L deviation of tongue aka “Lick your lesion”
Ex. R CN XII lesion==> R side tongue deviation (goes to R side) and vice versa
bc if R. sided lesion of R CN XII, L is STRONGER and pushes tongue R.
CN XII: Hypoglossal
“Lick your Lesion”
Type: Motor
Function: Mm’s of tongue
Affected: I/L deviation of tongue aka “Lick your lesion”
Ex. R CN XII lesion==> R side tongue deviation (goes to R side) and vice versa
bc if R. sided lesion of R CN XII, L is STRONGER and pushes tongue R.
Ex. R Hypoglossal (CN XII) lesion?
R sided tongue deviation (aka tongue goes TOWARDS LESION SIDE)
“Lick your lesion”
CN IX: Glossopharynegeal
Think 9 is backwards P for POSTERIOR tongue sensation and taste
Think Glossopharyngeal for Gag reflex (afferent)
Type: Both
Function: Posterior 1/3 tongue sesnation/taste (backwards P)
Gag reflex (G in Glossopharyngeal, G in Gag)- afferent (sensory messenger, CN X is the motor efferent for gag reflex)
Motor– Salivation*
CN X: Vagus N.
Type: Both
Function: Gag reflex–motor efferent (CN IX is the sensory messenger for gag reflex)
Sensory component== thoracic viscera
Testing CN X: Pt says “Ahh”–> CN X PULLS Uvula to SAME side—-OPPOSITE TONGUE MOTOR FUNCTION OF CN XII
- if this is Affected–> Uvula deviates C/L OR OPP side
Practice!
Pt presents w/ neuro sx’s, so we do CN assess. PT asks pt to say “Ah” (CN X assess.) Uvula deviates to L SIDE. Which CN affected?
Remember CN X lesion Uvual goes OPP side
R. CN X (Vagus)
Deciphering bw CN X (Vagus) vs CN XII (Hypoglossal) motor deviations
Tongue vs Uvula deviations
- CN X (Vagus): Uvla deviates to C/L or OPP side (bc PULLS uvula same side, so when lesion it cannot pull)
- CN XII (Hypoglossal): Tongue deviates to I/L OR SAME SIDE “Lick your lesion” (bc CN XII PUSHES tongue to opp side and when lesion cannot do so so stronger side pushes it towards lesion side)
Practice!
Which CN MOST likely affected in pt w/ lesion in PONS?
CI MI PONS MEDU
CI: 1, 2
MI: 3, 4
PONS: 5, 6, 7, 8
MEDU: 9, 10, 11, 12
Lesion to which CN affects TASTE to tongue
Sensory tongue is 5, 7, 9
Anterior 2/3–> 5 (sensation), 7 (taste)
Posterior 1/3–> 9 (sensation AND taste)
Lesion to which CN NOT likely to affect MOTOR fucntion of eyeball
Motor to eyes== III (up/in), IV (down/in), VI (ABDucts)
also remember restarurants open @ 3 (CN III) and close @ 7 (CN VII) for eyelids
CN II is SENSORY ONLY (messenger for Pup Lt Reflex, think constriction)
Anatomy Summary of Brain:
Frontal Lobe
A.CEO–> Executive Decisions
- Motor control (Premotor)
- Problem solve (Prefrontal)
- Speech production (motor-Broca’s area)
A. CEO
Anatomy Summary of Brain:
Parietal Lobe
- Touch perception (somatosensory cortex)
- Body orientation and sensory discrim
Anatomy Summary of Brain:
Temporal
remember right above EAR
- Auditory processing (WHAT we hear)
- Lang comprehension (comprehend what we hear)– Wernicke’s
- Memory/info retrieval
Anatomy Summary of Brain:
Occipital
VISION
- Sight (visual cortex)
- Visual reception and visual interp
Anatomy Summary of Brain:
Cerebellum
When Dr. Cohen says cerebellum you say….COORDINATION!
BALANCE & COORDINATION
Anatomy Summary of Brain:
Brainstem
INvoluntary mvmts
