Neuro Lecture

Question 1

CNS

Answer 1

Brain, brainstem
Cerebellum
Spinal Cord

Question 2

PNS

Answer 2

Motor & Sensory
CN & ganglia
Spinal nerves & dorsal root ganglia
Peripheral nerves

Question 3

ANS

Answer 3

Sympathetic & Parasympathetic nerves & ganglia

Enteric System

Question 4

UMN

Answer 4

Brain to anterior horn of SC
Hyperreflexia
Clonus - rapid DF/PF
Abnormal reflexes
Muscle weakness

Question 5

LMN

Answer 5

Anterior horn of SC via nerve roots to peripheral nerves
Hyporeflexia/Areflexia
Fasciculations - involuntary contractions
Atrophy
Muscle weakness

Question 6

ALS/Lou Gerhig’s is involvement of UMN or LMN?

Answer 6

BOTH

Question 7

Hallmark sign of ALS?

Answer 7

Hyperreflexia: Clonus in legs

Hyporeflexia/Areflexia reflexes in arms

Question 8

If it’s in the brain, is it only effecting the Upper?

Answer 8

NO

Question 9

ANS functions can happen when…

Answer 9

Nervous patients or other…

PNS/SNS

Question 10

ANS Presentations

Answer 10

Ringing in the ears
Dizziness
Blurred vision
Photophobia (light sensitivity)
Rhinorrhea (runny nose)
Sweating
Lacimation (tearing)
Generalized loss of muscle strength
Increased HR
Flushing (vasodilation)

Question 11

ANS Signs for Peripheral nerve lesions: SNS changes

Answer 11

Loss of sweat glands (dryness)

Loss of pilomotor response (no goosebumbs)

Question 12

ANS Signs for Peripheral nerve lesions: Sensory Changes

Answer 12

Loss of sensation
Loss of vasomotor tone
Skin may be scaly or smooth & shiny
Nail changes (brittle, no luster, irregular)

Question 13

Peripheral injuries in LE

Answer 13

Patients will say numbness/tingling in a certain body part

Question 14

Peripheral injuries in UE

Answer 14

Dropping things, b/c they can’t feel

Question 15

If patient has double vision… what nerves are involved?

Answer 15

Cranial nerves

Question 16

Coordination involvement is an involvement of what nerves?

Answer 16

CNS
Falling, LOB
Stiffness, difficulty moving quickly

Question 17

Mental status Changes involvement is an involvement of what nerves?

Answer 17

CNS
Confusion
Memory Loss
Attention
Behavior
Speech

Question 18

What are some red flags?

Answer 18

ANS signs
bowel/bladder dysfunction and/or sexual dysfunction
Onset of peripheral symptoms w/ acute neck/back pain
Severe headache w/ other near signs (subarachnoid hemorrhage)
Neck stiffness w/ fever (meningeal irritation)

Question 19

Red flags: Emergency Situations

Answer 19

Loss of speech
LOC
Sudden change in vision/tingling
Uncontrolled seizures
Sudden acute
No known dx

Question 20

Red flags: Non-emergency Situations

Answer 20

Known dx, but some changes

Question 21

Which test will help us understand upper vs lower motor neuron?

Answer 21

Reflexes
Deep Tendon
Pathologic: Babinksi

Question 22

Which regulates activity? UMN/LMN?

Answer 22

UPN

if this is involved, it gets our control

Question 23

If reflex is gone, which is involved?

Answer 23

LMN

Question 24

How to test for reflex?

Answer 24

Let the patient know that we are testing for the reflex… then distract them to relax them!

Question 25

How is reflex graded?

Answer 25

``` 0 - Absent 1+ - Diminished 2+ - Average 3+ - Brisk Clonus ``` (Grade what you see!)

Question 26

What is hyperreflexia?

Answer 26

3+/Clonus, but could be normal, further testing required.

Question 27

What is a second test to determine UMN?

Answer 27

Babinski, positive if toes extends up

Question 28

What are the steps to screen for LMN?

Answer 28

LSensation (Check bilaterally) 1) Light touch (yes/no) 2) Pin prick (dull/sharp) 3) Vibration (start/stop) * Determine patten of loss - Dermatome or Peripheral

Question 29

What are the two main pathways?

Answer 29

Light Touch, Vibration, Proprioception | Nociception, Temperature

Question 30

Dermatome:

Answer 30

Sensory region of skin innervated by nerve root

Question 31

Myotome:

Answer 31

ALL muscles innervated by nerve root - Each nerve root innervates more than one muscle; therefore each muscle is innervated by more than one nerve root - One nerve root will be involved, but you won't lose all movements (that muscle has other nerves running to it)

Question 32

After knowing the areas of involvement, how do you r/o spinal root or peripheral?

Answer 32

MMT

Question 33

Spinal nerve root is likely involved when...

Answer 33

There's muscles in two spinal nerve areas with MMT 2 peripheral nerves involvement is not likely *Look at myotome patterns & MOI...

Question 34

What MMT is considered a significant weakness with quads?

Answer 34

4/5

Question 35

Peripheral muscles: Femoral involvement:

Answer 35

Quads

Question 36

Peripheral muscles: Obturator involvement:

Answer 36

Adductors

Question 37

Peripheral muscles: Sciatic involvement:

Answer 37

HS

Question 38

Peripheral muscles: Tibial involvement:

Answer 38

HS | Gastroc/Soleus

Question 39

Peripheral muscles: Superficial Peroneal involvement:

Answer 39

PB/PL

Question 40

Peripheral muscles: Deep Peroneal involvement:

Answer 40

Gastroc/Soleus

Question 41

If peripheral is involved should you test all muscles in that area?

Answer 41

YES!

Question 42

What dx involved multiple peripheral nerve involvement?

Answer 42

Polyneuropathy (usually bilateral) Common: Diabetes, stock-glove pattern starts distal and comes proximally *B12 deficiency as well

Question 43

Romberg Test

Answer 43

Positive is when patient closes eyes and falls over... Has to be a profound loss to be considered - When patient can't feel the ground Must be absent not diminished (sensory)