Neuro Lecture Flashcards
CNS
Brain, brainstem
Cerebellum
Spinal Cord
PNS
Motor & Sensory
CN & ganglia
Spinal nerves & dorsal root ganglia
Peripheral nerves
ANS
Sympathetic & Parasympathetic nerves & ganglia
Enteric System
UMN
Brain to anterior horn of SC Hyperreflexia Clonus - rapid DF/PF Abnormal reflexes Muscle weakness
LMN
Anterior horn of SC via nerve roots to peripheral nerves
Hyporeflexia/Areflexia
Fasciculations - involuntary contractions
Atrophy
Muscle weakness
ALS/Lou Gerhig’s is involvement of UMN or LMN?
BOTH
Hallmark sign of ALS?
Hyperreflexia: Clonus in legs
Hyporeflexia/Areflexia reflexes in arms
If it’s in the brain, is it only effecting the Upper?
NO
ANS functions can happen when…
Nervous patients or other…
PNS/SNS
ANS Presentations
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)
ANS Signs for Peripheral nerve lesions: SNS changes
Loss of sweat glands (dryness)
Loss of pilomotor response (no goosebumbs)
ANS Signs for Peripheral nerve lesions: Sensory Changes
Loss of sensation
Loss of vasomotor tone
Skin may be scaly or smooth & shiny
Nail changes (brittle, no luster, irregular)
Peripheral injuries in LE
Patients will say numbness/tingling in a certain body part
Peripheral injuries in UE
Dropping things, b/c they can’t feel
If patient has double vision… what nerves are involved?
Cranial nerves
Coordination involvement is an involvement of what nerves?
CNS
Falling, LOB
Stiffness, difficulty moving quickly
Mental status Changes involvement is an involvement of what nerves?
CNS Confusion Memory Loss Attention Behavior Speech
What are some red flags?
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)
Red flags: Emergency Situations
Loss of speech LOC Sudden change in vision/tingling Uncontrolled seizures Sudden acute No known dx
Red flags: Non-emergency Situations
Known dx, but some changes
Which test will help us understand upper vs lower motor neuron?
Reflexes
Deep Tendon
Pathologic: Babinksi
Which regulates activity? UMN/LMN?
UPN
if this is involved, it gets our control
If reflex is gone, which is involved?
LMN
How to test for reflex?
Let the patient know that we are testing for the reflex… then distract them to relax them!
How is reflex graded?
0 - Absent 1+ - Diminished 2+ - Average 3+ - Brisk Clonus
(Grade what you see!)
What is hyperreflexia?
3+/Clonus, but could be normal, further testing required.
What is a second test to determine UMN?
Babinski, positive if toes extends up
What are the steps to screen for LMN?
LSensation (Check bilaterally)
1) Light touch (yes/no)
2) Pin prick (dull/sharp)
3) Vibration (start/stop)
* Determine patten of loss
- Dermatome or Peripheral
What are the two main pathways?
Light Touch, Vibration, Proprioception
Nociception, Temperature
Dermatome:
Sensory region of skin innervated by nerve root
Myotome:
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)
After knowing the areas of involvement, how do you r/o spinal root or peripheral?
MMT
Spinal nerve root is likely involved when…
There’s muscles in two spinal nerve areas with MMT
2 peripheral nerves involvement is not likely
*Look at myotome patterns & MOI…
What MMT is considered a significant weakness with quads?
4/5
Peripheral muscles: Femoral involvement:
Quads
Peripheral muscles: Obturator involvement:
Adductors
Peripheral muscles: Sciatic involvement:
HS
Peripheral muscles: Tibial involvement:
HS
Gastroc/Soleus
Peripheral muscles: Superficial Peroneal involvement:
PB/PL
Peripheral muscles: Deep Peroneal involvement:
Gastroc/Soleus
If peripheral is involved should you test all muscles in that area?
YES!
What dx involved multiple peripheral nerve involvement?
Polyneuropathy (usually bilateral)
Common: Diabetes, stock-glove pattern
starts distal and comes proximally
*B12 deficiency as well
Romberg Test
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)
