Neuro (lecture/trans) Flashcards by Josh Sap

Abnormal perception of pain from a normally nonpainful mechanical or thermal stimulus. Delay in perception and of after sensation

Allodynia

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Mainly spontaneous abnormal sensation that is mot unpleasant; usually described as “pins and needles”

Paresthesia

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It is measured through position sense and vibration sense

Proprioception

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In patients with immature brain or deep coma, meningeal signs are all positive. True or False

False. We will not be able to elicit the meningeal irritation signs

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If the patient cannot raise his hand but cam do side to side movement of the extremities

Active movement with gravity eliminated

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Character of the alteration of muscle tone in extra pyramidal syndromes

Plastic, equal throughout passive movement (rigidity) or intermittent (cogwheel)

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Superficial abdominal reflex direction of the stimuli

Towards the umbilicus

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Seen in loss of position sense in the legs from polyneuropathy or posterior column damage.

Sensory ataxia

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Gait is staggering and unsteady,
with feet wide apart and
exaggerated difficulty on turns. Patients cannot stand steadily with feet together, whether eyes
are open or closed.
Other signs are
present such as dysmetria,
nystagmus, and intention
tremor.

Cerebellar ataxia

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Modulates equilibration and the orientation of head and eyes
• Has connections with Vestibular Nuclei located in the Pons and Medulla

Flocculonodular lobe

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Left Frontal Lesion
• Instruction:
1. Verbally instruct the patient to do the different
tongue movements 2. Ask the patient to act as if blowing out a match or
sucking a straw 3. If verbal instruction fails, try miming
• If the person cannot do the action even if you already
showed him how

BUCCO-FACIAL APRAXIA

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Left Parietal Lesion
• Instruction:
1. Ask the patient to demonstrate sequential acts → Example: illustrate how to cook rice

Ideomotor apraxia

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Right Parietal Lesions
• Instruction: 1. Draw geometric figures

Constructional apraxia

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Dysfunction of the Medial Frontal Cortex
• One reason why a patient with no hemiparesis will still
stay bed-bound → patient’s brain forgot how to walk

Gait apraxia

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Perception of odor in absence
• Example:
HALLUCINATORY EXPERIENCE
• Causes:
a. Medial Temporal Lobe Seizure →
Uncinate Fit – abnormal neuronal discharge is coming from the Uncus of the Temporal Lobe

Phantosmia

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The preferential gaze and the hemiparesis will both be contralateral to the lesion
True or False

True

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Pontine gaze center, ipsilateral or contralateral

Ipsilateral

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If you have an infarct on the Right Pons, the
Preferential Gaze is on the

Left

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Ask the patient to say “ah” or to yawn as you watch the movements of the soft palate and the pharynx. What CN test?

CN IX, GLOSSOPHARYNGEAL NERVE

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In a patient experiencing weakness on the right face, right arm, and right leg, lesion will be on the

Left corticospinal tract

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Lesion is below the brainstem, weakness is what side

Ipsilateral to the lesion

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Manifest as the lower motor neuron type of lesion

Lesions at Ventral Gray Horn, Ventral Root, Spinal Nerves, Plexuses, Peripheral Nerves, NMJ, Muscle (if it is already involving the parts of the PNS + the Gray Matter of the Spinal Cord)

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will manifest as the UPPER MOTOR NEURON type of weakness

If the lesion is located anywhere between the
Cerebral Hemispheres to the Lateral White Matter of the Spinal Cord

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increased muscle tone, hyperreflexia

upper motor neuron signs

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decreased muscle tone, hyporeflexia, fasciculations and atrophy

lower motor neuron signs

mediate voluntary movement and integrate skilled, complicated, or delicate movements by stimulating selected muscular actions and inhibiting others.

Corticospinal (pyramidal) tract.

synapse on lower motor neurons in the spinal cord which directly mediate movement. Damage causes weakness.

the corticospinal tract system

helps to maintain normal muscle tone and to control body movements, especially gross automatic movements such as walking.

Basal ganglia system.

Damage can cause rigidity, slowness of movement (bradykinesia), involuntary movements, and/or disturbances in posture and gait.

to the basal ganglia

receives both sensory and motor input and coordinates motor activity, maintains equilibrium, and helps to control posture.

Cerebellar system.

also helps coordinate eye movements and speech, so other signs like nystagmus or dysarthria may be seen.

cerebellum

Damage can impair coordination (called ataxia), gait, equilibrium, and decrease muscle tone

cerebellum

True or False Disease of the basal ganglia system or cerebellar system cause paralysis

False. does not cause paralysis but can be disabling.

Origin area of corticospinal tract

Frontal Lobe / Area 4 / Prefrontal Gryus

MOST COMMON SITE of INTRACRANIAL HEMORRHAGES secondary to Hypertension

Basal ganglia

Atrophy slight and due to disuse • Comes AFTER the weakness

UMN (Supranuclear) paralysis

Atrophy pronounced; up to 70% of total bulk • May be present BEFORE the weakness

LMN (Nuclear- Infranuclear) Paralysis

Hallmark of LMN (Nuclear- Infranuclear) Paralysis

Fasciculations / Rippling of Muscles

Spasticity hyperactivity of the tendon reflexes and extensor plantar reflex (Babinski Sign)

UMN (Supranuclear) paralysis

Flaccidity and hypotonia of affected muscles with loss of tendon reflexes. Plantar reflex, if present, is of normal flexor type

LMN (Nuclear- Infranuclear) Paralysis

Individual muscles may be affected

LMN (Nuclear- Infranuclear) Paralysis

Pathognomonic Sign for a lesion anywhere in the Corticospinal Tract

+) Babinski Sign

Active movement done to evaluate the strength of proximal leg muscles

Hopping in place, rising from sitting position, or stepping up on stool

Excessive flexion of hips and knee with every step

Steppage Gait

Weakness of hip muscles cause drop of hip and trunk tilting to the side OPPOSITE foot placement

Waddling Gait

fall to SIDE OF LESION o Poor balance o Ask which side the patient is veering too → that side is IPSILATERAL to the lesion

Vestibular ataxia

Small, shuffling steps or festinating → strides become quicker and shorter than normal (hurrying)

Parkinsonian gait

If the Hemiplegia weakness of the face is on the SAME SIDE of the arm and leg weakness → lesion can be localized to

CEREBRAL HEMISPHERE

If the hemiplegia weakness of the face is opposite to the Hemiparesis → lesion can be localized to

Brainstem

A special form of Quadriplegia in which the legs are affected more than the arms

Diplegia

Occurs more often as a transitional condition in the development of or partial recovery from Tetraplegia

Triplegia

If the tone is spastic, it is an evidence of

Corticospinal Tract injury

There is resistance you start from the beginning the until the end of ROM

RIGIDITY

When you are about to finish the ROM, that is when you start encountering resistance

Spasticity

Clasp-knife effect

Spastic

Presence of tremor, chorea, athetosis, dystonia (Involuntary movements

Extrapyramidal syndromes

Presence of Babinski sign and paralysis of voluntary movement

Corticospinal syndrome

BICEPS REFLEX Subserved by what Segment

C5-C6

TRICEPS REFLEX Subserved by

C6, C7, C8

PATELLAR REFLEX Subserved by

L2, L3, L4

Achilles Reflex, what segment

S1 primarily

Abdominal Reflexes

Upper: T8, T9, T10 Lower: T10, T11, T12

True or False Movement of the Umbilicus should move towards the direction of the stimuli

True. If you are from the right going medially, the Umbilicus should move towards the stimuli → will meet the stimuli midway

Increased in: a. Parkinsonism b. Patients who are emotionally tense Absence in adults indicates abnormality in the Spinal Arc or Cortex

Abdominal Reflexes

Abdominal Reflexes Normally Absent in:

Infants less than 1 y/o And Patients in Deep Sleep (Anesthesia, Comatose)

weakness is usually on the proximal limb of the UE and there is also weakness on the muscles innervated by the Cranial Nerves

Myasthenia Gravis

sensory deficit will only appear if the problem is in the

Peripheral Nerves / Spinal Nerves

If you have a Cerebellar Lesion, the motor findings will be

IPSILATERAL to the lesion

middle part of the Cerebellum is known as

Vermis

jerky movement of the eye)

Nystagmus

True or False To test truncal ataxia, you will not ask the patient to walk

True

Concerned with posture gait and truncal tone

Anterior lobe of the cerebellum aka Rostral Vermis

• Lesions: 1. Unsteady Walking 2. Gait Ataxia 3. Hypotonia Caused by:

Alcoholism and Nutritional o Most common cause is Malnutrition o Chronic Alcoholism can cause the cells of the Cerebellum to die → imbalance even if the Anterior Lobe patient is not drunk

will manifest or amplify the Gait Ataxia of the patient

Tandem Gait (walking)

consists of slowness, slurring of words, and Scanning Speech • Voice varies from a low volume to a high volume o Due to failure to meter and modulate the strength of the muscular contraction that produce the speech sounds

Dysarthria

Coordination of skilled action • Lesions: 1. Limb Ataxia 2. Dysmetria 3. Dysdiadochokinesia 4. Tremor 5. Dyssynergia

Posterior Lobe of the cerebellum

Finger-to-Nose Test tests for

Dysmetria

CLINICAL TESTS FOR LEG DYSTAXIA

Heel-to-Shin/Knee Test Heel-tapping test

the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements.

Dysmetria

lack of muscular coordination resulting in shaky limb movements and unsteady gait.

Dystaxia

OTHER MANIFESTATIONS OF CEREBELLAR DYSFUNCTION

Decomposition of Movement Hypotonia Mild Asthenia

Patients with Cerebellar Dysfunction do not experience any weakness o However, generally, they complain of weakness o There is some form of generalize muscle weakness

Mild Asthenia

Floppy posture Rag Doll Gait Pendulous MSRs Manifests what cerebellar abnormality

Hypotonia

Classical Pathology of Unilateral Anosmia

OLFACTORY GROOVE MENINGIOMA

Distortion of sense of smell Causes: a. Recovery from Head Injury b. Psychiatric Disorders

Parosmia

Decreased sense of smell due to AGING

Presbyosmia

Triad of Parkinson’s Dss

Bradykinesia, Rigidity, and Resting Tremors

DEFICITS ASSOCIATED WITH LEFT HEMISPHERE DAMAGE

Aphasia 2. Right Left Disorientation 3. Finger Agnosia → Temporal Lobe 4. Constructional Apraxia 5. Limb Apraxia

DEFICITS ASSOCIATED WITH right HEMISPHERE DAMAGE

- Anosognosia -Visuospatially-oriented perception and behavior - musicality - verbal inflections, aand voice tone - dressing apraxia - prosopagnosia

Inability to understand or express words as symbols for communication even though the PRIMARY SENSORIMOTOR PATHWAYS to RECEIVE and EXPRESS LANGUAGE and mental status are RELATIVELY INTACT

Aphasia

difficulty in the production of the word and sound due to a defect in the muscular control of the muscles used for speech. The central symbolic aspect of language remains intact.

Dysarthria

disorder in producing or understanding language.

Aphasia

True or False Aphasics retain Exclamatory Speech and also singing and humming

True

Associated Speech Area

Supramarginal Gyrus o Angular Gyrus

Wernicke’s Area

Superior Temporal Lobe

Inferior Frontal Lobe

Broca’s Area

Conduction aphasia lesion

Arcuate fasiculus

Arcuate Fasciculus is a

Band of White Matter connecting the Broca’s and Wernicke’s Area

Aka motor aphasia

Broca’s aphasia,

Fluent speech but cannot understand

Receptive Aphasia / Wernicke’s Aphasia

the problem is in naming and repetition

Conduction aphasia

Problem is only in naming

Anomic

Global aphasia lesion area

Perisylvian region

Posterior border zone lesion produces transcortical motor aphasia True or False

False. produces transcortical sensory aphasia Motor - anterior border zone

Inability to perform a voluntary act even though the motor system, sensory system, and mental status are intact

Apraxia

Right parietal lesions

Constructional apraxia Dressing apraxia

Gait apraxia lesion

Medial frontal cortex

Inability to demonstrate sequential acts Left parietal lesion

Ideomotor apraxia

Bucco-facial apraxia lesion area

Left frontal lesion

if the sensory problem is in the Cord or CNS, the numbness will be

Contralateral to the lesion

If the numbness is in the PNS → abnormal sensation will be felt

IPSILATERAL to the lesion

True or False Proprioceptive Pathways alone should be the one maintaining the verticality

True

inability to understand the meaning, import, or symbolic significance of ordinary sensory stimuli

AGNOSIA

Ability to identify numbers written in hand

Graphesthesia

Graphesthesia Lesion

CONTRALATERAL PARIETAL

Prosopagnosia lesion

RIGHT or BILATERAL INFEROMEDIAL Lesion TEMPORO-OCCIPITAL region

Inability to locate, identify, and orient one’s body parts And what lesion area

Asomatognosia LEFT ANGULAR GYRUS

Inability to be aware of his own bodily defect Lesion area?

Anosognosia RIGHT PARIETAL (Classic)

Astereognosia lesion

Same with Agraphesthesia CONTRALATERAL PARIETAL

Seen with RIGHT PARIETAL LESION • Unilateral Neglect

LEFT-SIDE HEMISPATIAL INATTENTION demonstrate that there is intact sensation on both sides; when tested SEPARATELY but when tested SIMULTANEOUSLY, the patient was able to perceive only one side

True or False CN are already a part of PERIPHERAL NERVOUS SYSTEM

True

Lesion in the PRETECTAL NUCLEUS (Midbrain) o Seen in NEUROSYPHILIS

ARGYL ROBERTSON PUPIL

Horner’s Syndrome is a GOOD LATERALIZING sign → If miosis is on the Right, then the lesion is

also on the Right

Causes of 3rd Nerve Palsy

Uncal Herniation 2. Posterior Communicating Artery Aneurysm 3. Cavernous Sinus Thrombosis 4. Tolosa-Hunt Syndrome