Neuro Misc. Flashcards
Describe protective vs diminished monofilament testing
5.07 and 10 g of force for protective
The 5.07 Semmes-Weinstein monofilament is calibrated so that it takes 10 grams. of force to bend it when touched on the skin of the foot. Inability to detect this. degree of force indicates that the client has a loss of protective sensation.
5.07 OR UNDER FOR PROTECTIVE SENSATION
ANYTHING ABOVE MEANS LOSS OFF EITHER, POSITIVE TEST
4.18 OR UNDER for light touch…polyneuropathy
4.18 and 1 g of force for diminished b/c seeing if its there
A positive test for the 1g monofilament (4.17) occurs when the patient cannot feel the monofilament when applied to specific areas of the skin.
This indicates diminished light touch sensation and suggests early sensory loss or mild neuropathy.
Testing DCML b/c light touch.
What tract does crude touch fall under
Spinothalamic
Describe keyy diff in ACA vs MCA vs PCA lesion
ACA - Impacts LE more
MCA -Impacts UE and face more
PCA - Vision, cerebellar
What is prosopagnosia
Inability to recognize names, faces due to occipital lesion (PCA)
Main traits of frontal lobe
Motor, brocas area (non fluent aphasia), executive, judgement
Main traits for the parietal lobe
Interpretation, sensory + perception, memory
Temporal lobe
Memory, Wernickis area (fluent aphasia), auditory, all comprehension (related to Wernickes)
Occipital
Vision
Hippocampus
Memory
Basal Ganglia
Voluntary movement, muscle tone, posture, control
Parkinsons, Huntingtons, Tourettes, OCD, ADD, Dyskinetic CP
Amygdala
Emotion
Thalamus
Relay or processing center
(thalamic pain syndrome) spontaneous pain cont side
hypothalamus
Receives from autonomic ns, regulates hormones
Epithalamus
Pineal gland, melatonin, circadian rhythm
Cerebellum
Controls muscle tone, coordination, balance
CAUSES IPSILATERAL IMPAIRMENT
ataxia, nytsagmus, tremor, hypermetria, poor balance, dysmetria (under/over shoot)
Dysdiadochokinesia (rapid alternating movements)
Pons
Respiratory rate norm is 12-20 CN 5-8 come out of pons
30-60 for 0 to 1 yo
20-40 for 2 to 5 yo
20-30 for 3 to 11
Medulla oblongata
Regulation of respiration and HR, reflex centers e.g vomiting, cough, sneeze
Relay somatic sensory info
Causes contralateral effects. All tracts cross in the medulla accept ALS (spinothalamic tracts)
CN 8-12 come from here
ACA
Cont LE involvement…bowel and bladder, frontal lobe so personality changes, aphasia
MCA
Most common. Cont UE and face, Wernickes aphasa, If dominant side, then all aphasias
Global aphasia
is issue both understanding and producing speech
PCA
Thalamic pain syndrome* and cortical blindness
Cont pain and temp loss
Ataxia
Homonymous hemianopsia e.g Left 50 percent of both eyes is out
Prosopagnosia - difficulty recognizing faces
Visual agnosia - issues processing visual input
Vertebral basilar artery
Brainstem and cerebellum involvement
Locked in syndrome, vegetative state, vertigo, nystagmus, loss of consciousness
Signs of meningitis
Fever, headache, neck stiffness
Light sensitivity
Brudzinkis sign - neck flexion causes hip and knee flex
Kernigs sign - pain with hip flex and knee ext
Lumbar puncture, refer out
DCML
vibration, proprioception, two-point discrimination
graphesthesia - the ability to identify letter numbers etc.
spinothalamic
Ant - crude touch and pressure
Lat- pain and temp (ALS) - crosses at spinal cord
Corticospinal tract related to
Positive babinski (toes spread and extend with swipe under foot), absent superficial abdominal and cremasteric, loss of voluntary movement
Rubrospinal tract
Muscle tone control
Reticulospinal tract
Voluntary and reflex activity
Tectospinal tract
Cont postural tone related to auditory and visual stimuli
A fibers
fasted and myelinated for motor and sensory
Superficial abdominal reflex
L8-T1
stroke quadrant near umbilicus and should move in that direction
Corneal blink superficial reflex
involved trigeminal (sensory) to facial (motor) closes eye
stroke eye
Cremasteric superficial reflex
L1-L2 scratch medial thigh, scrotum should elevate on that side
Gag reflex
CN IX and X touch back of throat and gag should occur
Plantar reflex
L5-S1 Stroke lat aspect of sole of foot
Normal response is flexio of toes
Babinski would be ext and spreading toes (abd)
Superficial reflex test grading and indications
Absent or present
Consider peripheral neuropathy if pathology
Deep tendon reflex
0 (nothing), 1+, 2+ (normal), 3+ (brisk), 4+ (very brisk)
Biceps is more C5
Brachioradialis more C6
Could overlap though
Consider peripheral neuropathy if pathology
Dominant hemisphere is
opposite of the dominant hand. If im R hand dominant its because I’m L brain dominant.
L hemispehere (assuming dominant)
Brocas, Wernicke, global aphasia, positive thoughts, logical, judgment
R hemisphere (assuming nondominant)
Creativity
Negative thoughts
Spatial
Kinesthesia
Why is preservation of pinprick relevant post stroke
proximity corticospinal tracts and spinothalamic tract so if its preserved then better prognosis for moto recovery
Asia A
Complete. No sensory or motor below the leesion
Asia B
Sensory below the lesion (at least in sacral segments)
Asia C
Motor preserved in less than half of levels below lesion have more than 3/5
Asia D
Motor preserved in more than half of levels below lesion have more than 3/5
Asia E
Normal both sensory and motor
Spinal shock
Sympathetic loss, everything decreased (reflex, sensation, power, bowl and bladder flacid)
Edema buildup 3-6 days
Autonomic dysreflexia vs orthostatic hypotension
AD: if face is red, raise the head. Sit up to get blood flow to body
OH: If face is pale, raise the tail (Trendelnberg) to get blood flow to head
Autonomic dysreflexia
Lesion is at or above T6
Raise in BP flushed face
Sit pt up, check for stimulus, activate EMS in that order
Conus Medullaris
L1 typically, termination of spinal cord
Injury above will act as UMN (spastic, hyperreflexxixc bladder and bowel)
- suprapubic tapping for intervention to cause reflex
- Digital stimulation
Injury below will act as LMN
(flaccid, areflexic)
- catheter or valsalva to force out
- Manual evacuation
Catherization for both initially
How may breathing chnage visually with SCI
Normal is elevation and expansion at chest wall and epigastric region without abdominal rising
Paradoxical: Upper ribcage moves inwards and abdominals move out
*IN cervical or upper thoracic due to loss of external intercostals
Decreased functional cough due to internal intercostals
Pressure relief every 15 min
Lean forwards more than 45 degrees
Tilt in space more than 65
Intrinsic plus position for tenodesis grip
Wrist 20 ext
MCP 90 ( so that they stay tight so there is no give when stretched during active wrist extension)
IP sligjt flexion
Hamstrings and QL
Dont overstretch
HS 100 to 110 stretch in supine
Upright positioning
Gradually increase angle
May use abdominal binder or compressions
If symptoms of OH
Bring down to supine or trendelenberg (COMPLETELY GO DOWN) and let symptoms subside before proceeding
Connus medullaris
L1
Above is UMN spastic
Below is LMN Areflexic flacid
Internal capsule lesion causes
Contralateral hemiparesis in body and contralateral facial weakness (ON BOTTOM HALF OF FACE CONT)
Most common UE spasticity early stroke
Adductors, pronation, wrist, finger flexion
Dyspraxia
Impairment of skilled learned movement
vertebrobasilar insufficiency
Signs are visual field cuts, visual dysfunction, drop attacks, unsteadiness/incoordination
Location of cranial nerves in relation to infarct locations
CN 1, 2 anterior brain (vision, smell)
CN 3, 4 midbrain (eye movment)
CN 5,6,7,8 Pons
CN 9, 10, 11, 12 Medulla
Cerebrum
Cont sx in body and face
Brain stem
Face and body opposite side sx
Anosognosia
Denial, neglect, lack of awareness of paralaysis
Somatoagnosia
Perceptual disorder relayed to body scheme (aware of body and relationship of parts of body)
Prosopagnosia
Perceptual disorder inability to recognize faces
Visual agnosia
Inability to recognize objects in general
Monofilament
5.07 monofilament or less is normal sensation
Anything above , means loss of protective sensation
ALS
ALS
pain
crude touch
temperature
DCML
fine touch
proprioception
Two point discrimination
Key for bowel/bladder spasticity or flaccid quesitons
If the specific organ system (bowel/bladder/sexual dysfunction) is referenced → Use S2-S4 Reflex Arc…S2 is cutoff
If the question is more general motor control or spasticity/flaccidity → Use UMN vs. LMN ….L1 is cutoff
Cauda equina
Areflexic bowel dysfunciton
Myelomeningocele
Flaccid bowel
Parietal info
Impairments such as neglect, somatosensory loss, and impaired spatial relationship are common with resections in the parietal lobe
Basal ganglia info
Individuals who have basal ganglia dysfunction have difficulty initiating movements, and this can be addressed through the augmentation of sensory cues
Tongue towards
affected side
Crude touch vs fine touch
DCML is fine touch
Wallenberg syndrome is also called lateral medullary and posterior inferior cerebellar artery syndrome.
Signs (horners syndrome = decreased pupil size, drooping eyelid, decreased sweating) due to sympathetic loss
double vision,
slurred speech
dizziness
Medial medullary syndrome distinguishing factor
Ipsilateral tongue atrophy and deviation
BUT
LE and UE is affected on contralateral side
