Neuro MSE & CN Exam I Flashcards
Frontal Lobe
Functions
prefrontal cortex
primary motor cortex
broca’s area
Frontal Lobe
- higher mental processing, decision making & executive functioning
- primary motor cortex = precentral gyrus
- contrains action cortex: responsible for skeletal muslce movemens, ocualr, spech and expression emotional movements
- prefrontal cortex = judgement, decision making & planning
- Broca’s Area: lateral aspect (usually left) of the frontal lobe responsible for motor speech activity and ativation
most of the dopaminergeric neurons are within the cerebreal cortex: those associated with reward, attention, planning and short term memory
Parietal Lobe
primary somatosensory cortex
Wernicke’s area
lesions here result in what
Parietal Lobe: sits behind the Frontal Lobe: responsible for processing sensory information related to taste, touch and temperature
Primary Somatosensory Cortex: located in the postcentral gyrus: the sensory hommunculous! : processing tactile and proprioceptive information (location in space)
- Wernicke’s Area: locationf of langugage processing
- integrates information from other sensory processing areas (liek touch and visuospatial processing)
a lesion in the parietal lobe can result in hemineglect: the person becomes unaware of the contralateral side of their body
Temporal Lobe
function
Wernicke’s here
- audiotory perception in teh auditory cortex
- long term memory and modualtion with the amygdala
- interpret visual stimuli (facial recognition)
- werknicke’s can span to this side too
Occipital Lobe
primary visual cortex
- peripheral visual fields are projected anteriorly
- the fovea has a large representation posteriorly
Visual Association Cortex
- damange here can result in loss of conscious awareness and visual stimuli
- motion and color are analyzed here
- damage = color blindness (inferior occiptial) or total (lateral)
Diencephalon
contains waht sturctures & their functions
Diencephalon
Thalmus: relay center to take signals from elsewhere to and from the cerebral cortex (except olofaction)
- damange here = lost somatosensory sensations in the contralateral head and body and/or ataxia (proprioception altered)
Hypothalmus
- emotional behavior, anger, sex drive and need to feed
- maintains homeostasis, temperature, glucose in blood & hormonal concentrations
- HR and BP controls via autonomic outputs
- relay signals to pituitary via endocrine function
Epithalmus (pineal gland) = melatonin and circadian rhythm
subthalmus (plays a role with basal ganglia?)
Limbic System
what is it
what does it contain & control
Limbic = between hypothalmus and neocortex
drive-related behavior and emotions
Amygdala = strucutre of limbic
- recieves sensory input with physical and emtional inputs as well
- plays a role in memory and emotional link, fear, anxiety, etc.
Hippocampus = struutre of the limbic
- consolidates information for short term memory& long term memory
- spatial memory as well
Pituitary Gland
antierior v posterior
anterior
- portal system between hypothalmus and pituitary for passing hormones to endocrin system
- adenohypophysis
- ACTH, FSH, LH, porlactin & TSH secreted from here
posterior
- a neurohypophysis: neruonal connection between pitutairy and hypothalm
- ADH/vasopression
- Oxytocin
Basal Ganglia
role in corrdination of motor movements
- think of basal ganglia as the bouncer: only lets some motor movement signals get through
- located at the base of teh forebrain and just above the midbrain
Function
- muscle tone
- control voluntary movement (motor)
- eye movemetsn
- procedural learning, habits, etc.
injury or lesion here: parkinsons = tremor and uncoordinated movements
Corpus Callosum & Internal Capsule
Tracts of White Matter (myleinated axons)
Corpus Callosum - connects left and right hemispheres
Internal Capsule: myleinated fibers connecting within one hemisphere, the top to the bottom
- from cerebral cortex to the brainstem (a two way street, both down and up!)
- corticobulbar fibers: crainal nerves & brainstem motor nuclei
- cortiocospinal fibers : spinal cord motor neruons
Blood supply: MCA and internal carotid
Cerebellum
base of brain = location
- movement coordination
lesion here = imparied coordination, gait, and equlibrium
Brainstem
parts
functions
pathway for acending tracts to the thalmus and decending tracts to the spinal cord
Midbrain
- controls sleep/wake cycles & some visual information (CN II)
Pons
- location for CN V, VI, VII
- basilar artery runs here
Medulla (autonomic functions: deepest)
- controls HR, BP, and respirations
- gag and cough reflex : because 9, 10 & 11 are here
ROS: Headache
primary headaches
seondary headaches
red flags
(also ask about vision, motor or sensory disturbances, seizure LOC)
Primary Headaches
Migraine: unilatera, thorbbing, rapid onset to peak with aura & photophobia
Tension: bilateral, band-like, episodic
Cluster: ice pick sensation behind the eyes in episodes with autonomic symptoms (runny nose and eyes)
Secondary Headahces : due to underlying issue
- infections (meningitis, sinusitis, etc.)
- ocular disorder (glacoma)
subarachnoid hemorrhage and venous sinus thrombus = red flag DNM dx.
Red Flags
- new onset of headache over 50
- thunderclap like headache (SAH)
- increase severity/frequency
- HIV and CA pt. with new onset HA
- systemic illness + HA
Venous Sinus Thormbus
DO NOT MISS
- HA will be common symptoms
- local or diffuse HA with no relation to where the clot is
- +/- thunderclap type of HA
- HA worse with valsalva and laying down (because decreasing drainage)
- papilledema, inc. pressure, seizures, encephalopahty, motor deficts & paresis
CT can be normal: get CT-venogram
treat like clot: heparin and anticoag with seizure prevention
Seizures
Focal & types
General & types
Focal Seizures: occuring in one location of the body
- focal unaware: LOC
- focal to general progession (spreading)
- focal aware: no LOC (jacksonian: tonic-clonic movemetns unliaterally that spread or nonmotor: tonic-clonic movements in one area which do not spread)
Generalized Seizures:
- tonic-clonic (grand mal)
- absence
- myoclinic
- myoclinic atonnic
pseudo-seizure!
MSE
appearance and behavior
- Level of Consciousness
- awake, alert
- lethargic (drowsy but arosued to you speaking)
- obtunded (shake to wake)
- stuporus (arousal to painfuls timuli)
- coma (no response)
assess posture and behavior
grooming ahd hygeine (unilateral?)
facical expression
affect (outward expression of inward emotions)
MSE
Speech and Language
characteristics
Quantity: talktive v silent
Rate of speech
Articulation: clarity or no
- dysarthia: defective articulation (slur)
- aphasia: disordered langugage
Fluency
Word Comperhenision (follow command)
Repetiton (repeat this sentence)
Naming (nam eobjects)
Reading Comprehension (read paragraph)
Writing (write sentence)
MSE
Mood and Thoughts
Mood
- assess mood
Thougths
- circumstantiality: excess detail
- derailment: take convo elsewehre
- filght of ideas: understanbale but rapid chagne of topics
- neologims: new words
- incoherence: illogical just randome words
- blokcing: stop midsentence
- confabulation: fabrication
- perserveration: repetition of a fact or idea
- echolalia: repeat what you say
- claning: rhythimg
asses content of thought about
- phobias, compulsions, obsessions, anxiety, etc.
- perceptions: see or hear things that others dont (illusions or hallucinations)
- delusions: fixed, inacurate beliefs about self or others (they’re out ot get me)
asses
- insight and judgement
MSE
Cognition - what to ask
Time (day, month, week, year)
Place (where are we)
Person (name)
Attention
- spell WORLD backwards
- count backwards from 100 by 7s
Remote Memory and Recent Memory
New Memory : remember these three words
Vocabulary
Calculations (ask to do math)
Abstract Thinking (what does chickens before thye hatch mean)
similarities: apple and orange
construction: draw and repeat shape (or clock draw)
CN: I
Olfactory Test
- test nares patency
- then close eys and test nares 1 at a time for common smell (coffee)
CN: II
Optic Nerve
pure sensory nerve
- vision via afferent pupillary light response
Tests
- visual fields (peripheral and central)
- visual acuity (chart)
- fundoscopic exam
- pupillary reflex (test CN III too) via direct and consensual responses (CNIII constricts cillary and iris muscles)
difference in pupillary size of > .4 = anisoria benign if pupillary rxn is normal
CN III : Occulomotor Nerve
CN IV: Trochlear Nerve
CN VI: Abductens Nerve
CN III
controls most EOM movement (besides superior oblique and lateral rectus)
elevates the eyelid
pupillary constriction to light (iris and cillary muscles)
CN IV: trochlear
- superior oblique: for inward and down movement
CN IV: Abducens
lateral rectus for lateral deviation
Test
- the pupillary response to light direct and consentual (CN III)
- the H test or 6 points : nystagmus and conjugate movements
- convergence
CN: V : Trigeminal
motor and sensory
Motor: temporal and masster muslces = jaw clentch and move side to side
Sensory: Facial sensation (V1, 2 & 3) & corneal Reflex
- sharp v dull on three locaions each side of face with eyes close
- light touch of cotton in same areas
- temperature too if needed
- corneal reflex to blink
CN VII: Facial Nerve
Facial Motor and Sensory
Motor: facial movment (expression)
- raise eyebrows
- frown
- close eyes and dont let me open
- wrinkel forehead
- bare teeth
- smile
- puff out cheeks
Sensory: anterior 2/3 of the tongue
- taste test with flavors for salty, sweet, bitter and sour
CN: VIII Vestibulocochlear Nerve
Sensory only: hearing of cochlear and vestibualr (balance)
- otoscopic exam
- whipser test
- weber (laterlzation to conduction of wax in ear!)
- rhinne (bone and air conduction)
CN IX: glossopharyngeal
Motor & Sensory
Motor: pharynx
Sensory: taste to posterior 1/3 of tongue
CN X: Vagus
Motor
- palate, pharylnx & larynx (speech!!)
Sensory
- pharynx and larynx
- gag reflex test
Test IX and X
- sensory tast of 1/2 back (IX)
- motor: gag reflex of IX
- motor: say “ah” for X
CN XI: spinal accessory nerve
motor only
traps: shrug shoulders and resist force
SCM: turn to resist hand & watch opposite SCM
CN XII: hypoglassal
Motor
- tongue movement
- test for at rest, movement, deviations and side to side & strength
