neuro nml Flashcards
which lobe is responsible for behavior, judgment, motor planning, and some language
frontal lobe
which lobe is responsible for sensory processing
parietal lobe
which lobe is responsible for auditory processing, memory, some language (werknicke’s area)
temporal lobe
which lobe is responsible for visual processing, visuospatial processing
occipital lobe
which lobe is responsible for relaying visual, auditory, and sensation but not motor pathways
thalamus
which structures are part of the brainstem
- midbrain
- pons
- medulla
which structure’s function is coordination of voluntary movements, balance, and equilibrium
cerebellum
where does the spinal cord end
T12-L1
injury to the spinal cord above what level is not compatible with life
above C5
diseases of the spinal cord are called
myelopathies
transmission of motor information form CNS are done via what 3 structures
- corticospinal tracts
- extrapyramidal tracts
- cerebellar tracts
transmission of sensory information to the CNS are done via
- spinothalamic tracts
- posterior columns
corticospinal tract is responsible for what type of movement
voluntary motor movement
spinothalamic tracts carry what information
light touch, pain, temperature, and pressure
posterior columns carry what information
- vibration
- proprioception
- discriminative touch
what conditions are characterized by increased tone (spasticity), “stiff man” gait, elevated reflexes, proprioceptive changes, and positive romberg sign
myelopathies
what is the principle component of the neuromuscular junction exam
checking for strength of certain muscles and for fatigability
*diseases affecting the NMJ are characterized by proximal weakness and fatigability that is improved with rest
components of peripheral neuropathy exam
- light touch
- pin prick
- vibration
- proprioception
- muscle strength
the lumbosacral plexus consists of what nerve roots
L3-S1
what are plexopathies
characterized by
- loss of reflexes
- widely distributed weakness
- multifocal numbness with or without pain
what are most plexopathies caused by
- compression
- infiltration
diseases of the nerve root are called
radiculopathies
the cervical roots C5-8 innervate what
upper extremities
which nerve roots are responsible for biceps reflexes
- C5
- C6
which nerve roots are responsible for triceps reflex
- C7
- C8
which nerve roots are responsible for patellar reflex
- L3
- L4
which nerve roots are responsible for achilles reflex
- S1
- S2
components of brief mental status examination
“JOMAC”
- Judgement
- Orientation
- Memory
- Affect
- Cognition
Optic nerve examination
- visual acuity
- visual fields: assess 4 fields of gaze (superior, inferior, lateral, medial)
- funduscopic exam
oculomotor nerve examination
- pupillary responses: direct and consensual
- eyelid elevation: ptosis
- EOMS
- CN III: inferior oblique, superior/inferior/medial rectus
- CN IV: superior oblique
- CN VI: lateral rectus
trigeminal nerve examination
- facial sensation
- 3 divisions: light touch
- corneal reflexes
- CN V: afferent limb
- CN VII: efferent limb
- muscles of mastication
- temporalis and masseter
facial nerve examination
- muscles of facial expression
- taste
Vestibulocochlear examination
- gross hearing
- weber and rinne test
- sensineural vs conductive hearing loss
glosspharyngeal and vagus nerve examination
- palate elevation: check for symmetry
- gag reflex
spinal accessory nerve examination
- sternocleidomastoid
- trapeizius
hypoglossal nerve examination
- assess for tongue in midline
- tongue movement side to side
pronator drift: function and technique
- detect a subtle contralateral upper motor neuron lesion (weakness secondary to CVA)
- stand with arms extended outward and palms up for 20-30 seconds with eyes closed
- watch for pronation of arm and drift downward
Romberg test: function
- tests position sense (dorsal column and in some measure sensation in the feet)
Romberg test: technique
- pt stands with feet together with eyes open and then closed for 20-30 seconds
- loss of balance = positive test
**check Romberg before gait testing to avoid a fall
what dermatome contains the thumb
C6
what dermatome contains the middle fingers
C7
what dermatome contains the fifth digit
C8
what dermatome contains the nipple line
T4
what dermatome contains the umbilicus
T10
what dermatome contains the anterior thigh
L3
what dermatome contains the anterior shin
L4
what dermatome contains the top of foot
L5
what dermatome contains the bottom of foot
S1
technique for vibration, primary sensory testing
- place tuning fork on bony prominence and as what is felt and when it stops
technique for proprioception, primary sensory testing
- hold sides of digit
- assess by moving thumb up and down and ask direction
- repeat with great toe
technique for two point discrimination, cortical sensory
- move two pins closer together until patient can only appreciate one point
- normals
- fingertips: 2 mm
- toes: 3-8 mm
- palms: 8-12 mm
- back: 40-60 mm
technique for graphesthesia, cortical sensory
- draw a number (0-9 oriented to patient) on palm and dorsum of foot, ask patient to identify
technique for stereognosis, cortical sensory
- ask patient to identify common object placed in hand
technique for tactile localization (extinction or “double simultaneous stimulation”), cortical sensory
- simultaneously touch two seperate sites on opposite sides of the body and ask what was felt
“reflex dance”
- 1,2 ..achilles reflex (S1, S2)
- 3, 4 … patellar reflex (L3, 4)
- 5, 6.. biceps reflex (C5, 6)
- 7, 8… triceps reflex (C7, 8)
scale used to rate reflex responses
-
0-4
- 0: no response
- +1: dimininished
- +2: normal
- +3: increased
- +4: hyperactive, associated with clonus
clonus
- consistent with upper motor neuron disease
- rhythmic oscillations between plantar and dorsiflexion
what is the biceps reflex
- tap biceps tendon to elicit forearm flexion
brachioradialis relfex exam
- C5,6
1. tap tendon/radius about 1-2 inches above the wrist to elicit forearm flexion and supination
triceps reflex exam
- C7-C8
1. tap triceps tendon to elicit forearm extension
patellar reflex exam
- L3-L4
1. tap patellar tendon to elicit knee extension
achilles reflex exam
- S1-S2
1. tap achilles to elicit plantar flexion
babinski reflex
- stroke the lateral aspect of the plantar aspect of the foot upwards then across the ball of the foot
* abnormal response: dorsiflexion of the great toe and fanning of the other toes
cerebellar examination: finger to nose
- alternately touch examiner’s finger, then thier own nose
**best for picking up dysmetria
- plan b: arms at sides, alternately touch nose with one finger
cerebellar examination: heel to shin
- lying down
- slide heel of one foot down shin of other leg slowly and smoothly
- repeat one more time
- switch legs
cerebellar examination: rapid alternating movements
- look for speed and coordination while assessing
- rapid pronation and supination of forearms
- touching fingertips to thumb
- tapping the feet
what is dysdiadochokinesia
inability to do rapid alternating movements
- slow, but regular: cerebral dysfunction
- fast but irregular: cerebellar dysfunction
cerebellar examination: gait
- heel walk: also checks L5
- toe walk: also checks S1
- heel-to-toe (slight swaying is normal)
kernig’s sign: function and technique
- assess meningeal irritation
- patient supine
- flex hip and knee
- then attempt to straighten the leg
- +LBP: positive sign
Brudzinski’s sign: function and technique
- patient supine
- place hands behind patient’s neck and attempt to flex the neck toward the chest
- involuntary flexion of hips and knees is (+) sign suggesting meningeal irritation
what neurological tests do you do when the patient is standing
- Romberg
- gait
- stand on one foot and hop; switch
- finger to nose
- RAMs
what neurological tests do you do when the patient is sitting
- ophthalmic exam
- cranial nerve exam
- DTR of UE
- Motor exam of UE and LE
- DTR of LE
- vibration at ankles
- graphesthesia
- temperature (warm/cold)
