Neuro Std Exam Liza Flashcards
sensory processing is which lobe
Parietal lobe
which lobe is behavior, judgmnt, mood, motor cortex, Broca’s motor language
Frontal love
Auditory processing, memory, Wernicke’s lang comprehension, hearing, taste, smell
Temporal lobe
Vision, visuospacial
Occipital lobe (back)
Relays visual, auditory, sensation but NOT motor pathways
Thalamus
precentral gyrus is
Motor
postcentral gyrus is
sensory area
What is included in examination
cognition language vision sensory processing movements and tone gait
automated movements are
Basal ganglia
Primary sensory relay
Thalamus
Brainstem consists of
Midbrain, pons, medulla
Cranial nerves, sleep wake centers, breathing, descending motor tracts, ascending sensory tacks are contained in
Brainstem
Coordination, balance/equilibrium and smoothness movement is
Cerebellum: sends track to midbrain from spinal cord and pons
Brainstem exam is made of
assess cranial nerves, gait and cerebellar fx (coordination and smoothness of movement)
Where is cardio-respiratory center located in the brain?
Brainstem
Where are cranial nerve nuclei are located
Brainstem
Where are ascending and descending tracts located
brainstem
Spinal cord starts at C1 and ends at
T12-L1
Injury above which vertebra is not compatible with life?
above C5
meylopathy definition
disease of spinal cord
Which tracts transmit sensory info to the CNS/brain?
- Spinothalamic tract (spinal cord to thalamus)
- posterior columns
transmission of motor into from CNS/brain is throug
Conticospinal tracts
extrapyramidal tracts
Cerebellar tracts
Which tract carries voluntary motor movement?
Corticospinal tract
Where does UMN (Upper Motor Neuron) cross to contralateral side?
at medulla, UMN dessicates and goes to contralateral side (sx manifests on opposite side)
Where does UMN (upper motor neuron) originate?
In Pre-Central gyrus (responsible for motor cortex)
If have a lesion in precentral gyrus on left side, it will manifest itself on opposite side
did I get this right?
??????????? So conticospinal tract dessicates at medulla and fibers cross to contra-lateral side but continue to descend IPSILATERALLY (to sypanse with anterior horn)
??????????? ask if that’s correct and if lesion is on the left side above medulla, how will it manifest in real person?
tract that carries light touch, pain, temp, pressure is
** spinothalamic tract**
tract that carries vibration, proprioception and discriminative touch is
Posterior Columns
!!! what is characterised by increased tone (spascity), “stiff man” gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels?
Myeolopathies
Due to dessication at medulla
have sensory deficit on one side and motor on the other
Meylopathies are characterized by
!!! increased tone (spascity), “stiff man” gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels!!!!
Spinal Cord/Meylopathy exam includes
gain, Romberg, reflexes and tone
Optic nerve is
CNII
Hypoglossal nerve is and responsible for
CN XII: tongue movement
Trochlear
CNIV: eye movement of SO Superior Oblique
Facial
CNVII: facial motor and some taste
Glossopharyngeal
CN IX: soft palate
Spinal Accessory
CN XI: motor to trapezius
Trigeminal
CNV: sensation and taste
Abducens
CNVI: eye movement LR (lateral rectus)
Acoustic/Vestibulocochlear
CNVIII: hearing and balance
Vagus
CNX: soft palate, voice, swallowing
Oculomotor
CNIII: eye movement of IO, SR, IR, MR
Olfactory
CNI: smell
Optic
CNII: vision
Myopathy
disease of muscle
What has proximal distribution (what is that?)
muscle disease
like in muscular dystrophy
What are the elements of the muscle/motor exam:
bulk, strength, tone
Proximal weakness and fatigability that is improved with rest is a characteristic of what disease?
dz affecting Neuro Muscular Junctions (NMJ)
Whats in NMJ exam?
* check strength of certain muscles and for fatigability (e.g., ptosis)*
peripheral neuropathy
dz affecting peripheral nerves
Peripheral neuropathy/Nerve exam:
* light touch, pin prick, vibration, proprioception and muscle strength*
Most important nerves in upper extremety
median, ulnar, radial, musculocutaneous, axiallary
Most impt nerves in lower extremity
femoral, obturator, sciatic, tibial and peroneal
Brachial plexus is at
C5-C8
congregation of roots exiting at above
lumbarsacreal plexus
congregation of L3-S1 roots
in pelvis
What are plexopathies characterized by
*** loss of reflexes, widely distributed weakness and multifocal numbness with or without pain
what is the cause of most plexopathies?
* compression or infiltration*
Plexopathy exam
** strength, motor, reflexes **
radiculopathy is
dz of the root
most rediculopathies are cause by
** complression or other mechanical causes **
** which cervical root innervate upper extremities? **
** C5-C8 **
injury can cause pain, focal weakness, loss of reflexes, motor issues
** which lumbarsacrial roots innervate lower extremeties? **
L3-S1
31 pairs of spinal nerves
cervical 8, thoracic 12 lumbar 5 sacral 5 coccygeal 1
what is frequently mistaken for neuropathy and how to distinguish?
radiculopathies (by careful exam)
Root/radiculopathy exam
strength, sensation, reflexes
lumbar radicular pain/ sciatica
look at slide!! memorize!
Mental Status exam
** behavior, oriented to person/place/time, level of consciousness **
-begins when you first meet the person
-formal MSE only when deficit:
score <24 is dementia
establish baseline and monitor progress
Brief Mental Status Exam
JOMAC Judgement Orientation Memory Affect Cognition
Levels of consciousness
Alert, lethargic, stuporous, comatouse
-responsive or not
Mental status exam of memory
Recent: check recall of 3 words after one minute
remote: ask about well known events, dates locations (name of president, capital of france)
CN exam Optic CN II
visual acuity (eye chart) visual fields (H) funduscopic exam (direct exam of CNII)
Exam of CNIII
Extra Ocular Movements: IO, SR, IR, MR
direct and consensual pupillary responses
Eyelid elevation: ptosis
EOMS: H for CN4 and 6: check for conjugate gaze and nystagmus
Trigeminal CN V (three)
1) Facial sensation/light touch (check frontal, maxillary, mandibular areas)
2) Corneal reflexes (cotton to cornea):
CNV - afferent (sensation TO brain)
CNVII - efferent (motor from brain)
3) Muscles of mastication:
Temporalis and masseter
Facial Nerve exam (CN VII)
- m of facial expression (raise eyebrows, frown?? smile, puff out cheeks, close eyes against resistance):
Central v peripheral VII lesion (what about it??) - Taste
- efferent corneal reflex (motor from brain)
Acoustic N exam (CNVIII vestivulocochlear)
- hearing: whisper/rub fingers
- Weber and rinne testing (test sensorineural v conductive hearing loss)
Glossopharyngeal exam CN IX (with Vagus X)
- say ah, palate elevation - check for symmetry (vagus)
- gag reflex
- swallowing ?
spinal accessory nerve (CNXI) exam
shrug your shoulders against resistance (and move head right to left?):
eval SternoCleidoMastoid and trapezius
Hypoglossal CN XII exam
Stick your tongue out and move side to side
?????? do we need to know all spinal root nerves for upper and lower extremities exams ??????
???? ask prof ?????
1) Pronator Drift tests
2) Romberg tests
1) Pronator - tests upper extremety motor fx
2) Romberg - test dorsal column fx and in some measures sensation in feet
Pronator drift test
- arms extended out/forward and palms up (supinated) for 20-30 secs with eyes CLOSED: watch for pronation of arm and drift down
- used to detect subtle contralateral upper motor neuron lesions (weakness due to CVA)
Robberg test
stand with feet together with eyes open and then closed for 20-30 sec.:
- tests position sense (dorsal column and some sens in feet)
- stand close in case they fall
- loss of balance = (+)
- ** check Romberg BEFORE GAIT to avoid fall **
Sensory exam
- is done in RANDOM fashion on pts without specific sensory complaints
- all tests done with eyes closed
- check sharp vs dull, keep dermatomes in mind
Thumb, middle fingers, 5th digit
- Thumb C6
mid fingers C7
5th digit C8
Anterior thigh, anterior shin, top of foot, bottom of foot
Ant thigh - L3
Ant shin - L4
top of foot - L5
bottom of foot - S1
Nipple line
T4
Umbilicus
T10
Proprioreceptor exam
- move pt’s thumb/toe up and down, ask which direction, eyes closed
- make sure to hold SIDE of digit
Corticosensory exam
2 pnt exam, hold like chopstick
Stereognosis
ask to id common object places in hand: key, coin
cortical sensory
Graphesthesia
draw a number (0-9) on palm facing pt (eyes closed) and dorsum of foot
(cortical sensory specialized)
Tactile localization
aka “extinction” or “double simultaneous stimulation”
- sim. touch 2 separate sites on Opposite sides and ask what is felt
1, 2 (S 1, 2)
Achilles reflex
3, 4 (L!!! 3, 4)
Patellar reflex
5, 6 ( C5, 6)
Biceps reflex
7,8 (C7, 8)
Triceps reflex
Clonus
seen with hyperactive reflexes, with UMN dz
- rhythmic oscillations between plantar and dorsiflexion
- 4+ on reflex scale
Brachioradialis
C5-C6 (like bicept) but tap lower arm: 1-2 inches above WRIST!!! (although the muscle is in upper arm)
reflex scale
0 no response 1+ diminished 2+ normal 3+ increased 4+ hyperactive, with CLONUS
Jendrassik’s maneuver
reinforcement technique if difficulty getting reflexes:
UE - grit teeth
LE - isometric exercise
Babinski reflex
stroke lateral part of plantar foot upwards and then across the ball of the foot:
abnormal : dorsiflexion of great toe and fanning of other toes
(normal in babies)
Cerebellar exam
- test coordination of movement, balance and equilibrium
- finger to nose
** Heel to Shin **
- cerebellar exam (bilateral)
- slide heel of one foot down shin of other leg SLOWLY AND SMOOTHLY; repeat; then switch legs
Rapid Alternating Movements (RAMs)
- rapid pronation supination of forearms
- touch fingertips to thumb
- tap feet
Dysdiadochokinesia
inability to do RAMs
if slow but regular RAMs, which part of brain is impaired?
Cerebral dysfx
if fast but irregular
cerebellar dysfx
Heel walk gait
L5 integrity
Cerebellar test
Heel-to-toe (tandem gain)
avoid if (+) Romberg
Toe walk
S1 integrity
** Kernig’s sign **
pt supine, flex hip and knee, then straighten the leg:
LPB (low back pain)= (+) Kernig’s
** Brudzinski’s Sign **
pt supine, place your hands behidn the pt’s neck and flex neck toward chest:
involuntary flexion of hips and knees = (+) meningitis irritation
10 minutes neuro exam
Must know?? check last few slides
Stiff man gait is a sign of
Myelopathy
Also increased tone and reflexes
