NeuroExamination

Question 1

What is a common problem with internal capsule?

Answer 1

sometimes when you do a scan, there will be no gross morphological problems, because there is usually damage into internal capsule that cuts through basal ganglia, white matter usually neurons that are heading out
= if someone comes in with motor problems, this might be the case
think: stroke

Question 2

When do you get a neurological examination?

Answer 2

Following trauma/stroke
Suspected neurodegenerative changes
Following exposure to neurotoxic agent.

Question 3

What are common components of examinations?

Answer 3

Patient history, cranial nerve function, motor function, somatosensory function, coordination, mental status

Age, Education (delays cognitive decline later in life), Handedness

past medical history
use of medication and drugs
family medical history
disease process

Question 4

How is handedness related to central brain problems?

Answer 4

Brain is lateralized. Language is strongly left hemisphere dominant
Left language is dominant for right handed people, however left handed people are only 75% left hemisphere dominant for language, and 14% are distributed evently, and 10% is right hemisphere dominated. REALLY WEIRD

language is the only thing thats really left dominant

Question 5

what is the disease process?

Answer 5

temporal profile: sudden/gradual, acute/chronic
change over time: static, improvement, worsening
identify triggers/relievers of symptoms
gauge severity of symptoms

These can be very weird, can reappear even years after

Triggers: changes in blood sugar, dehydration, blood sugar

Question 6

Write out all the cranial nerves !!

Answer 6

do it

Question 7

Describe olfactory nerve

Answer 7

I.
Sensory info coming from smell.
Often don’t notice if you have this deficit, notice difference in taste more often.

Common damage - minor knock to the head
ETHMOID RIDGE has a bone called CRIBIFORM PLATE where all axons go for olfactory system (though holes) if you get hit in the head, the bone shears the axons
common with mild injury and TBI

tested by holding one nostril and have them smell with eyes closed

Question 8

Describe the optic nerve

Answer 8

II.
Info from retina, goes through optic nerve, common issues: neoplasm/growth/tumor growing beside to place pressure on it OR damage to nerve itself. The former is more common

Tested
1) Using Snellen chart to test visual acuity in each eye
2) Visual field confrontation. Looking far away and assess reflexes ans shape of disk (not really nerve realted but we do it) FUNDOSCOPY
3) Look for center of vision, fovea, and see if its weird and swelled/goopy.
Papilledema and intracranial pressure, swelling of fundus.

Question 9

Describe the Oculomotor, Trochlear and Abducents nerves.

Answer 9

III. Oculomotor
- 4/6 controlled by this, the 6 are pulleys that move your eye.
IV. Trochlear: 1/6, smallest
VI: Abducents: 1/6

all specifically control your eye

Test:
Follow an object without moving head and restrict gaze.
Use an H formation
If they can’t look at a specific angle, one of the 6 muscules is having a problem.

Common Issues: Gaze palsy: trouble moving eyes in a certain way, distinct from nystagmus (uncontrollable darting eyes) and also distinct from damage to superiour colliculus (which is more bilateral)

Question 10

What is a common condition associated with eyelid motion?

Answer 10

other things control eyelid motion***

Ptosis (tom york effect) where one eye looks normal and the other one is droopy (pupil covered)

Question 11

what is Nystagmus?

Answer 11

eyes move on their own accord, acquired or in early life

Question 12

Describe the Trigeminal nerve.

Answer 12

V. Trigeminal
- Facial somatosensation
3 branches, recieve info from parts of the face, could have issues with any one of them. Different types of sensations tested (cotton ball and neurotip)
Important for jaw muscles to perform motor action (ask pt. to squeeze muscles and touch them to compare muscle tone)

and

Motor function: most of the movement in our face is trigeminal
- sensory, reflex, motor
(place cotton on eye and see if pt. blinks)

Question 13

Describe the Facial nerve

Answer 13

VII
Muscle tone (test w resistance)
Facial asymmetries

Issues: bells palsy: one side of the face looses muscle control, droopy half, resolves itself

Question 14

Describe the Vestibulocochlear Nerve!

Describe damage

Answer 14

VIII
Auditory perception
- vestibular info, sound info (test one ear at a time - absolute threshold and what you heard test)
Look for asymetries when eyes are closed (walk in a circle, balance will shift)

Question 15

Describe glosopharyngeal nerve

Answer 15

IX
Pharynx, speech /swallowing
taste and sensation from posterior tongue

Question 16

Describe Vagus nerve

Answer 16

swallowing, voice, gag reflex
*** 
ask about different w Ix nerve
***
Heart, in general is viscera (internal)

Question 17

Describe the accessory nerve.

Answer 17

shrugging shoulders,
head resistance

called spinal accessory (reistence tests)

Question 18

Describe hypoglossal nerve

Answer 18

Movement in abck of the tongue.

diagnostics: look for asymmetry, ask pt. to stick out tongue laterally

Question 19

What are features to examine when diagnosing nerve damage?

What is the effect of lesioning upper or lower regions?

Answer 19

Best type is resistance based
Appearance of muscle
Tone/strength of muscle

If you lesion top/upper/closer to spine: more spastic reaction, overreaction to reflexes
If you lesion lower (away from spine/periphery) you get weakening/underexaggerated reflex, or lack of reflex

Question 20

How do you test if info is coming into the body?

Answer 20

pain, light touch and proprioception

Question 21

How do you test for astereognosis and agraphesthesia?

Answer 21

Stereognosis: putting something in your hand, if you have no other info you can still move it around and determine what it is, but if you have ASTEROGNOSIS: lack of this ability. central problem in the brain

Graphethesia: integration of time and sensation, with no other sensory info you could know what someone “drew” on your hand. Agraphesthesia is loss of this ability. Central level failure rather than afferent info coming from body

Question 22

What are ways in which we test for coordination?

Answer 22

Quick alternating movements
Point - to - point movements **
Heel to shin test **
Standing/sitting
Gait: (posture can represent cerebellar damage)
ROMBERG test: close eyes, hold hands forward and see if they maintain posture (cranial nerve 8)
- in order to balance, you need 3 things, vision, vestibular input from inside muscles or within the ear, and your cerebellum to be okay. you need 2/3
how to tell if someone is driving under influence!!

Question 23

What is a MSE? How is it performed?

Answer 23

Mental status exam

• attention/orientation
• language
• memory,
• Visuospatial function
• executive functions

How to perform:
Observe alertness, spelling a word backwards, counting backwards form 20, auditory vigilance,
current whereabouts/time

Involved in focal/sub cortical regions
Origins can be diffuse (toxins)

Question 24

What are some attentional problems associated with the MSE test?

Answer 24

Contralateral Neglect: failure to see left side of the world

Agnosognosia: failure of individual to realize they have a diorder (common with contralateral neglect and after stroke )

Question 25

Examples and causes of contralateral neglect?

Answer 25

Damage to right parietal lobe (i.e. stroke?) causes inability to atend to left half of world. Problem with attentional system

1) Drawing a clock (know there are 12 numbers but draw them all on one side)
2) drawing a house
3) drawing a box
4) which house do you want to live in -when one is on fire (say that they could live in either one)
5) dress half of themselves
6) eat food on one side of the plate

Question 26

What are some language problems relating to MSE test?

Answer 26

Fluency: PROCITY: flow/rhythm of words, where punctuation is and where it lines up, where one word ends and anther begins

Praxis: asking someone to do something they should be able to perform, but they can’t if they have APRAXIA!!! fine to do it spontaneously but can’t do it on their own ** cut a sandwhich with this hammer example*

Naming
Repetition
Prosody*
Comprehension
Reading
Writing

Question 27

What are some common language disorders when it comes to MSE diagnosis?

Answer 27

1) Aphasia: problems with language production/comprehension
2) Alexia: problems with reading
3) Agraphia: problems with writing

Regions: focal or diffuse damage to left hemispherical network

Question 28

What are some common memory problems that can be observed with MSE?

Answer 28

Digit span: numbers you have to repeat back (range of about 7)
Pointing span (point to corners of the room, must repeat)
Verbal/visual object learning
Past public/personal events
Factual knowledge

Regions: medial temporal structures (hippocampus) thalamus, basal forebrain, Prefrontal cortex.

Question 29

What is the cortex around hippocampus and amygdala called?

Answer 29

Medial Temporal lobe.

**

Question 30

What are some tests for Visuospatial function?

Answer 30

Line cancellation
Copy geometric designs
Judgement of line orientation
Ojbect/face/colour recognition.

Contralateral neglect ppl will only cross out lines on one side of an image

Question 31

What is prosopagnosia, constructional apraxia and dressing apraxia? what regions do these all involve?

Answer 31

1) failure to recognize faces (lower side of ventral cortex)
2) difficulty putting object together
3) difficulty getting dressed.

all involve right hemisphere’s attention network

Question 32

How do you test for executive functions in MSE?

Answer 32

Judgement tasks
Verbal fluency
Luria 3 step (fist edge palm) 
Drawing loops with alternating patterns
Oral trail making test ( A-Z 1-25 then alternate) 

Regions: prefrontal cortex and associated projections