Neurologic System Flashcards
Central nervous system
1. Parts
2. Function
Composed of the brain and the spinal cord.
The main network for control of coordination of the body.
The peripheral nervous system
1. Parts
2. Function
The peripheral nervous system is composed of the cranial nerves spinal nerves. Ascending and descending pathways.
Transmit information from the peripheral nervous system to the central. And from the central to the peripheral.
The autonomic nervous system
1. Divisions and their functions
The autonomic nervous system is primarily controlled by the hypothalamus. It has effects on blood pressure, heart rate, temperature, and digestion.
The sympathetic division controls the “fight or flight” response. Stimulation results in increased awareness, heart rate, blood pressure.
The parasympathetic division controls the “rest and digest” response. Lowered vitals increased digestion.
The brain
1. Main components
2. CO
The brain is divided into three main parts
1. The cerebrum
2. The cerebellum
3. The brainstem
The brain receives roughly 20% of the hearts CO
The cerebrum
Part of the brain. Divided into lobes. Lobes control contra lateral parts of the body.
Lobes - frontal, temporal, parietal, occipital
The frontal lobe
The front most portion of the cerebrum. Involved in movement both gross and fine. The motor cortex is located here. Works with the cerebellum to control movements.
The parietal lobe
The parietal lobe is located at the top most portion of the cerebrum. The parietal lobe is responsible for sensory reception. Taste, smell, touch, hearing, temperature, pressure, pain, size, shape, etc. Recognition of body parts and body positioning.
The occipital lobe
The posterior most part of the cerebrum. Vision center. Interprets visual data.
The temporal lobe
Located over the temples. Part of the cerebrum. Over the ears. Controls hearing and location of sounds. Plays a role in processing sensations alongside the parietal lobe. The Wernicke area is located here which is the reception and interpretation of speech.
The cerebellum
1. Main function
2. Location
3. Controls
A part of the brain. Located under the occipital lobe at the back of the head.
Works together with the motor cortex in the frontal lobe to control voluntary movement. processes sensory information alongside the parietal and temporal lobes.
Ipsilateral control over the body parts
Brainstem
1. Function
2. Structures
Controls many involuntary functions.
Medulla, pons, midbrain, thalamus, diencephalon
Olfactory Nerve
Cranial nerve #1. A sensory nerve. Controls sense of smell.
Optic nerve
Cranial nerve #2. A sensory nerve. Controls visual acuity and visual fields.
Oculomotor Nerve
Cranial nerve #3. A sensory and motor nerve. Controls eyelid movement and extra ocular movements. Plays a role in pupillary constriction.
The tochlear nerve
Cranial nerve 4. A motor nerve. Controls the downward, inward eye movements.
The trigrminal nerve
Cranial nerve 5. A sensory and motor nerve. Controls facial sensation (forehead, chin, cheeks, etc.). Controls cornea sensation. Opens and closes the jaw.
The abducens nerve
Cranial nerve 6. A motor nerve. Controls lateral movement of the eyes. Often the first cranial nerve affected with brain swelling
The facial nerve
Cranial nerve 7. A motor and sensory nerve. Controls facial movements. Plays a role in in speech (labial b, m, w, rounded vowels). Anterior 2/3 of the tongue.
The acoustic nerve
Cranial nerve 8. A sensory nerve. Plays a role in hearing and equilibrium.
The glossopharyngeal nerve
Cranial nerve 9. A sensory and motor nerve. Plays a role in speech and swallowing. Controls the gag reflex. Posterior 1/3 of the tongue.
The vagus nerve
Cranial nerve 10. A sensory nerve and motor nerve. Plays a role in heart, lungs, and digestive tract.
The spinal accessory nerve
Cranial nerve 11. A motor nerve. Turns the head and shrugs the shoulders.
Hypoglossal Nerve
Cranial nerve 12. A motor nerve. Controls the movement of the tongue. Plays a role in speech.
Components of the focused neurologic exam
- Proprioception/ cerebellar function
- Cranial nerves
- Reflexes
- Sensory function
Proprioception/Cerebellar function
1. What is being assessed
2. Different examinations
Assesses the patients gross and fine motor movements.
1. Rapid rhythmic alternating movements
2. Accuracy of movements
3. Balance
4. Gait
Rapid rhythmic alternating movements
A portion of the Proprioception/Cerebellum Function exam which is a portion of the focused neurologic assessment.
Assess by having the patient pat their knees with their hands rhythmically alternating between palms and back of the hands. Increase the speed if the patient is able to maintain the activity.
A normal response is the ability to perform the activity without difficulty. Abnormal response can be seen with stiff, slowed, nonrhythmic, or jerky movements.
Accuracy of movements
A portion of the Proprioception/Cerebellum Function exam which is a portion of the focused neurologic exam.
- Finger to nose test - with the patients eyes open, ask them to move their finger between touching your finger and their nose. The provider should hold their finger out for the patient so that a full arm extension is observed. Have them repeat the process several times.
- Have the patient close their eyes and touch their nose with alternating index fingers.
- Heel-shin exam - have the patient run their heels up and down the opposite legs shin multiple times.
These exams should be done without difficulty
Balance
A portion of the Proprioception/Cerebellum Function exam which is a portion of the focused neurologic exam.
- Always assessed with the Romberg exam. Patient is asked to stand feet together, arms at their side. Perform the exam first with the eyes open and then closed. Gentle swaying is a normal response. Loss of balance or straightening arms to rebalance is abnormal. A positive Romberg test is seen with loss of balance.
- Can ask patient to stand on one foot with eyes closed.
Gait
A portion of the Proprioception/cerebellum function exam which is a portion of the focused neurologic exam.
The patient is observed walking. First with their eyes open the closed. Having them do heel-to-toe walking can exaggerate any abnormalities.
Primary sensory functions
- Superficial touch
- Superficial pain
- Temperature/ Deep pressure
- Vibration
- Proprioception
Superficial touch
A primary sensory exam part. Patients eyes are closed. Lightly touch hands, feet, arms, abdomen, legs with a cotton wisp or fingertip. Ask the patient to point where and when they are touched
Superficial pain
Part of the primary sensory exam. Performed by having the patient close their eyes. Alternate between sharp and smooth sensations in a random pattern. Ask the patient to point to the location the sensation is felt and which sensation was felt. Gradually increase pressure if there is no sensation felt.
Temperature and deep pressure
This portion of the primary sensory functions exam is only performed if there is abnormalities noted in the response to superficial pain.
Hot and cold water filled test tubes are rolled on the patients skin.
Squeeze the trapezius, calf, or biceps muscle to assess for deep pressure. These should illicit discomfort.
Vibration
This is part of the assessment of primary sensory functions.
A tuning fork is placed on various bony prominences. The patient is asked to identify when and where the buzzing sensation is felt.
Proprioception or position of joints
Part of the primary sensory function exam.
Assess the great toe of each foot and a finger on each hand. With the patients eyes closed, move the digit up or down or left or right. Tell the patient to let you know when and in what direction the digit was moved.
Stereogensis
Part of the cortical sensory function exam. With the patients eyes closed. Hand them a familiar object and have them identify it. For instance a key.
Graphesthesia
Part of the assessment of cortical sensory function exam. With the patients eyes closed, draw a familiar shape, number, or letter on the patients palm. Have them tell you what you drew.
List the superficial reflexes
- Plantar
- Abdominal
- Cremasteric
Plantar Reflex
1. How is it done? What should happen?
2. Babinski
3. Innervation
The plantar reflex is a superficial reflex.
1. This reflex is performed by stroking the lateral side of the foot in an upwards motion. Once at the ball of the foot, move medial across the ball. This should illicit plantar flexion of all toes.
2. Babinski reflex is seen when the great toe dorsiflexes in response to the exam.
3. L5, S1, S2
Abdominal reflex
1. What type of reflex.
2. How is it performed?
3. Expected outcome?
A superficial reflex.
Performed by lightly stroking the abdomen either up or down from the umbilicus. There should be a slight movement of the umbilicus toward the area being stroked.
Upper abdomen - t8 t9 t10
Lower abdomen - t10 t11 t12
Cremasteric reflex
1. Type of reflex
2. How performed and expected outcome?
- Superficial
- Of the inner thigh is stroked on a male patient, the scrotum should rise on that side.
List the deep tendon reflexes
- Biceps
- Brachioradial
- Triceps
- Patellar
- Achilles
Bicep reflex
1. How to perform?
2. Type of reflex?
3. Innervation
- Patients are is flexed 45 degrees, find the nerve in the antecubital fossa, place fingers under the elbow, strike the thumb over the fossa. The biceps should contract.
- Deep tendon reflex
- Innervated C5 and C6
Brachioradial Reflex
1. How performed
2. Type of reflex
3. Innervation
- Flex patients arm 45 degrees, rest forearm on your arm. Strike the Brachioradial tendon (1-2 inches above wrist).
- Deep tendon reflex
- Innervation - C5 and C6
Tricep reflex
1. How is it performed?
2. Type of reflex
3. Innervation
- Flex the patients arm at the elbow 90 degrees, support the arm proximal to the antecubital fossa, strike tricep tendon.
- Deep tendon reflex
- Innervation - C6, C7, C8
Patellar Reflex
1. How is it performed?
2. Type of reflex?
3. Innervation
- Flex the patient’s knee 90 degrees. Support the upper portion of the leg allowing the lower portion to hand loosely. Strike the patellar tendon (found just below the patella).
- Deep tendon reflex
- Innervated L2, L3, and L4
Achilles Reflex
1. How is it performed?
2. Type of reflex?
3. Innervation?
- Performed while the patient is sitting. Flex knee 90 degrees. Hold the foot with the ankle in a neutral position. Strike the Achilles tendon. The foot should plantar flex.
- Deep tendon reflex
- Innervated by S1 and S2
Clonus
1. Who specifically?
Can be assessed by dorsiflexing the patient’s ankle and maintaining the flexion. No rhythmic oscillating movements between dorsiflexion and plantar flexion should be felt. Patient’s with hyperreflexia should especially have this assessment.
What are the three advanced skills?
- Meningeal Signs
- Protective Sensation
- Posturing
Meningeal Signs
1. Ways to perform?
2. What are these associated with?
One of the advanced skills. A couple different ways to perform.
1. Brudzinski sign - assessment of neck stiffness. Patient lies supine. Place your hands behind the patients back of the head and neck. Flex the neck forward toward the sternum. A positive Brudzinski sign is seen when the knees and hips flex involuntarily. Even if the patient complains of pain or discomfort with this motion it can indicate nuchal rigidity.
2, Kernig sign - patient lies supine. Practitioner flex the knee and hip and then attempts to straighten the leg back out. A positive kernig sign is seen when the patient has pain in the lower back and resistance to straightening the leg.
Both of these assessments being (+) indicates the possible presence of meningeal irritation associated with meningitis or intracranial hemorrhage.
Brudzinski sign
Assessment of neck stiffness. Patient lies supine. Place your hands behind the patients back of the head and neck. Flex the neck forward toward the sternum. A positive Brudzinski sign is seen when the knees and hips flex involuntarily. Even if the patient complains of pain or discomfort with this motion it can indicate nuchal rigidity.
Kernig sign
Patient lies supine. Practitioner flex the knee and hip and then attempts to straighten the leg back out. A positive kernig sign is seen when the patient has pain in the lower back and resistance to straightening the leg.
Protective Sensation
One of the advanced skills. Should be assessed in all patients with diabetes or peripheral neuropathy. Assesses patients ability to feel pain and pressure in their feet, which is a vulnerable area for this patient population.
A microfilament is used to apply pressure on several sites of the plantar surface of the feet, testing both feet. Enough pressure should be applied that the microfilament bends. Pressure should be applied for 1.5 seconds. Inability to feel the sensation places the patient at a much greater risk for foot injury.
Posturing
One of the advanced skills. Associated with severe brain injury.
Decorticate (flexor) posturing - associated with injury to corticospinal tracts above the brainstem. Arms brought in over the chest.
Decerebrate (extensor) posturing - associated with injury to the brainstem.
Nuchal rigidity sign vs brudzinski sign
Nuchal rigidity and Brudzinski sign are performed essentially the same way. The difference is with the response.
NR - the patient complains of pain associated with neck flexion. The hips and knees do not flex.
Brud - flexion of the hips and knees
Brocas Vs Wernicke
1. Area
2. Function
3. aphasia
Brocas area is located in the frontal lobe.
Brocas area plays a role in speaking words in coordination with the motor cortex
Brocas aphasia results in trouble speaking fluently
Wernicke area is located in the temporal lobe.
Wernicke area plays a role in language comprehension
Wernicke aphasia results in difficulty understanding language.
Jolt Accentuation of Headache
This is an advanced skill used to assess the presence of meningitis. If the patient presents with headache and fever this should be done. The patient is asked to extend their legs, shake their head back and forth. If the headache increases over the baseline, this is a positive result.
Rooting Reflex
Has to do with CN 5 (trigeminal) - Touching the infant’s corner of mouth results in the infant turning toward the sensation seeking a nipple. Disappears 3-4 months of age.
Palmar Grasp
Infants head midline. Touch the infants palm from ulnar side. Infant grasps finger. Disappears 3 months.
Moro reflex
AKA startle reflex. Can be assessed by carefully decreasing the infants head from sitting to almost laying. This surprises the infant who throws up their arms and fan their fingers bilaterally. Disappears by 6 months.
Plantar Reflex
Touch the plantar surface of the infants’ feet at the base of the toes. The toes should curl downward. Disappears after 8 months.
Placing reflex
Hold the infant next to a table or step. Touch their foot to the incline. The infant will flex the hip as if going to step up.
TUG assessment
Timed get up and go test. Used to evaluate elderly patients’ ability to function on a basic mobility level. Has the patient stand from a chair w/o using the arms, walk 10 feet to a spot and back, then sit back down in the chair. Any result over 12 seconds is considered a positive exam and means the patient is at greater risk of falls.
POMA assessment
Performance Oriented Mobility Assessment
This assessment tool evaluates a patients change in gait, balance, and mobility overtime. Commonly used to assess elderly and MS patients.
Multiple Sclerosis
- Progression
- Who is most commonly affected?
A progressive autoimmune condition that results in inflammation and progressive demyelination of the of the brain’s white matter. Leads to decreased brain mass and nerve impulses.
Progression is unpredictable. Can have periods of relapses and remissions.
Women are twice as likely as men to be affected.
Subjective data for multiple sclerosis
General - Fatigue, weakness.
GU - frequency, hesitancy, urgency
Sexual dysfunction
Vertigo, numbness
Eyes - Blurred vision, diplopia, loss of vision
Objective data for MS
Muscle weakness, ataxia
Hyperactive deep tendon reflexes
Paresthesia - sensory loss
Intention tremor
