Neurologic system Flashcards
What does the peripheral nervous system include?
12 pairs of cranial nerves
31 pairs of spinal nerves
What does the central nervous system include?
Brain and spinal cord
Cerebral cortex
Outer layer of nerve cells
Thought, memory, reasoning, sensation, voluntary movement
Frontal lobe
Personality, behaviors, emotions, intellectual function
Precentral gyrus
Of the frontal lobe initiates voluntary movement
Parietal lobe
Post central gyrus located in the parietal lobe is the primary center for SENSATION
Occipital lobe
Visual receptor center
Temporal lobe
Auditory reception center w/functions of hearing, taste and smell
Wernickes area
In temporal lobe
Language comprehension
Receptive aphasia
Receptive aphasia
Damage to the wernickes area
Broca’s area
Frontal lobe
Motor speech
Expressive aphasia
Expressive aphasia
Can’t talk but understand what is being said
Damage to Broca’s area
When does damage occur
Neurological cells deprived of blood
Cerebral artery becomes occluded or when cerebral artery becomes occluded
Dermatome
A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve
C6 dermatome
Thumb
C7 dermatome
Middle finger
C8 dermatome
Fifth finger
T1 dermatome
Axilla
T4 dermatome
Nipple
T10
Umbilicus
L1
Groin
L4
Knee
Syncope
A sudden loss of strength, a temporary loss of consciousness (a faint) due to lack of cerebral blood flow
Vertigo
Rotational spinning
Aura
A subjective sensation that precedes a seizure, could be auditory, visual or motor
Paresis
Partial or incomplete paralysis
Dysmetria
The inability to control the distance, power and speed of a muscular action
Parenthesia
An abnormal sensation (burning, tingling)
Dysarthria
Difficulty forming words
Stroke risk factors
Increased blood lipids
Family history
Medications for high blood pressure
Blood thinners
Who is more prevalent for strokes (culture)
American Indians/native Alaskans followed by African Americans
Stroke belt
Southeast us
High percentage of people with hypertension
Heatstroke
Hyperthermia (too hot) extremely high fevers, summer
If you have ….. You’re more prone to stroke
Diabetes, heart disease (plaques)
CN I
Olfactory
Sensory
Origin: Nasal chamber
Smell
CN II
Optic
Sensory
Origin: retina
Vision
CN III
Oculomotor
Motor
Origin: midbrain
All ocular muscles except lateral rectus and superior oblique
Parasympathetic— Pupil constriction
CN IV
Trochlear
Motor
Origin: Midbrain
Down and in eye motion
CN V
Trigeminal
Mixed
Origin: Pons and midbrain
Motor– Muscles of mastication
Sensory– sensation of face, scalp, cornea, mucous membranes of mouth and nose
CN VI
Abducens
Motor
Origin: pons
Lateral (abduction) of eye
CN VII
Facial
Mixed
Origin: pons
Motor— facial muscles, close eyes, labial speech
Sensory— taste (sweet, salty, sour, bitter) on anterior 2/3 of tongue
Parasympathetic— saliva and tear secretion
CN VIII
Acoustic
Sensory
Origin: pons
Hearing and equilibrium
CN IX
Glossopharyngeal
Mixed
Origin: medulla
Motor— pharynx (phonation and swallowing)
Sensory— taste on posterior one-third on tongue, gag reflex , ear pain
Parasympathetic— parotid gland, carotid reflex
CN X
Vagus
Mixed
Motor— pharynx and larynx (talking and swallowing)
Sensory— General sensation from carotid body, carotid sinus, pharynx, viscera , hunger
Parasympathetic— carotid reflex, peristalsis, digestive juices, breathing, heart rate
CN XI
Spinal accessory
Motor
Origin: medulla and cord
Movement of trapezius and sternomastoid muscles
Neck and shoulder girdle motion
CN XII
Hypoglossal
Motor
Origin: medulla
Speech, eating (movement of tongue)
Autonomic
Part of the Peripheral nervous system
Smooth muscles, cardiac muscles, glands
Involuntary
Somatic
Part of the peripheral nervous system
Somatic fibers innervate the skeletal ( voluntary) muscle
Testing CN I (olfactory nerve)
Assess Patency (occlusive nostril and sniff)
Use aromatic substance… Ask to Identify odor
Testing CN II (optic nerve)
Cardinal fields of gaze
Examine ocular funds with ophthalmoscope
Papillae dens with increased intracranial pressure; optic atrophy
Testing CN III, IV, VI
Oculomotor, trochlear, abducens
Ptosis -CN III
Strabismus, nystagmus
Pupil size, regularity, equality, direct and consensual light reaction and accommodation
Testing CN V (trigeminal nerve)
MOTOR
Muscles of mastication by palpating TMJ
Clench, open and close mouth
SENSORY - light touching of face with cotton wisp, corneal reflex (CN V and VII)
Testing CN VII( facial nerve)
Motor—Smile show teeth, close eyes against nurses attempt to open them
Sensory— test only when suspect facial nerve injury, taste (applicator with different tasting solutions)
Testing CN VIII (vestibulocochlear nerve)
Whispered voice test
Testing CN IX and X (glossipharyngeal and vagus nerve)
Motor— depress tongue and say ahhhh (should see midline rise in tongue and uvula) , gag reflex
Sensory — test too difficult
Testing CN XI (spinal accessory nerve)
Press cheek on nurses hands, press up with shoulders on nurses hands
Testing CN XII (hypoglossal nerve)
Inspect tongue (should see no tremors) speech is clear and distinct ( sounds of letters l,t,d,n)
Flaccidity
Decreases resistance, hypotonia occur with peripheral weakness
Testing cerebellar function
Balance tests, gait, Romberg test (eyes close feet together), rapid alternating movements (RAM) , finger to finger test , finger to nose test, heel to shin test
When is a Romberg test positive? What causes this?
Loss of balance that occurs when closing eyes
Sensory loss
Occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication)
Testing the spinothalamic tract
Pain (sharp/dull) , temperature (tuning fork-metal feels cool, warmth of nurses hand) , light touch (cotton wisp)
Hypoesthesia
Decreased touch sensation
Anesthesia
Absent touch sensation
Hyperesthesia
Increased touch sensation
Clonus
A set of rapid, rhythmic contractions of the same muscle
Biceps reflex
C5 and C6
Spasticity
Increased tone, hypertonic, increased resistance to passive lengthening
Upper motor neuron injury
(Paralysis with stroke develops spasticity days or weeks after incident)
Rigidity
Constant state of resistance (dystonia— resists passive movement in any direction)
Damage to basal ganglia with Parkinsonism
Cogwheel rigidity
Type of rigidity in which the increased tone is released by degrees during passive range of motion so it feels like small, regular jerks
Parkinsonism
Hemiplegia
Spastic or flaccid paralysis of one side (right or left) of body and extremities
Paraplegia
Symmetric paralysis of both lower extremities
Quadriplegia
Paralysis in all four extremities
Paresis
Weakness of muscles rather than paralysis
Fasciculation
Rapid continuous twitching Id resting muscle or part of muse without movement of king that can be seen by clinicians or felt by patient
Fine- lower motor neuron disease
Coarse- cold exposure or fatigue and is not significant
Myoclonus
Rapid sudden jerk
A hiccup Id a myoclonus of diaphragm
Single arm or limb is normal when falling asleep
Severe with grand mal siezures
Rest tremor
Occurs when muscles are quiet and supported against gravity (hand in lap)
Parkinson’s- thumb and opposing fingers
Intention tremor
Older people
Voluntary movement as in reaching toward a visually guided targets
Chorea
Sudden, rapid, jerky purposeless movements involving limbs trunk or face
Athetosis
Slow twisting movement resembling a snake or worm
Cerebral palsy
Disappears with sleep
Peripheral neuropathy
Loss of sensation most severe distally
Diabetes, chronic alcoholism, nutritional deficiency
Individual nerves or roots (sensory loss)
Decrease or lass of all sensory modalities. Area of sensory loss corresponds to distribution of the involved nerve
Trauma, vascular occlusion
Spinal cord hemisection (brown-sequard syndrome)
Loss of pain and temperature, vibration
Meningioma, neurofibromas, cervical spondylosis, multiple sclerosis
Complete transaction of the spinal cord
Complete loss of all sensory modalities below level of lesion. Condition is associated with motor paralysis and loss of sphincter control
Spinal cord trauma
Demyelinating disorders
Tumor
Thalamus (patters of sensory loss)
Loss of all sensory modalities on the face, arm, and leg in the side contralateral to the leis on (in brain)
Vascular occlusion
Cortex (sensory loss)
Loss of descrimination
Cerebral cortex, parietal lobe lesion (ex: CVA, stroke)
Decorticate rigidity
Upper extremeties— flex ion of arm, wrist, and fingers;
Addiction of arm (tight against thorax)
Lower extremeties— extension, internal rotation, plantar flex ion,
Indicated hemispheric lesion of cerebral cortex
Decerebrate rigidity
Upper extremities stiffly extended, addicted, internal rotation, palms pronated
Lower extremities stiffly extended, plantar flex ion, teeth clenched, hyperextended back
Indicated lesion in brainstem at midbrain or upper pons
Flaccid quadriplegia
Complete loss of muscle tone and paralysis of all four extremities
Indicated completely nonfunctional brainstem
Opisthotonos
Prolonged arching of the back with head and heels bent backward
Indicated meningeal irritation
Brudzinski (pathological reflexes)
Method of testing: with one hand under the neck and the other hand on the persons chest, sharply flex chin on chest and watch hips and knees
Abnormal response (reflex is present)— resistance and pain in neck, with flexion of hips and knees
Indicates meningeal irritation (meningitis)
Grasp (frontal release signs)
Method of testing — touch Palm with your finger
Abnormal reaponse (reflex is present)— uncontrolled, forced grasping (grasp is usually last of these signs to appear, so it’s presence indicates severe disease)
Indicates there is an unilateral frontal lobe lesion on contralateral side; when bilateral, diffuse bifrontal lobe disease
