Neurologic System Flashcards
The PNS carries what to the CNS from sensory receptors?
Carries what from the CNS out to muscles and glands, and autonomic messages that govern the internal organs and blood vessels?
Sensory/afferent
Motor/efferent
What makes up the PNS?
What makes up the CNS?
12 pairs of cranial nerves, 31 pairs of spinal nerves.
Brain, spinal cord
Areas connected with personality, behavior, emotions, and intellectual function. Its precentral gyrus initiates voluntary movement.
Frontal lobe
This lobe’s postcentral gyrus is the primary center for sensation.
Parietal lobe
The primary visual receptor center.
Occipital lobe
Lobe behind the ear that has the primary auditory reception center, with functions of hearing, taste, and smell.
Temporal lobe
Area in the temporal lobe that is associated with language comprehension. What results when damaged in the dominant hemisphere?
Wernicke’s area. Receptive aphasia results, the person hears sound but it has no meaning, like hearing a foreign language.
Area in the frontal lobe that mediates motor speech. When injured in the dominant hemisphere, what occurs?
Broca’s area. Expressive aphasia results, the person cannot talk. They can understand language and knows what they want to say but can only produce garbled sound.
Large bands of gray matter located deep within the two hemispheres that form the subcortical-assoaicted nervous system (the extrapyramidal system)
Basal ganglia.
Helps to initiate and coordinate movement and control automatic associated movements of the body.
The main relay station where the sensory pathways of the spinal cord, cerebellum, basal ganglia, and brainstem form synapses on their way to the cerebral cortex.
Thalamus. Integrating center with connections that are crucial to human emotion and creativity.
Major respiratory center with basic vital functions: appetite, sex drive, HR, BP, sleep, anterior and posterior pituitary gland regulator, and coordinator of ANS activity and stress response.
Hypothalamus
Concerned with motor coordination of voluntary moments, equilibrium, muscle tone, “auto pilot”.
Cerebellum
It does not initiate movement but coordinates and smooths it.
Central core of the brain consisting mostly of nerve fibers. Which cranial nerves originate from nuclei in here?
Brainstem. Nerves III through XII.
The most anterior part of the brainstem that merges into the thalamus and hypothalamus. Contains many motor neurons and tracts.
Midbrain
The enlarged area of the brainstem that containing ascending sensory and descending motor tracts.
Pons
Has two respiratory centers (Pneumotaxic and apneustic) that coordinate with the main respiratory center in the medulla.
The continuation of the spinal cord in the brain that contains all ascending and descending fiber tracts. It has vital ANS centers (respiration, heart, GI function) and nuclei for cranial nerves what?
Medulla
Nerves VIII through XII
Pyramidal decussation occurs here
Ascending and descending fiber tracts that connect the brain to the spinal nerves. Mediates reflexes of postural control, urination, and pain response. Where does it occupy?
Spinal cord. Occupies upper two thirds of vertebral canal form the medulla to the lumbar vertebrae L1-L2.
Visceral and involuntary PNS? Parasympathetic vs sympathetic?
Autonomic.
Para is rest and digest. Sympathetic is fight or flight.
Voluntary muscle movement of the PNS?
Somatic
Left cerebral cortex receives sensory information from and controls motor function to right side of body and vice versa.
Crossed representation of nerve tracts
Contains sensory fibers that transmit sensations of pain and temp (ascend the lateral), and crude or light touch (form anterior)
Spinothalamic tract.
Fibers enter the dorsal root of spinal cord and synapse with a second sensory neuron. At thalamus, fibers synapse with this sensory neuron, carrying message to sensory cortex for full interpretation.
These fibers conduct sensations of position, vibration, and finely localized touch.
Posterior/dorsal columns
An area of skin that is supplied by a single nerve. Corresponds with spinal cord. Anterior and posterior.
Dermatomes.
Can determine nerve related pathologies. C1 has no dermatome.
Basic, involuntary defense mechanism of the nervous system. Help the body maintain balance and appropriate muscle tone. Four types?
Reflexes.
Deep tendon, superficial, visceral, pathologic.
Neuro system for infants?
System is not completely developed at birth. Movements primarily directed by primitive reflexes.
As myelination develops, motor response develops, reflexes diminish. Persistence of primitive reflexes is an indication of CNS dysfunction.
Newborn reflexes?
Tonic neck, stop, grasp, crawl, suckling, plantar, startle
What neurological changes occur in the aging adult?
Atrophy with steady loss of neuron structure in the brain and spinal cord. Loss of muscle bulk/tone, decreased muscle strength, impaired fine coordination and agility, dizziness and loss of balance, walk more slowly and deliberately, diminished touch, smell, taste
Subjective data for the nervous system?
Headache, head injury, dizziness/vertigo, seizures, rumors, weakness, incoordination, numbness, tingling, difficulty swallowing or speaking, history, environmental/occupational hazards.
What to ask about infants during a neuro assessment?
Mother had any health problems during pregnancy, infant premature or full term, birth trauma to the infant
When to do a screening vs complete examination?
Neurologic recheck?
Screening for well persons with no significant findings from history.
Complete on persons with neurological concerns.
Recheck for those with neurologic deficits who require periodic assessments
Sequence for complete neurologic examination?
Mental status, cranial nerves, motor system, sensory system, reflexes
Involuntary eye movement that can be congenital, idiopathic, or secondary to a preexisting neurologic condition.
Nystagmus.
Causes are drugs, alcohol, roller coasters, Down’s syndrome, optic nerve disease. Severe is almost always consistent with disease of the cerebellum or brainstem.
A sudden loss of strength, a temporary loss of consciousness (a faint) caused by lack of cerebral blood flow, low BP
Syncope
A partial or incomplete paralysis.
A loss of motor function caused by a lesion in the neurologic or muscular system or loss of sensory innervation.
Paresis
Paralysis
The inability to control the distance, power, and speed of a muscular action.
An abnormal sensation like burning or tingling.
Dysmetria
Paresthesia
Why are teens more susceptible to concussion?
Thinner cranial bones, larger head-to-bdoy ratio, immature CNS, larger subarachnoid space in which the brain can rattle.
What to assess for children?
Seizures, motor or developmental milestones, environmental exposure to lead, reflexes/gait/balance issues, family history
What to assess for motor as far as muscles?
Size, strength, one, involuntary movements
What to assess for motor as far as cerebellar function?
Balance tests, gait, tandem walking, Romberg’s test, shallow knee bend
What to assess for motor as fares coordination and skilled movements?
Rapid alternating movements, finger-to-finger test, finger-to-nose test, heel-to-shin test
What does a screening neurologic examination consist of?
Mental status, cranial nerves, motor function, sensation, reflexes
When is CN I, olfactory, tested?
Those who report loss of smell, head trauma, and those with abnormal mental status and when the presence of an intracranial lesion is suspected
Romberg’s sign?
Observe balance as patient stands with eyes open, feet together, arms at sides. Ask patient to close eyes.
Positive sign is loss of balance that occurs when closing the eyes.
Sensory assessment spinothalamic tract? Posterior column tract?
Pain, temp, light touch
Vibration, position, tactile discrimination: sterognosis, graphesthesia, extinction and unilateral extinction, point location
Testing the stretch or deep tendon reflexes?
Technique, grading, reinforcement, biceps, triceps, brachioradialis, quadriceps, achilles
Testing the superficial reflexes?
Abdominal, cremasteric, plantar
4-pont reflex response scale?
4: very brisk, hyperactive with clonus (twitching), indicative of disease
3: brisker than average, may indicate disease
2: average, expected finding
1: diminished, low normal, or occurs with reinforcement
0: no response
Ability to perceive passive movements of the extremities.
Ability to recognize objects by feeling their forms, sizes, and weights.
Ability to read a number by having it traced on the skin
Kinesthesia
Stereognsis
Graphesthesia
What’s involved in a neurologic recheck?
LOC, motor function, vitals, pupillary response, Glasgow coma scale
What do stretch reflex and deep tendon reflexes (DTRs) test for?
Reveals the intactness of the reflex arc at specific spinal levels and the normal override on the reflex of the higher cortical levels
Decrease or loss of smell that occurs bilaterally with tobacco smoking, allergic rhinitis, and coke use.
Loss of smell in the absence of nasal disease.
Anosmia
Neurogenic anosmia
Decreased resistance, hypotonia of muscles that occurs with peripheral weakness.
Types of increased resistance that occurs with central weakness.
Flaccidity
Spasticity and rigidity
Hypoalgesia
Analgesia
Hyperalgesia
Decreased pain sensation
None
Increased
Hypoesthesia
Anesthesia
Hyperesthesia
Decreased touch sensation
None
Increased
Peripheral neuropathy is? As opposed to?
It’s worse at the feet and gradually improves as you move up the leg. As opposed to a specific nerve lesion, which has a clear zone of deficit for its dermatome.
A good measure of sensory loss if the person cannot make the hand movements needed for what?
Graphesthesia is a good measure
Stereognosis
Can occur with arthritis
Seen when the monosynaptic reflex arc is released from the usually inhibiting influence of higher cortical levels.
Hyperreflexia
Occurs with the interruption of sensory afferents or destruction of motor efferents and anterior horn cells
Hyporeflexia
