Neurological Flashcards
Mnemonic for Cranial Nerve Names
On Old Olympus Towering Tops a Finn and German Viewed Some Hops
CN I
Olfactory
Test ability to identify familiar aromatic odors, one naris at a time
CN II
Optic
Test distant and near vision
Perform opthalmoscopic examination of fundi
CN III
Oculomotor
CN IV
Trochlear
CN VI
Abducens
CN V
Trigeminal
Inspect face for muscle atrophy and tremors
Palpate jaw muscles for tone and strength when clenches teeth
Test superficial pain and touch sesnation in each branch
Test corneal reflex
CN VII
Facial
Inspect symmetry of facial features with various expressions (eg. smile, frown, puffed cheeks, wrinkled forehead)
Test ability to identify sweet/salty tastes on each side of tongue
CN VIII
Acoustic
Hearing with whisper screening or audiometry
Compare bone and air conduction
Test for lateralization of sound
CN IX
Glossopharyngeal
CN X
Vagus
CN III, IV, VI
Occulomotor, Trochlear, Abducens
Test visual fields by confrontation and extinction of vision
Inspect eyelids for drooping
inspect pupils’ size for equality and their direct and consensual response to light and accommodation
Test extraocular eye movements
CN IX, CN X
Test ability to identify sour and bitter tastes on each side of tongue
Test gag reflex and ability to swallow
Inspect palate and uvula for symmetry with speech sounds and gag reflex
Observe for swallowing difficulty
Evaluate quality of guttural speech sounds (nasal, hoarse)
CN XI
Spinal accessory
Test trapezius muscle strength (shrug shoulders against resistance)
Test sternocleidomastoid muscle strength (turn head to each side against resistance)
CN XII
Hypoglossal
Inspect tongue in mouth and while protruded for symmetry, tremors, atrophy
Inspect tongue movement toward nose and chin
Test tongue strength with index finger when tongue is pressed against cheeck
Evaluate quality of lingual speech sounds (l, t, d, n)
Claasification of each CN by function
Sensory (S) Motor (M) Both (B)
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Distinguish between upper and lower neuron disease
Observe patient’s face when crying or laughing
Upper motor neurons (CVA, brain attack) = voluntary movements are paralyzed, but emotional movements spared
Lower motor neurons (Bell’s palsy) = all facial movements on affected side are paralyzed
Enhanced physiologic tremor
Seen with arms held extended, disappears at rest
Drug, alcohol withdrawal
Hyperthyroidism, hypoglycemia
Toxicity associated with medications (lithium, methylxanthines, valproate, tricyclic)
Essential tremor
Bilateral, symmetric Primarily hands, outstretched arms, intention tremor Head, trunk, voice, tongue Worsens with stress, fatigue; may improve temporarily with alcohol Progressive Usually absence of other neuro signs Lower limbs rarely affected No consistent pathology Autosomal dominant inheritance pattern
Intention tremor
Seen during intentional movement, writing, pouring, finger to nose test
Not at rest
Associated with cerebellar disorder, MS, alcohol
Resting tremor
Seen when limb at rest
Slow supination-pronation (pill-rolling) movements
Parkinson disease
Scoring Deep Tendon Reflexes
0 No response 1+ Sluggish, diminished 2+ Active, expected 3+ More brisk, slightly hyperactive 4+ Brisk, hyperactive, intermittent clonus
Stereognosis
Patient identifies a familiar object by touch
Two point discrimination
Needle/paper clip, alternately place one or two points simultaneously
Graphesthesia
Draw a letter or number on the body, ask to identfiy
Multiple Sclerosis (MS)
R/t infectious agents in susceptible individuals
Onset 20-40 y/o
Women > men
Subjective:
Fatigue; urinary frequency, urgency, hesitancy; sexual dysfunction; vertigo, weakness, numbness; blurred vision, diplopia, loss of vision; emotional changes; relapse of symptoms develop rapidly, takes weeks to recede
Objective:
Muscle weakness, ataxia; hyperactive DTR; parasthesia, sensory loss, vibration sense; intention tremor; optic neuritis; cognitive changes; MRI reveals brain lesions, spinal cord lesions (sometimes)
