Neurological Flashcards
Structure of CNS
Cerebral Cortex Frontal lobe Parietal lobe Occipital lobe Wernicke’s area Broca’s area
Basal ganglia Thalamus Hypothalamus Cerebellum Brainstem Spinal Cord
Pathways of CNS
Crossed representation
Sensory Pathways
Motor Pathways
Corticospinal or Pyramidal Tract
Extrapyramidal Tracts
Cerebellar system
Upper and Lower Motor Neurons
Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Autonomic Nervous System
Reflex Arc
Components of Neuro Exam
Cerebral Cranial Nerves Cerebellar and Proprioception Sensory Reflexes
PMHx
Incoordination Numbness or tingling Difficulty swallowing Difficulty speaking Significant past history Environmental/ occupational hazards Headache Head injury Dizziness/Vertigo Seizures Tremors Weakness
Equipment
Penlight Tongue blade Cotton swab Tuning fork Percussion hammer Occasionally need: familiar aromatic substance
General Cerebral Functions
General Appearance & Behavior Level of Consciousness Intellectual Performance Emotional Status Thought Content
Cranial Nerves
I Olfactory II Optic III Oculomotor, IV Trochlear, VI Abducens V Trigeminal Motor function Sensory function VI Facial Motor function Sensory function VIII Acoustic IX Glossopharyngeal, X Vagus Motor function Sensory function XI Spinal Accessory XII Hypoglossal
Inspect and palpate Muscles
Muscles Size Strength Tone Involuntary Movements
Coordination and Skilled Movement s
Finger to Nose Finger to Nose and Examiners Finger Rapid Alternating Movements Heel down shin Shallow Knee Bend Gait Romberg Tandem Walking
Sensory Function
Person is alert, cooperative, comfortable Spinothalamic tract Pain Temperature Light touch
Sensory Function: Posterior column tract
Posterior Column tract Vibration Position (Kinesthesia) Tactile Discrimination (Fine touch) Stereognosis Graphesthesia Two-point discrimination
Sensory system
Superficial Tactile Sensation Superficial Pain Sensitivity To Temperature Sensitivity to Vibration Deep Pressure Pain Motion and Position
DTRs
Technique Grading Reinforcement Biceps reflex Triceps reflex Brachioradialis reflex Quadriceps reflex
Achilles reflex
Clonus
Superficial reflexes
Abdominal reflex
Cremasteric reflex
Plantar reflex
Grading reflexes
0 no resposne
1+ Diminished, low normal
2+ Average Normal
3+ Brisker than average, may mean disease
4+ Very brisk, hyperactive with clonus, indicative of disease
Testing CN I
Cover one nostril and ask the pt to smell a particular scent c their eyes closed
Inflammation of the mucus membrane, allergic rhinitis, and excessive tobacco smoking interfere c sense of smell
Abnormalities of CN III, IV and VI
CN VI is the first to lose function in the incidence of increased cranial nerve pressure
Testing CN V
Use sharp and dull touch on bilateral sides of the face
Use hot and cold test tubes if unable to distinguish touch
Test using corneal reflex (remove contact lenses) to prevent diminished or absent reflex
Testing CN VII
Raise eyebrows, squeeze eyes shut, wrinkle forehead, frown, smile and puff out cheeks
Abnormal CN V
Presence of fasculations, muscle atrophy of face or deviation of jaw
Abnormal CN VII
Tics, unusual facial movements, asymmetry of expression, mouth drooping, ptosis
Sweet and salty taste is CN VII
Sour and bitter is CN IX
Testing of CN IX AND X
Gag reflex test
Abnormal CN X
Drooping or absence of an arch on either side of the soft palate is unexpected
Palate should rise and uvula should stay midline
Test swallowing for aspiration
Testing CN XII
Move tongue up and down outside of mouth
Have pt press tongue against cheek into your hand
Abnormal CN XII
Fasculations, asymmetry, atrophy, or deviation from midline is unexpected
What to examine for in coordination and fine motor skills
affected, quality, rate and rhythm
Positive Romberg sign
loss of balance
cerebellar ataxia
vestibular dysfunction
sensory loss
Evaluation of Gait
Should be smooth, regular, rhythm and symmetric stride length
Trunk should sway c gait
Arms should be symmetrical and smooth
Evaluation of tandem gait
Note extension of arms for stability Instability Tendency to fall Lateral staggering or reeling Shuffling, widely placed feet, toe walking, foot flop, leg lag, scissoring, loss of arm swing, staggering or reeling
Primary sensory function
Superfiical touch
Superficial pain
Temperature or deep pressure - squeeze traps, calf or biceps to elicit discomfort
Vibration - Test at bony prominences like finger, toe, sternum, shoulder, elbow, wrist, shin and ankle
Position of joints
Hands, lower arms, abdomen, feet and lower legs
Stereognosis
Inability to determine an everyday object through touch
Indicating a parietal lobe lesion
Two-point discrimination
Alternate using a paper -clip or needle against two bilateral areas on a patient
Extinction Phenonmenon
Simultaneously touch an area on both sides of the patients body using a sharp object
Graphesthesia
Using a blunt pen or applicator stick, trace a letter, number or shape in the patients hand
Point location
Touch an area of the patients skin and ask them to point to where they felt the touch
Brain Blood Supply
Brain receives about 20% of Q from two carotid and two vertebral arteries
Deoxygenated blood flows to venous plexus to the dural sinuses that empty into the internal jugular veins
Cerebrum
Houses higher mental function and is responsible for general movement, visceral functions, perception and behavior
Comissural fibers allow interconnection of activities between two brain hemispheres
Frontal Lobe
Voluntary skeletal movement
fine receptive motor movement
controls eye movement
Parietal Lobe
Processes sensory data
Interprets tactile sensations like heat, pressure, pain, texture
Regulates vision, taste and smell and recognition of body part and body position (proprioception)
Occipital Lobe
Contains primary vision center
Temporal lobe
Perception and interpretation of sounds and determination of their source
Also integrates smell, taste and balance
Contains Wernicke’s area - interprets speech
Basal Ganglia
Refines motor movements
Connects thalamus, motor cortex, reticular formation and the spinal cord
Cerebellum
Aids motor cortex of the cerebrum of integration of voluntary movement
Processes sensory data from ear, eyes, nose and mouth along with the vestibular system to coordinate muscle tone and balance, and posture
