Neurological Flashcards
Older adults developmental considerations
atrophy & loss of neurons in brain & spinal cord
- decrease weight & volume of brain
- decrease muscle strength & impaired fine coordination
- Slowed reaction time
- Dizziness & loss of balance
- irregular pupil shape
- decreased cerebral blood flow
- dyskinesias( reparative grinning)
- postural hypotension
What subjective data for neurological health history
- Headache
- head injury
- dizziness or vertigo
- seizures
- tremors
- weakness
- incoordination
- numbness or tingling
- difficulty swallowing
- difficulty speaking
- significant past history
- environmental or occupational hazards
Additional Neurological subjective info for infant & child
- Maternal health
- Neonatal period
- reflexes
- weakness & balance
- seizures
- physical development
- Environemental hazards
- cognitive development
- family history
Additional neurological subjective for older adults
- risk for falls
- cognitive function
- tremor
- vision
Objective data for Neurological assessment
- Mental status
- crainal nerves
- inspect & palpate motor system
- assess sensory system
- test the reflexes
- neuro recheck overtime
CRANIAL NERVES HOW TO REMEMBER
OOOTTAFVGVAH
SSMMBMBSBBMM
1) Olfactory (smell)
2) Optic (sight)
3) Oculomotor ( moves eye)
4) Trochlear ( oblique eye muscle)
5) Trigeminal ( Sensory from face & mouth & chewing)
6) Abducens (moves eye)
7) Facial ( facial expression & taste)
8) Vestibulocochlear (hearing & equilibrium)
9)Glossopharyngeal (Gagging & swallow & taste )
10) Vagus (Gag, swallow, speech)
11) Spinal accessory ( head & shoulder movement)
12) Hypoglossal (tongue movement)
How to test cerebellar function
- Balance tests (Gain, Tandem walking, Romberg test, shallow knee bend)
- Coordination & skilled movements (rapidly alternating movements, finger to finger, finger to noes, heel to shin test)
What is the romberg test
Stand upright & close eyes. A loss of balance is a positive sign. A patient who has a problem with Proprioception (Somatosensory) can still maintain balance by compensating with vestibular function and vision. Tests cerebellar function
What are you looking for when you assess the sensory system
- intactness of peripheral nerve fibres, sensory tracts, and higher cortical discrimination.
- Person is alert, cooperative & comfortable
How to test the Spinothalamic tract
-Pain, temp, light touch
how to test the posterior column tract
- vibration
- position/kinesthesia
- tactile discrimination (fine touch)
- Stereognosis, Graphesthesia, 2 point discrimination, extinction, point location
what is stereognosis
perception of depth
what is graphesthesia
the ability to recognize writing on the skin purely by the sensation of touch
Which are the deep tendon/ stretch reflexes
Patellar & achilles
what are the superficial reflexes
- abdominal reflex
- cremasteric reflex
- plantar reflex
What are the developmental considerations for an infant
- Spontaneous waking & response to environment
- cranial nerves cannot be directly tested
- motor system: Nopissing district development screen
- head control
- reflexes: Babinski, Palma, moro, rooting, tonic neck, sucking
What are the developmental considerations for preschool & school age
- observe them undress
- developmental milestones
- test balance, fine motor coordination
- lack of reliability in sensation testing
What are the developmental considerations for older adults
decrease in muscle bulk
- senile tremors
- dyskinesia (abnormal/impaired voluntary movement)
- Difference in gait
- loss of ankle jerk
- less brisk
Order of Neurological recheck
1) mental health
2) cranial nerves
3) Motor system
4) sensory system
5) Reflexes
What part of brain regulates vital signs
Hypothalamus
what part of brain regulates motor coordination & equilibrium
cerebellum
what part of the brain regulates movement (autonomic associated movements)
basal ganglia
what part of the brain regulates nerve impulse conduction
cerebral cortex ( grey matter)
what part of the brain is for sensory
Spinal cord, brain stem & parietal lobe
What part of the brain is for motor speech
brocas area
what does the frontal lobe do
personality, behaviour, emotions, intellectual function
what does the pre-central gyrus do
voluntary movement
what does the parietal lobe/ post central gyrus do
sensation
what is the occipital lobe for
vision
what is the temporal lobe for
auditory
what is the wernickes area for
language comprehension
what could a damaged wernickes cause
receptive aphasia: hear sound but no meaning
what happens if u damage ur broca’s area
Expressive aphasia: can’t talk but understands what everything means & wants to talk
Damage to any area in the cerebral cortex/ cerebrum can cause:
moto weakness
paralysis
loss of sensation
impaired ability to understand & process language
What does the hypothalamus do
control temp, hr, bp, sleep,
what does the medulla do
autonomic centers (resp, cardiac, GI)
What do the extrapyramidal motor pathways do
maintain muscle tone, gross movements (walk)
what does the cerebellar motor pathway do
things you aren’t aware of doing like flexing back
What is a reflex arc
involuntary quick run to potentially painful event
what does somatic mean
voluntary (skeletal)
what does visceral mean
involuntary (cardiac & smooth muscle)
what inhibits infants reflexes
cerebellar function
what is subjective vertigo
u spin
what is objective vertigo
room spins
what is syncope
sudden loss of stenght or temporary loss of consciousness (fainting) causes by lack of cerebral blood flow, occurs with low BP
what is true vertigo
feeling of ratational spinning
what is a paresis
weakness of voluntary movements
what is dysmetria
inability to control ROM of muscles
what is paraesthesia
abnormal sensation ( burn or tingle)
what is dysarthria
difficulty forming words
what is dysphagia
difficulty swallowing
what is dysphasia
difficulty with langue comprehension or expression
what are significant past history
stroke, spinal cord injury, meningitis, encephalitis, cognitive defect, alcoholism
What are some critical findings
immediate interventions or transport to hospital needed
- Sudden decrease alertness/consciousness
- sudden change in speech
- signs of stroke
- sudden onset of severe headache
- signs of raised intracranial pressure
- onset of weak, numb, eye movement problems, double viison
- sudden seizures
- sudden extreme lethargy
When would u do a screening neurological exam
seemingly health patient with a history of no significant findings
when would you do a complete neurological exam
a pt. with neurological concern or sign of disfunction
when would you do a neurological recheck
pt with neurological deficits who require periodic reassessment
how should pt. be for neurological exam
pt. sit up right with head @ eye level
How to test olfactory nerve
- not routine, only if loss of smell, head trauma, abnormal mental status, or intercrainal lesion
1) patentcy
2) occlude + a scent
what is anosmia
decrease or loss of smell
-bilaterally with smoking, allergies or cocaine
what is neurogenic anosmia
unilateral loss w/o nasal disease or trauma
What would u inspect for optic never
- visual acuity
- fields of vision via confrontation
- papilledema with increase pressure
Testing the oculomotor, trochlear & abducens
-Pupil: Size, regularity, equality, direct light reaction, accommodation
what is ptosis & what cranial nerve
drooping of eye & oculomotor
what is strabismus
deviated gaze & limited movement
what is nystagmus
back & forth oscillation of eyes
occurs with disease of vestibular, cerebellum or brain stem
how to test trigeminal nerve
- palpate temporal & masseter muscle
- clench teeth
- close eyes touch face
- should blink when you bring cotton near eye
how to test facial nerve
motor: symmetry & muscle weakness
Sensory function: not routine. cotton soaked with lemmon
what is bells palsy
lower/upper on one side of face
how to test vestibulocochlear nerve
whisper
how to test glossopharyngeal & vagus nerve
Depress tongue & note soft palate symmetry
- uvula should deviate to one side
- symmetry of tonsillar pillar
- gag
- voice smooth (not hoarse or twang)
- sensory not tested (posterior tongue)
How to test spinal acessory nerve
head rotate against hand & shrug
how to test hypoglossal nerve
inspect tongue for wasting, symmetry, midline, tutors or tremors
-say light tight dynamite
size of muscles
1cm different is insignificant
- atrophy = small bc disease injury, polio or diabetic neuropathy
- hypertrophy
what is flaccidity vis spasticity
flaccidity = decreased resistance spasticity = increased resistance
What are the 2 balance tests
gain & Romberg
what is gait test
smooth, rhythmic, opposing arm swing
what is ataxia
involves uncoordinated or or unsteady gait
what would not being able to do tandem walk indicate
upper motor neuron lesion
what is dysdiabochokinesia
lack of coordination or slow & sloppy
can mean cerebellar disease
what is demetria
clumbsy movement could mean cerebellar disorder or alcohol
what is the pain/pinprick test for
randomly alternate sharp & dull with 2s in between to avid summation
what is hypolgesia & hyperalgesia
increase & decreased pain sensation
what is analgesia
absence of pain sensation
how do you do light touch
cotton ball on different parts
what is hypoaesthesia , hyper & anesthesia
decreased touch feel, increased feeling of touch & absent
what would inability to feel vibration mean
peripheral neuropathy/ diabetes/ alcoholism
-worst at feet
if they have problems with tactile discrimination it could mean
lesion of the sensory cortex or pos. column
where is the most sensitive
finger least = upper arm, thigh & back
what is stereognosis
identify item with eyes closed
so astereognosis = inability to identify (stroke symptom)
how are reflexes graded
4+ = brisk, hyperactive w/ clonus disease(not good) 3+ = brisker than ave, maybe disease 2+ = average and normal 1+ = diminished /low 0= nothing
what is hyper & hyporeflexia
exaggerated reflex (upper motor neuron lesion or stroke) and reduced functioning of reflex ( spinal cord injury)
Biceps reflex
- hold arm, strike bicep tendon
- it contract & flex
triceps reflex
- tap triceps tendon above elbow
- extension
brachioradialis reflex
- hod thumb, strike forearm 2-3 cm above raid styloid process
- flexion & supination od arm
quad/patellar reflex
- strike just below patella
- extension of leg & quad contract
achilles reflex
- stike achilles
- plantar flexion occurs
clonus reflex
move foot up and down to relax, dorsiflex & it should just not move
abdominal reflex
-abs should tighten when stroke skin
cremasteric reflex
stroke inner right, elevation of ipsilateral testical
plantar reflex
stroke sole upward, should have flexion, abnormal would be fanning
what is opisthotonos
head arched back, stiff neck, extended limbs in baby
occurs with meningeal or brainstem irritation
babies usually have
hypoaesthesia
hyperasetheia could mean a spinal cord lesion, CNS infection, inter cranial pressure
what is the rooting reflex
brush cheek turn head (3/4m)
what is the sucking reflex
tough lip will suck (till 10/12m)
what is palmar reflex
offer finger will grasp (till 3/4 mo)
what is plantar grasp
toes curl ( 8/10mo)
what is babinski reflex
toes fan till 2 yr
what is tonic neck reflex
supine, turn head to side, ipsilateral extension of arm & leg, flexion of opposite side
-till 6 mo
what is moro reflex
startle - abduction & extension of arms, fan fingers
till 4 months
65+ =
loss of vibration sensation in ankle & loss of achilles
what is the earliest most sensitive indication of change
level of consciousness
stimulus to awaken
1) call name
2) light touch
3) vigorous shoulder shake
4) pain applied
Glasgow coma scale
original designed for head trauma, assess function of entire brain, standardized
fully alert = 15
coma = 7 or less
limitation: inconsistence, impossibility or verbal score
what is decorticate rigidity
-hemespheric lesion of cerebral cortex
-felxed arm, wrist, fingers, abducted,
legs extended & internal rotate with plantar flex
what is decerebrate rigidity
lesion @ midbrain or upper pons
-arms stiffly extended, plantar flexion, palms pronated, legs extended & teeth clenched
what is flaccid quadriplegia
nonfunctional brainstem
complete loss of muscle. tone & paralysis
what is osisthotanos
meningeal irritation
-prolonged back arch with head & heels bent backwards
