Neurological diagnosis Flashcards
direct light reflex, indirect light reflex
tests cranial nerves II and III
when the light is shined in one eye, CN II sends the signal to the brain and CN III sends the signal to constrict the pupil
CN III on the other side also sends the signal to constrict the other pupil
L -< (o) (O) R
L (o) (o) >- R
Describe what is happening.
since the light is being shown in the left eye, we can say that CN II and CN III is working in the left eye.
since the pupil on the other side did not constrict when the light was on the left but did on the right, we can say that CN III is not working properly.
L -< (o) (o) R
L (o) (O) >- R
when the light is shown in the left eye, both pupils constrict, which means that CN II and III are working on the left and CN III is working on the right
when the light is shown in the right eye, the right eye doesn’t constrict, but the left one does, which means CN II isn’t working on the right side.
Six cardinal fields of gaze
in reference to the right eye: lateral rectus moves the eye laterally, which is innervated by CN VI, superior oblique moves the eye down and medial, which is innervated by CN IV, and the rest are innervated by CN III which are: the inferior oblique moves the eye upward and medial, the inferior rectus brings the eye down and lateral, the superior rectus brings the eye up and lateral, the medial rectus brings the eye medially, and the levator palpebrae lifts the eyelid
sensory test for CN V (face)
have patient close their eyes, touch forehead, cheekbone and chin with cotton wisp and ask the patient to say yes when they can feel you touch their face
general sensation to the anterior 2/3 of the tongue
corneal reflex
touch cornea with cotton wisp, eye will blink or tear
problem with CN V or CN X if this is not achieved
oculocardiac reflex
press on closed eye and heart rate decreases
problem with CN V or CN X if this is not achieved
tic douloureaux
extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. lightening like, excruciating pain is repetitive, occurring several times per day. pain is typically felt on one side of the jaw or cheek
usually a result of dental work
jaw jerk reflex
the mandible is tapped with hammer and masseter draws the jaw upward
muscles of mastication
TIME masseter external pterygoid internal pterygoid temporalis
sensory for CN VII
taste to anterior 2/3 of tongue (sweet, sour, salty)
motor for CN VII
muscles of facial expression
Bell’s palsy
unilateral facial paralysis caused by trauma, virus or immune mediated response and is not permanent. initial pain behind the ipsilateral ear, twitching, weakness or paralysis, drooping eyelid, drooping corner of mouth, drooling, dry eye, and impairment of taste
bell’s palsy vs stroke
bell’s: LMNL of CN VII, ipsilateral motor loss of entire face, forehead does not wrinkle
stroke: UMNL of CN VII, contralateral motor loss below eye, forehead does wrinkle
CN VIII sensory
vestibular: balance, mittelemeyer and romber’s. barany caloric test
cochlear: hearing, weber and rinne
endolymphatic hydrops/central vertigo
meniere’s disease
cause is unknown, but probably results from an abnormality in the fluids of the inner ear. symptoms are episodic rotational vertigo, hearing loss, tinnitus, and fullness in the ear
sensory CN IX
gag reflex and uvula reflex (CN IX afferent, CN X efferent (stroke uvula)
carotid reflex (CN IX afferent, CN X efferent) massage carotids and heart rate drops
taste to posterior 1/3 of tongue (bitter)
motor CN IX
stylopharyngeus muscle elevates pharynx and larynx, dilates pharynx to permit swallowing
sensory CN X
epiglottis and laryngeal muscles of swallowing (palate, pharynx, contracting muscles
motor CN X
gag reflex and carotid reflex
uvular reflex: palate and uvula deviate to opposite side of lesion when patient says Ahhh
CN IX
trapezius and SCM muscles: shoulder shrug (traps) and lateral flexion with head rotation (SCM)
wry neck
torticollis
spasm of SCM muscle
CN XII
tongue muscles: stick out tongue. deviation to side of lesion
graphesthesia
with patient’s eyes closed the doctor draws a letter in the patient’s open palm and asks them to identify the letter. repeat on the other side
sterognosis
with the patient’s eyes closed the doctor places a familiar object into the patient’s open palm and asks them to identify it. repeat on other side
how do you tests reflexes (generally)?
bilaterally, starting with normal side first
bicep nerve and nerve root
C5
brachioradialis nerve and nerve root
C6
triceps nerve and nerve root
C7
patellar nerve and nerve root
L4
medial hamstring nerve and nerve root
L5
Achilles nerve and nerve root
S1
UMNL: definition paralysis DTR path reflex clonus tone reaction of degeneration atrophy fasciculation superficial reflexes
lesion of the brain and spinal cord not including the anterior horn cells spastic hyperactive present present hypertonic absent absent absent absent
LMNL: definition paralysis DTR path reflex clonus tone reaction of degeneration atrophy fasciculation superficial reflexes
lesion of the anterior horn cells out to the myoneural junction flaccid hypoactive/absent absent absent hypotonic present present present present
ciliospinal reflex
pinch neck wile noting dilation of the eyes
sensory from neck
cervical sympathetics
oculocardiac reflex
press on eye, note slowing of the heart by 10BPM
CN V
CN X
carotid sinus reflex
press on carotid sinus note slowing of heart and decreased pressure
CN IX
CN X
conditions of UMNL
meningitis MULTPLE SCLEROSIS cerebral palsy CVA BRAIN TUMOR ALS (lower extremity)
conditions of LMNL
SUBLUXATION MYASTHENIA GRAVIS DISC PROTRUSION polio bell's palsy ALS (upper extremity)
babinski
stroke up lateral aspect of foot to great toe
dorsiflexion of great toe with slaying of other toes
chaddock
stroke down lateral malleolus to 5th toe
dorsiflexion of great toe with slaying of other toes
oppenheim
stroke down tibial crest to ankle
dorsiflexion of great toe with slaying of other toes
Gordon’s calf
squeeze calf below knee
dorsiflexion of great toe with slaying of other toes
schaefer
squeeze Achilles tendon
dorsiflexion of great toe with slaying of other toes
rossolimo
tap ball of foot
plantar flexion of great toe with curling of the other toes
hoffman
examiner extends middle phalanx and flicks distal phalanx inferior
flexion and adduction of the thumb and flexion of the fingers
tromner
examiner sharply taps the tips of the middle 3 fingers
flexion and adduction of the thumb and flexion of the fingers
Gordon’s finger
examiner strokes the pisiform of the patient
flexion of wrist and fingers or thumb and index finger
chaddock’s wrist
examiner strokes the distal ulnar side of the forearm near the wrist
flexion of wrist with extension and fanning of fingers
