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
