Neurological exam 2 Flashcards
Cranial n. emerge from the brain via?
Skull foramina
Where is CNI nuclei found?
Cortex
Where is CNII nuclei found?
Thalamus
CNIII & CNIV nuclei found?
midbrain
CNV, VI, VII, VII nuclei found?
pons
CN IX, X, XI, XII nuclei found?
medulla
CN I Function, pathway, entry/exit point?
CN1: olfactory, Sensory
FNC: Smell
PATHWAY: nasal cavity > olfactory bulbs > temporal/frontal lobes
EXIT/ENTRY Point: cribriform plate (ethmoid bone)
CN I test?
-ask pt to identify distinctive smell with eye closed
Anosmia?
-loss of sense of smell
-Cause: infections, head injuries
CN II function, pathway, entry/exit point?
CN II: Optic, Sensory
FNC: vision
PATHWAY: retina > thalamus > occipital lobe
ENTRY/ EXIT POINT: Optic foramen (canal)
CN II Tests (5)?
- Snellen eye chart (central vision)
- Peripheral field tests (peripheral vision)
- Asses retina (w/ ophthalmoscope
- Pupillary movements
- Rapid eye movements
CNIII, CNIV, CNVI Function & entry/exit points?
CNIII: Occulomotor
CNIV: Tochlear
CNVI: Abducens
ALL MOTOR
FNC: Eye movements (somatic motor)
ENTRY/EXIT: Superior orbital fissure
CNIII, CN IV, CNVI pathways?
CN III: midbrain > m. around eye (most eye movements + pupil)
CN IV: midbrain > superior oblique (directs gaze don & outwards)
CN VI: pons > lateral rectus (directs gaze laterally)
CNIII, CN IV, CNVI Test?
H Test
CN V function, pathway, entry/exit points?
CN V: Trigeminal, BOTH
SENSORY: sensation over face
1. Superior orbital fissure: upper face
2. Foramen rotundum: mid face (maxillary)
3. Foramen ovale: lower face
MOTOR: m. of mastication, some neck, middle ear
1. Foramen ovale
CNV Test?
- SENSORY: sharp, dull, light touch over face
- MOTOR: clench jaw, movements of jaw
CN VII Function & pathway?
CN VII: Facial n, BOTH
SENSORY:
1. Taste of tongue (anterior 2/3)
2. Somatic sensation ear canal
MOTOR:
1. Facial movements (except tongue, eye, mastication)
2. Autonomic input to glands (salivary, nasal)
pons > internal acoustic meatus & facial canal > stylomastoid foramen
CN VII Test?
Ask pt to do different facial expressions
CN VIII function, pathway?
CN VIII: Vestiobulocochlear, SENOSRY
FNC: Hearing & balance
Internal acoustic meatus > pons > thalamus > temporal lobe
Sound conduction path?
sound waves > ear canal > vibration of typanic membrane > movement of middle ear bone (malleus, incus, stapes) = Inc. amplitude > cochlear (inner ear) > vibration in cochlear fluid > move hair = transduce vibrations into electrical pulse > CN VIII
CN VIII tests?
Hearing: tests ear canal, drum bones
- whisper in pts ear
-tunning forks (if heard better through skull then ear = problem)
Balance & eqm: tests vestibular apparatus
-observe pt standing with eyes closed (if falls or goes to one side = issue)
CN IX function & entry/exit points?
CN IX: glossopharyngeal, BOTH
SENSORY:
1. sensation from pharynx, external ear & chemo/barorecptors in carotid body (autonomic)
2. Tast posterior 1/3 of tongue (somatic)
MOTOR:
1. Swallowing (somatic)
2. Parotid gland (salivary gland) innervation (autonomic)
EXIT/ENTRY: jugular foramen
CN IX Test?
Gag reflux
- tongue elevates (CN X) when stimulus detected (CN IX)
CN X Function & entry/exit?
CN X: Vagus, BOTH
SENSORY:
1. Sensation from visceral organ, pharynx, external ear (somatic)
2. sensory input from aortic baro/chemoreceptors (autonomic)
MOTOR:
1. Pharyngeal m. (swallowing) + laryngeal m (vocal cords) (somatic)
2. Parasympathetic NS input into visceral organs (heart, lungs, liver, GI) (autonomic)
ENTRY/ EXIT: Jugular Foramen
CN X Test?
Vagus n
-does pt have hoarse voice?
- tell pt to say ahhh (elevation of palate)
CN XI function, entry & exit points?
CN XI: Accessory N, MOTOR
FNC: Innervation of SCM & Trapeziums (somatic)
ENTRY: foramen magnum
EXIT: Jugular Foramen
CN XI test?
turn head against resistance & shrug shoulders
Which CN is not a true CN?
CN IX: Accessory
-cell body located in cervical spinal cord
CN XII function & entry/exit point?
CN XII: Hypoglossal, MOTOR
FNC: Innervate tongue (speech, swallowing)
ENTRY/EXIT: hypoglossal canal
CN XII test?
-ask pt to stick out tongue & move to the side
Dorsal column-medial lemniscal system pathway?
touch, vibration & proprioception
Dorsal horn, dorsal column, cross over in medulla
sensory > 1st neuron > dorsal horn > dorsal column > synapse in medulla w/ 2nd neuron >crosses over > synapse with 3rd in thalamus > post central gyrus
Spinothalamic tract pathway?
pain & temp
dorsal horn, crosses over in dorsal horn, lateral, anterior column
Sensory > neuron > dorsal horn > synapse w/ 2nd neuron & crosses over >lateral, anterior column > synapse w/ 3rd in thalamus > post central gyrus
To test dermatomes of dorsal column-medial lemniscal pathway & spinothalamic tract?
dorsal column-medial lemniscal pathway:
- dull/soft (touch)
-for vibration: use running fork on bony prominence
Spinothalamic tract:
-sharp
