Neurological Exam Flashcards
Cerebrum
“Upper Brain” separated into 2 hemispheres by the median longitudinal fissure. Each hemisphere is composed of convolutions called gyri (gyrus singular) and 4 lobes. Each lobe is separated by a deep separation called a sulcus (sulci plural). The cerebrum is charged with our upper cognitive ability as well as motor control, sensations, and senses.
Cerebellum
“Lower Brain” located inferior to the cerebrum and posterior to the brainstem. Primarily functions to help smooth out voluntary motor movements.
Frontal lobe
The most anterior lobe of the brain. Responsible for voluntary motor movements. The most posterior gyrus on the frontal lobe is the precentral gyrus and is home to the motor homunculus. Left is usually home to Broca speech center.
Parietal lobe
Most superior lobe of the brain. Responsible for most conscious perception of sensory stimuli except for the special senses. The special senses make a stop here before going to the appropriate lobe for interpretation. The most anterior gyrus on the lobe is the post central gyrus and is home to the sensory homonculus.
Occipital lobe
Most posterior lobe. Charged with interpreting visual sensory data.
Temporal lobe
Most lateral lobe. Charged with interpreting sound, taste and smell. Also home to the Wernicke speech center.
Limbic System
- Composed of the group of structures between the diencephelon and the cerebrum. Responsible for emotions, consciousness, and memory.
Brainstem
“Primitive Brain” connects the spinal cord to the cerebrum. Made up of 3 structures: Midbrain, Pons, and Medulla. Responsible for most of the involuntary functions of the body. Decussation of the nerve fibers happens in the medulla resulting in opposite sides of the brain controlling opposite sides of the body.
Cranial nerves I-XII
Pneumonic for remembering sensory/motor/both for cranial nerves: Some Say Marry Money But My Brother Says Big Brains Matter Most.
Basal ganglia
Controls subconscious motor movements. IE cyclic motions like walking or when you grab an object you consciously move your hand and wrist, but unconsciously the basal nuclei stabilize and move shoulder and elbow.
Spinal cord
Resides in the vertebral foramen. Separates into the Cauda Equina in the lumbar spine. Primary functions are to interface between the brain and PNS as well as house reflex centers.
Ascending spinal tracts
Carry sensory information from the PNS toward the brain.
Descending spinal tracts
Carry motor information from the brain toward the PNS.
Spinal nerves
Leave the spinal cord via the intervertebral foramen between each pair of vertebra. Composed of 2 roots, a dorsal root and a ventral root. The dorsal root as an enlargement called the dorsal root ganglion. The dorsal root is responsible for taking sensory stimuli form the PNS into the spinal cord. The ventral root has no enlargement and is responsible for taking the motor stimuli from the spinal cord to the PNS.
Differentiation between an upper motor neuron lesion and lower motor neuron lesion
Genererally The upper neurons modify and tone down reflexes of lower nerves and fine tune the movements.
Upper: Weakness, increased reflexes, and tone (NO atrophy or fasciculations)
Lower: Weakness, atrophy, fasciculations, decreased reflexes and tone
Voluntary nervous system
Somatic Nervous System (SNS)
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Autonomic nervous system
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Glascow Coma Scale and its usefulness in evaluating level consciousness
Used to quantify consciousness; assesses function of cerebral cortex. Best for emergencies.
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Equipment and supplies necessary to examine the neurological system
Penlight, tongue blade, tuning forks, familiar objects (paper clips, coins, keys), cotton wisp, monofilament, reflex hammer, vials of aromatic substances
Mental status/ memory
Assess for orientation (person, place, time, purpose), ask patient to remember three words, and have them recall the words later in the exam
Cranial nerve status
Taste and smell not normally assessed unless suspect for an abnormality
Proprioception & cerebellar function
One test for each of the following is given: Rapid rhythmic alternating movements, accuracy of movement, balance (usually Romberg test), gait, and heel to toe walking.
- Rapid Rhythmic alternating movement – pat the knees rapidly alternating between palm and back of hand.
- Accuracy of movements
1. finger to finger test (pt touches his nose then your finger) with patients eyes open.
2. Finger to nose test, pt touches his nose, with eyes closed, alternating hands
3. Heel to shin test, pt moves heel up and down his shin in a straight line. - Romberg test, pts stands with feet together and arms at their side, first with eyes open, then closed. Small sway is normal, loss of balance is (+)Romberg sign.
- observe pts gait. Then have pt walk heel to toe to exaggerate any unexpected finding in the gait exam.
Motor function
When performing the motor exam, look for symmetry between the sides of the body. Also, both the proximal and distal muscles of the upper and lower extremities should be tested. To test muscle strength, the examiner applies maximum force to the extremity while the patient pushes against that force. Muscle strength is graded on a scale of 0 to 5.
Superficial reflexes
stroke each quadrant of the abdomen looking for contraction near the umbilicus for contraction.
Stroke inner thigh for cremastic reflex, scrotum will rise on the same side
Check plantar flexion by stroking the lateral side of the foot from heel to toe, toes should flex.
