Neurological exam - SA Flashcards
1
Q
Can you have the same disease of a different localisation?
A
Yes
2
Q
Does lesion size = CS severity?
A
No
3
Q
Does CS severity = prognosis?
A
No
4
Q
Does location (anatomy) = function?
A
Yes
5
Q
What is using the loss of function to work out the location?
A
Neurolocalisation
6
Q
How is the spinal cord divided?
A
- C1-C5
- C6-T2
- T3 - L3
- L4 - Cd
7
Q
Where might a neurological lesion be located?
A
- BRAIN (forebrain, brainstem, cerebellum)
- SC
- Neuromuscular
8
Q
2 aims of neuro exam
A
- neurologically normal or abnormal?
- localisation of lesion
9
Q
Tools for neuro exam
A
- room
- chair
- yoga mat
- reflex hammer
- haemostats
- Q tips (corneal reflex)
- cotton balls
- penlight
- lens
10
Q
State the 8 parts of the neuro exam
A
- mentation
- posture
- gait
- postural reactions
- spinal reflexes
- cranial nerves
- palpation
- nociception
11
Q
Define mentation
A
- LEVEL of consciousness: alert, obtunded, stupor / semicoma, coma
- QUALITY of consciousness: appropriate, inappropriate (compulsion, dementia/ delerium)
12
Q
What is assessed with posture?
A
- head
- limbs
- body
13
Q
Outline head posture
A
- Tilt (roll) suggests vestibular disease
- Turn (yaw) suggests forebrain disease
14
Q
Outline limb posture
A
- wide based stance - proprioceptive loss
- narrow based stance - weakness?
- decreased weight bearing - evidence of pain?
15
Q
What are the 3 different body postures?
A
- decerebrate
- decerebellate
- Schiff-Scherrington
16
Q
Control of gait = ?
A
requires integration of proprioceptive and motor systems
17
Q
What is determined in gait analysis?
A
- normal or abnormal
- which limbs?
- paresis, ataxia, lame, combination?
18
Q
Define paresis
A
- decreased voluntary movement
- can be UMN or LMN
- differentiation cannot be based on severity alone
- also assess postural reactions, spinal reflexes, mm tone
19
Q
Features - UMN paresis
A
- MUSCLE TONE is normal to increased in limbs caudal to the lesions
- SPINAL REFLEXES are normal to increased in limbs caudal to the lesion
- STRIDE: length is normal to increased, spastic
+/- ATAXIA (sensory) - swaying/ floating gait, knuckling
20
Q
Features - LMN paresis
A
- MUSCLE TONE is decreased in limbs with a reflex arc containing a lesion
- SPINAL REFLEXES are decreased to absent in limbs with a reflex containing the lesion
- STRIDE: length is normal to decreased, stiff, ‘bunny hopping’, +/- collapse
+/- ATAXIA (sensory) knuckling
21
Q
3 types of ataxia
A
- sensory (proprioceptive)
- cerebellar
- vestibular
22
Q
Describe sensory ataxia
A
= loss of sense of limb/ body position
- wide based stance
- increased stride length
- swaying/ floating gait
- knuckling
23
Q
Describe cerebellar ataxia
A
= disorder of rate and range of movement
- hypermetria
- intention tremor
- postural tremor
- jerky movements
- (high step thoracic gait)
24
Q
Describe vestibular ataxia
A
- UNILATERAL: falling/ leaning/ circling to one side, head tilt
- BILATERAL: wide excursions of the head, +/- head tilt, crouched posture
- strabismus nystagmus commonly
25
Outline the purpose of assessing postural reactions
= requires integration of proprioceptive and motor systems
- similar pathways to gait
- pathways are long ('sensitive/ non-specific', interpret with gait, spinal reflexes, mm tone)
26
List some possible postural reactions to teat
- paw positioning
- hopping
- wheelbarrowing
- hemiwalking (tactile, visual)
- extensor postural thrust
* always look for symmetry*
27
What does the biceps tendon reflex test?
Tendon reflex - musculocutaneous nn - C6-8
28
What does the triceps tendon reflex test?
Tendon reflex - radial nn - C7-T2
29
What does the patellar tendon reflex test?
Tendon reflex - Femoral nn - L4-6
30
What does the gastrocnemius tendon reflex test?
Tendon reflex - sciatic nn - L6-S2
31
Name 2 flexor (withdrawal) spinal reflexes
- thoracic limb
| - pelvic limb
32
What does the thoracic limb withdrawal reflex test?
multiple nn - C6-T2
33
What does the pelvic limb withdrawal reflex test?
Sciatic nn - L6 - S2
34
What does the perineal spinal reflex test?
Pudendal nn (S1-3) - there should be a bilateral response to a unilateral stimulus
35
How do you do the cutaneous truni mm spinal reflex test?
pinch skin in lumbar region with haemostats (not cats!)
36
Interpretation - decreased/ absent spinal reflex
- lesion within reflex arc
- physical limitation of movement (joint fibrosis, mm contracture)
- excitement/ fear
- 'spinal shock'
37
Interpretation - exaggerated spinal reflex
- lesion to UMN pathways cranial to the spinal cord segment tested (since UMN attenuates tone in reflex arc)
- excitement/ fear (increased SNS tone)
- 'psuedohyperreflexia' due to loss of antagonism form mm on other side of limb
38
List the cranial nn
```
1 olfactory
2 optic
3 occulomotor
4 trochlear
5 trigeminal
6 abducent
7 facial
8 vestibulocochlear
9 glossopharyngeal
10 vagus
11 accessory
12 hypoglossal
```
39
Which CN is tested in a vision test?
CN2 --> forebrain
40
Which CN is tested in a menace response?
CN2 --> forebrain --> cerebellum --> brainstem --> CN 7
41
Which CN is tested in a PLR?
CN 2 --> brainstem --> CN 3
| both direct and indirect
42
Features of Horner's syndrome
= sympathetic denervation of the orbit
- miosis
- ptosis
- enopthalmos
43
Which CNs give motor to the extraocular mm? 3
3 occulomotor
4 trochlear
6 abducent
44
What controls strabismus (eye position)?
CN 8 --> central vestibular/ brainstem --> CN 3, 4, 6 (i.e. same as nystagmus)
45
What controls nystagmus (eye movement)?
CN 8 --> central vestibular / brainstem --> CN 3, 4, 6 (i.e. same as strabismus)
46
What causes palpebral reflex?
CN 5 --> brainstem --> CN 7
47
What causes corneal relfex?
CN 5 --> brainstem --> CN 6 (globe reaction, any blinking is controlled by CN 7)
48
Function - trigeminal - CN 5
- motor to mm of mastication so signs of dysfunction include atrophy and inability to close jaw
49
Function - facial - CN 7
- motor to mm of facial expression
- signs of dysfunction: facial paresis/ paralysis, facial asymmetry
- palpebral reflex: 5 > brainstem > 7
- menace response: 2 > forebrain > cerebellum > brainstem > 7
- autonomic innervation of lacrimal glands (test with STT-1)
50
Function - vestibulocochlear nn (CN 8)
COCHLEAR: auditory
VESTIBULAR: signs of dysfunction: ataxia (vestibular), head tilt, strabismus, nystagmus (abnormal)
PHYSIOLOGIC NYSTAGMUS: 8 > brainstem > 3, 4 and 6
51
Describe the types of nystagmus
- PHYSIOLOGIC: normal, decreased/ absent
- SPONTANEOUS / PATHOLOGIC
- DIRECTION: horizontal, rotary, vertical, fast-phase
- CONJUGATE/ DYSCONJUGATE
- POSITIONAL: inducible
52
Function - vagus nn - CN10
- sensory and motor to pharynx
| - gag reflex: CN9 and 10 --> brainstem --> CN 9 adn 10
53
Function - hypoglossal nn - CN 12
- motor to tongue
| - signs of dysfunction: paresis/ paralysis of tongue, atrophy/ asymmetry of tongue, seen as deviation of tongue
54
What are the types of palpation?
- LIGHT: swelling, atrophy
- DEEP: pain
- LOCATION: head, spine, limbs
- determine if focal or diffuse
55
Define nociception
= conscious perception of pain
- receptors --> brain
- SUPERFICIAL: skin
- DEEP: bone (periosteum)
- test cutaneous autonomous zones as necessary
56
T/F: limb withdrawal does not equal pain perception
Ture
57
Name 3 different types of lesion to then use to work out ddx
- focal
- multifocal
- diffuse
