Neurological exam - SA Flashcards

1
Q

Can you have the same disease of a different localisation?

A

Yes

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2
Q

Does lesion size = CS severity?

A

No

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3
Q

Does CS severity = prognosis?

A

No

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4
Q

Does location (anatomy) = function?

A

Yes

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5
Q

What is using the loss of function to work out the location?

A

Neurolocalisation

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6
Q

How is the spinal cord divided?

A
  • C1-C5
  • C6-T2
  • T3 - L3
  • L4 - Cd
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7
Q

Where might a neurological lesion be located?

A
  • BRAIN (forebrain, brainstem, cerebellum)
  • SC
  • Neuromuscular
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8
Q

2 aims of neuro exam

A
  • neurologically normal or abnormal?

- localisation of lesion

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9
Q

Tools for neuro exam

A
  • room
  • chair
  • yoga mat
  • reflex hammer
  • haemostats
  • Q tips (corneal reflex)
  • cotton balls
  • penlight
  • lens
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10
Q

State the 8 parts of the neuro exam

A
  1. mentation
  2. posture
  3. gait
  4. postural reactions
  5. spinal reflexes
  6. cranial nerves
  7. palpation
  8. nociception
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11
Q

Define mentation

A
  • LEVEL of consciousness: alert, obtunded, stupor / semicoma, coma
  • QUALITY of consciousness: appropriate, inappropriate (compulsion, dementia/ delerium)
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12
Q

What is assessed with posture?

A
  • head
  • limbs
  • body
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13
Q

Outline head posture

A
  • Tilt (roll) suggests vestibular disease

- Turn (yaw) suggests forebrain disease

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14
Q

Outline limb posture

A
  • wide based stance - proprioceptive loss
  • narrow based stance - weakness?
  • decreased weight bearing - evidence of pain?
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15
Q

What are the 3 different body postures?

A
  • decerebrate
  • decerebellate
  • Schiff-Scherrington
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16
Q

Control of gait = ?

A

requires integration of proprioceptive and motor systems

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17
Q

What is determined in gait analysis?

A
  • normal or abnormal
  • which limbs?
  • paresis, ataxia, lame, combination?
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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
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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
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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
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21
Q

3 types of ataxia

A
  1. sensory (proprioceptive)
  2. cerebellar
  3. vestibular
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22
Q

Describe sensory ataxia

A

= loss of sense of limb/ body position

  • wide based stance
  • increased stride length
  • swaying/ floating gait
  • knuckling
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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