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PSYC 301 > Neurological Examination > Flashcards

Neurological Examination Flashcards

1
Q

Neurological Examination

A

A neurological examination is a series of tests conducted by a neurologist to evaluate the integrity of the nervous system for many reasons, including (but not limited to):
1. Following trauma or stroke
2. When there are suspected neurodegenerative changes
3. Following exposure to a neurotoxic agent

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2
Q

When do we use neurological examination?

A

Aging, trauma, meningitis

Global assessment on how the person is doing
Mental status exams that show basic problems with attention of executive control

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3
Q

Neurological damage

Localization

A

Neurological damage can be located virtually everywhere, some can be much easier to identify

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4
Q

Peripheral Nervous System and localization

A

Sensory disturbance- more global effect, bilateral dysfunction

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5
Q

Localization

Internal Capsule

A

a two-way tract for the transmission of information to and from the cerebral cortex

Cuts through between basal ganglia and thalamus→ has both A&E axons→ Number of strokes can damage this

Damage: motor and sensory impairments, damage in spinal cord, brain stem until cranial nerves, can be at neuromuscular junctions itself (musuclar reflexes)

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6
Q

Basic components of neurological exam

A
  1. Patient history
  2. Cranial nerve function
  3. Motor function (e.g., reflexes)
  4. Somatosensory function
  5. Coordination
  6. Mental status (sophisticated cog functions)
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7
Q

What are things that are considered for patient history

A
  1. Age
  2. Education (predictor of number of later life decline problems)
  3. Handedness
  4. Past medical history
  5. Use of recreational drugs
  6. Family medical history
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8
Q

Patient History

Handedness

A

Brain has some lateralization (language is typically left hemisphere dominant, attention is right) → Matters because it can somehow predict handedness,
- Over 95% Right handed, left hemisphere is dominant for language (always sure)
- 10% Left handed, 3/4 are still hemisphere dominant for language, but ¼- ½ bilateral dominance (equal ), ½ right hemisphere dominance

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9
Q

Patient History

Past medical history

A

matter in terms of the dysfunction as a complication of a previous surgery

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10
Q

Cranial Nerves

Sensory, motor, or both (Mnemonic)

A

Some say Money Matters, but my brother says big brain matters more

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11
Q

Cranial Nerves

A

set of 12 nerves that send electrical signals between your brain and different parts of your head, face, neck and torso

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12
Q

What are the 12 Cranial Nerves?

A

I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulocochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal

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13
Q

Mnemonic for cranial nerves

A

On Over October, Tonight This Ant Farts Viagra Graciously, Viagra Acts Hot

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14
Q

I

Olfactory

A

The ethmoid ridge (sensory axons) and cribriform plate (spongy bone, has holes where axons come in from) support sensory axons connecting to cranial nerve I. Impact can easily shear these axons, causing loss of smell.

Damaged from mild head injury (mild tbi)

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15
Q

I

Testing Olfactory

A

Cover one nostril and have the patient close their eyes, then ask them to identify a common scent (e.g., coffee or vanilla). The olfactory nerve can be damaged by mild head injuries, such as mild traumatic brain injury (TBI).

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16
Q

II

Optic Nerve

A
  • Standard visual acuity tests
  • Visual field confrontation
  • Papilledema and intracranial pressure
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17
Q

Testing sensory nerve vs. motor nerve

A

if test vision, test eyes; if motor, have to test motor control, muscle integrity (atrophy)

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18
Q

Atrophy

A

a process where a body part partially or completely wastes away

muscles can atrophy one side or another, damage to one of the cranial nerves, tend to atrophy ; can either look or touch muscle (to test)

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19
Q

II

Standard Visual Activity

A

Snellen chart- visual acuity one eye at a time, read from a distance usually at 10 feet

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20
Q

II

Visual field confrontation

A

Fundoscopy is an examination of the fundus, the inside back of the eye. To perform it, the lights are dimmed to enlarge the pupil. Focuses on a specific point, and the examiner observes the macula, which is the center of vision.

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21
Q

II

Papilledema and intercranial pressure

A

Papilledema is the swelling of the optic disc due to increased intracranial pressure, which pushes the optic nerve forward into the eye. This condition often indicates elevated pressure within the skull, which can have various underlying causes.

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22
Q

Which cranial nerves are associated to eye movement?

A

III- Oculomotor
IV- Trochlear
VI- Abducens

23
Q

III

Oculomotor

A

controls four of the six muscles responsible for eye movement

24
Q

III

What to check for oculomotor?

A

check for ptosis- drooping of the upper eyelid

25
Q

IV

Trochlear

A

smallest of all cranial nerve, controls 1 single eye muscle

26
Q

VI

Abducens

A

Controls only 1 nerve in the eye

27
Q

Testing Abducens, Oculomotor, and Trochlear

A

To test the abducens nerve (cranial nerve VI), have the patient fixate on a pen and move it through all directions. If there is an issue with cranial nerve III or VI, the affected eye may struggle to follow in certain directions, leading to gaze restriction. This misalignment can cause double or blurry vision, as one eye cannot keep up with the other.

28
Q

V

Trigeminal

A
  • Facial somatosensation
  • Motor function
    The trigeminal nerve branches into three divisions, each responsible for sensation in different facial areas: the jaw, cheeks, and forehead.
29
Q

V

Testing Trigeminal- Motor or Sensory?

A

When testing, different facial areas are touched to assess sensation, as each area has distinct types of touch receptors. These receptors send sensory information via afferent pathways to the brain, covering various touch sensations.

  1. hold the patient’s chin and apply resistance as they attempt to open or close their mouth.
  2. palpate the jaw muscles to assess their condition, checking for signs of atrophy or good muscle tone.
30
Q

VII

Facial

A
  • Facial asymmetries
    The facial nerve is responsible for both facial sensation and movement, including expressions. Facial nerve dysfunction can significantly impact these abilities, often visibly.
31
Q

VII

Testing Facial nerves

A

To test the motor function, ask the patient to smile, look up, and wrinkle their forehead, checking for symmetry in these movements. Asymmetry may indicate facial nerve issues.

32
Q

VII

Bell’s palsy

A

condition caused by facial nerve dysfunction, leading to drooping on one side of the face. It typically resolves on its own over time.

33
Q

VIII

Vestibulocochlear

A

Auditory perception

34
Q

VIII

Testing Vestibulocochlear

A

test hearing by covering one ear and whispering a word or phrase into the other ear at varying distances, then switch ears. Additionally, evaluate balance, as this nerve is responsible for both hearing and equilibrium.

35
Q

IX

Glossopharyngeal

A

glosso-tongue, pharyn- pharynx
- responsible for taste at front of tongue

36
Q

X

Vagus

A
  • Swallowing and voice
  • Gag reflex
37
Q

XI

Accessory nerve

A
  • Shrugging of shoulders
  • Head resistance
38
Q

X

How to test the Vagus

A

assessed by evaluating the ability to speak and swallow. Issues with voice quality can indicate dysfunction. Gag reflex can be tested to assess nerve function and the integrity of the throat muscles.

39
Q

XI

How to test accessory nerve

A

apply some pressure against head and force down on shoulders

40
Q

XII

Hypoglossal

A
  • Stick out the tongue, lateral movement
41
Q

XII

How to test the Hypoglossal nerve

A

ask the patient to stick out their tongue and move it laterally. You can also have them push their tongue against their cheek. Asymmetry in the tongue’s position or movement may indicate a problem with the nerve.

42
Q

Motor Function Features

A

Key features to examine:
- Gross appearance of muscle
-Muscle tone, strength

Lots of neurons considered motor neuron→ brain to brain stem, brain stem down to spinal cord, out of spinal cord to muscle themselves→ any damage along this pathway cause probs with motor control

43
Q

Motor Function

Upper vs lower motor lesions

A

Upper motor neuron lesions (in the cerebral cortex or spinal cord) result in exaggerated movements and hyperreflexia, which are heightened reflex responses.

In contrast, lower motor neuron lesions (from the spinal cord to the muscles) lead to hyporeflexia , characterized by diminished reflexes and weakened muscle responses.

44
Q

Somatosensory function

A
  • Pain
  • Light touch and proprioception
  • Testing for astereognosis
  • Testing for agraphesthesia
45
Q

Somatosensory function

Proprioception

A

Proprioception refers to the body’s ability to sense its position and movement in space. During a test of proprioception, the doctor will have the patient close their eyes and then guide one hand to touch another body part. The patient is then asked if they can identify the position of their hand, assessing their awareness of spatial awareness and body positioning.

46
Q

Somatosensory function

Testing for astereognosis

A

Testing for astereognosis involves assessing a person’s ability to identify objects through touch alone, without visual input. During the test, the patient can feel the texture (hard, soft, long, cold) of the object

47
Q

Somatosensory function

Testing for agraphesthesia

A

Testing for agraphesthesia involves the doctor writing a number on the patient’s skin (typically on the palm or back) using a finger or stylus. The patient is then asked to identify the number without looking.

48
Q

Coordination

A
  • Quick, alternating movements
  • Point-to-point movement
  • Heel-to-shin test
  • Standing/sitting
  • Gait
  • Romberg test
49
Q

Coordination

Point-to-Point Movement

A

Task: Touch the index finger to the nose, then touch the examiner’s finger.

50
Q

Coordination

Heel-to-Shin Test

A

Position: Lie on side.
Task: Place one heel on the opposite knee and slide it down to the shin back and forth.
Difficulty indicates potential cerebellum problems.

51
Q

Coordination

Standing/Sitting

A

Assess posture and stability in standing and sitting positions.

52
Q

Coordination

Gait

A

Observe the patient’s walking pattern. An unusual gait may suggest cerebellar issues.

53
Q

Coordination

Romberg Test

A

Task: Ask the patient to close their eyes and extend their arms out.
Balance relies on three sources of information: visual input, cerebellar function, and vestibular input.
To maintain balance, only two out of these three criteria need to be functional.

PSYC 301 (8 decks)

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