Neurological Examination Misc. Flashcards
Internal capsule
A bundle of white matter the natural continuation of afferent and efferent neurons. The fibres transfer information to and from the cerebral cortex.
6 Steps of Neurological Examination
- Patient History
- Cranial Nerve Exam
- Motor Component
- Sensory Component
- Coordination Component
- Mental Status Exam (MSE)
Process of disease
Temporal profile
Two dimensions
Sudden v. Gradual
and
Acute V. Chronic
Process of disease
Change over time
Static, improving, worsening
Lower motor neuron
A motor neuron that travels from your spinal cord to your muscles and helps your muscles contract
Upper motor neuron
Part of motor pathway
How does a reflex work
Information comes into the spinal cord, a motor signal is sent right back out to same area, before signal even reaches to the brain
The brain has some control over these, can send signal to spinal cord to reduce refleces (descending inhibition)
What is the result when there is damage to the upper motor neurons (upper motor neuron lesions)
Reflexes will be exaggerated (hyperreflexia) due to lack of descending inhibition, and there will be muscle spasticity (exhausting the muscle, causes lactic acid build-up and pain).
What is the result when there is damage to the lower motor neurons (lower motor neuron lesions)
Reflexes will be damaged/diminished (hyporeflexia)
Examining for Somatosensory Function
What do you look for and how
- Pain (checking for pain can often be just by light touch)
- Light touch and proprioception (a knowledge of where your body is in space)
- Testing for astereognosis
- Testing for agraphesthesia
Related to cortical strokes:
Sensation might be intact but perception altered, thus the tests for the latter two (detailed further in following flashcards)
Testing for Astereognosis
Define steregnosis as well
Stereognosis - one’s ability to identify an object by touch alone - relating to perception, organizing and interpreting
Astereognosis - Tested for via asking a participant to identify an object by touch (they cannot see the object) - if they cannot identify it, then they have astereognosis
Relevant in cortical strokes
Testing for Agraphesthesia
Test: Ask the person to hold their hand open, you draw a letter/number on the person with closed eyes hand, ask them to interpret
If they cannot interpret it, they have agraphesthesia
Relevant in cortical strokes
Coordination
Heel-To-Shin Test
Laying on side, with the one foot in the air, you would be asked to quickly move the foot heel to shin rapidly.
If there is cerebellar damage, this movement would be jerky and very effortful.
Also used for cerebellar damage: Point-to-point test: Takes a lot of effort to touch your nose
To maintain balance, you need ⅔ following things:
- Healthy functioning cerebellum
- Healthy functioning vestibular organ
- Healthy functioning visual system
Romberg Test
- Palms up, hands forward, eyes closed (eyes closed means there is only the vestibular system and cerebellum at play)
- So if your vision is removed and the two other systems for balance are fine you should be able to balance fine
- If not, it can be detected that there is an issue with the cerebellum or the vestibular system/organ
To identify lack of coordination, remove a sense
