Neurological Seminology Flashcards
Bell’s Palsy
Idiopathic disorder of facial nerve 7 - unilateral facial weakness and inability to close the eye
Bilaterla ptsosi
Unusual finding that signals NM weakness…consider MG, Miller fisher variant of G-B syndrome and botulism
Corneal reflex
Use cotton wisp and approach lateral aspect…predominantyl tests opthalmic division of trigeminal but facial nerve involved in efferent
Deep tendon reflexes
2/4 normal
Hyper reflex - hyeradrenergic and focal with UMN dz as you lose inhibitory effect of LMN
Hyporeflexia - neuropathy, acute spinal dz, LMN damage, NMJ dz like MG
CLonus and hypothyroidism
Clonus - repeated contractiojn after elicitation of deep tendon reflex…indicating extreme hyper reflexia
Hypothyroidism - slow relaxation phase of deep tendon reflex
Diff cortical and lacunar stroke
Hemiplegia/paresis usually indicats vascular etiology
Cortical - 80% by ischemia produce weakenss in predictable patter based on cortical motor strip
Hand and face have large rep due to complication actions with sparing of lower…also may involve sensroy cortex and involve speech problems
Lacunar - pure motor or sensory defects…large infarcts of small penetrating arterioles that effect radiation of the cortical neurons and as such, small lesion can effect a large dist without sensory def or other indicaiton of cortical event
Motor units of cranial nerves receive cortical input so pt does not develop deviated tonuge unless hypoglossal nucleus or nerve is inovlved…upper face involvement diff cortical stroke from bells palsay
TIA mechs
1) low flow state due to large art occlusion
2) small emboli from large artery or heart
3) lacunar TIA from stenosis of small penetrating vessel…may involve anterior (carotid) or posterior (vertebral and basilar arteries)…resolves in 24 hours but IDs pt at high risk of stroke
Dolls eyes
Tests CN 8 and semicricular canal function…performed in comatose ony
Manually raise both eyelids and move head side to side….if they don’t move in tandem, damage to one or more
Frontal release signs
Palmomental relfex (stroke thnar area of hand and cause contraction ipsi or orbicularis oris and mentalis)
Suck reflux - sucking movements of lips when stroked or touched
Snout - puckering or protrusion of lips with percussion
Grasp - examiner hand is placed softly into pts palm during distraction - stroking produces grasps that persists with movement
Cerebellar ataxia
Wide-based, unsteady, lateral veering…MS or tumor or cerebellum
Sensory ataxia
Loss of propioception so pt subs visual and nociceptive glues
Stamp and stick gait with pt looking at ground
B12 def, tabes dorsalis, and other post column dz
Festinating gait
Shuffling steps with rigitdity…lowwrr body chassing upper…Parkinsons
Steppage or equine gait
Cannot dorsiflex foot - trauma to peroneal nerve, Charcot-Marie-Tooth
Plantar relfex
Firmly strok the plantar surface from post to ant
rResponse normally flexin
Ext normal in newborn but otherwide pathologic - UMN
Common etiologies - cortical stroke, spinal cord dz from B12 def, and occasisonaly drug-induced
Triple flexion
Ultimate babinski reflex with exten and fanning of toes, dorsiflexion at ankle and flexion of knee and hip
