Neurology Exam Flashcards
Ptosis
CN3
Dropping eyelid past the upper margin of the pupil
= levator palpebrea weak
Pupillary Dilation or asymmetry
CN3
Due to disruption of the ciliary plexus
(Parasympathetic to pupil = constriction [miosis] lost) = dilation and fixed
Ophthalmoplegia
CN 3 to major extraocular muscles lost
DOWN AND OUT
Presentation of CN 3 lesion
Sudden, unilateral ptosis + ophthalmoplegia
Diplopia can be masked if ptosis is severe
Esotropia
CN 4
Eye shifts medially
CN 4 lesion
Weak down gaze
Superior oblique is weak
EYE DRIFT UP
(Vertical diplopia, difficult reading plus walking down, head tilting can cause torticollis)
CN 4
Vertical diplopia
Double vision that increases when looking down
CN 4
Head tilting
To opposite side of lesion
CN 6 lesions
Convergent (medial) strabismus (esotropia):
Horizontal diplopia:
Most common palsy
Seen in patients often with subarachnoid hemorrhage, late syphilis, and trauma
Inability to abduct eye (lateral Rectus lost)
Looking to the side that is effected causes maximum separation
CN 5 lesions
Decreased face sensation and mucus membranes
Lost CORNEAL REFLEX
weak of mastication muscles
Jaw deviation toward weak side (weak pterygoid muscle)
Trigeminal Neuralgia
CN 5
(90% due to to artery or vein compressing the nerve)
Brief episodes of unilateral shock like pain along one or more of the CN 5 dermatomes
CN 7 lesions
Facial muscle paralysis (Bells Palsy)
COREAL REFLEX lost
Hyperacusis (sensitive to sounds)
Crocodile tear syndrome (damaged nerves regenerate and cause tears while chewing), usually when surgery on parotid gland
Bilateral facial palsy(Guillain-Barre Syndrome)
Supranuclear (central) facial palsy : lower face droop due to CBC neurons and hemiplasia
CN 8 Vestibular lesions
Disequilibrium (imbalances)
Nystagmus (rapid involuntary and rhythmic movement of eye
CN 8 Cochlear
Destructive leasion: sensorineural hearing loss (Acoustic Neuroma)
Irritative lesion: tinnitus (ringing in ear)
(Medications like aspirin and some ABs)
CN 9 and 10
Lite to voice and nasal tone (palatal weakness)
Gag
Say ahhh (palate raised)
Lesion 9:
No gag
No sensation in posterior 1/3 tongue
Some dysphagia
Lesion 10: No gag or cough Dysphonia Dysphasia Dyspnea
CN 11 lesions
Can turn head to side that is effected
Shoulder drop
Documenting CN test if lazy
CNs gossly intact
I didn’t spend time doing the test only I also didn’t notice anything that made me think I would need to go though them
Documenting CN test after doing it
CNs 2-12 intact to testing
Sensory dermatomes C4 C6 C7 C8 T1 T4 T10 L4 L5 S1
T4:
Pain and temp
Vibration and proprioception
Spinothalamic Tract
Posterior column
Stereognosis
Able to identify shapes of objects or what is in my hand
Graphesthesia
Can identify numbers written on the palm
Two point discrimination
Double simultaneous stimulation
Distinguish if being touched by one amid two points
Can fell 2 locations being touched at the same time
Sensory loss patterns
Single nerve
Root (many nerves)
Spinal cord
Brain stem= crossed findings face and body opposite ()
Thalamic: hemiplasia pall over
Cortical loss: loss of cortical sensation still functional primary sensations
Functional loss: no anatomical distribution it’s by function
Cerebellum testing
Rapid alternating movement (dynsenmeteinuys) Finger to nose (Dysmetria) Heel to shin Gait Get up and go Romberg test Pronator drift
Reflex
0
1 low to normal
2 normal
3 brisker then average only doesn’t have to be a disease
4 very brisk and clonus (flex and ext oscillations)
Motor grading
0 no muscle contraction
1 flicker or trace of contraction
2 actively move however not against gravity
3 move against gravity no resistance
4 move agains t gravity and some resistance
5 normal
Cerebellar Ataxia
Staggering, unsteady, feet wide apart
Sensory ataxia
Unsteady, feet wide apart, feet thrown forward and down heel to forefoot and looks down when walking
Parkinsonian gait
Stooped forward, shuffling with some hesitation and less swinging of arms
Plantar babinski reflex
UMNs
Nuchal Rigidity
84% meningitis
21-86% subarachnoid hemorrhage
Utilize imaging to rule out any trauma
Brudzinski sign
Patient lays down and physician flexes neck causing pain and knees and hips flex up in response
Kernigs sign
Flex patients hip and leg while laying down
If patient lifts neck due to pain it is positive
