Neurovascular Pathology (2) Flashcards
How might you be able to gain information from an obtunded patient?
History from paramedics, bystanders.
ABC
GCS
Pupils
What must you consider in an obtunded patient?
Cerebral perfusion/metabolic, cerebral herniation.
How might you gain information from a confused/dysphasic/preverbal patient?
History from family/notes. Observe posture, focal lack of movement, neglect, eye movements, assess the speech. Do mini mental score.
What sort of posture results from damage to one or both corticospinal tracts?
Decorticate posture.
What may you inspect when there is high suspicion of frontal lobe damage?
(maybe take this out? - shite q)
Decorticate posture, magnetic gait, urinary catheter, abulia (lack of willpower), UMN signs (weakness, increased tone, brisk reflexes, up-going plantar, pronator drift)
Saccadic eye movements, primitive reflexes
Damage to orbitofrontal cortex (restraint) - go/no go tests, stroop tests, speech and behavioural socially appropriate?
Supplementary motor cortex/anterior cingulate damage (initiative) - lack of motivation, apathy, abulia, depression.
Dorsolateral prefrontal cortex (order) - lack of executive function (ability to keep appointment on time, coherent accounts of history, spell words backwards, say as many words as they can starting with a particular letter.
How can you examine the language skill os f patient?
ENSURE hearing in tact and English is first language. Fluency - Brocas Nominal aphasia Difficulty with repetition - arcuate fasiculus. 3 step command - Wernicke's. Baby hippopotamus - Cerebellar speech. Orofacial movement - ppp, ttt, mmm Reading and writing
What are signs of a parietal lobe lesion?
Cortical sensory syndromes - Sensory inattention Astereoagnosia Dysgraphasthesia Two point discrimination
Dominant side - Dyscalculi Finger anomia Left/right disorientation Agraphia
Non-dominant - Idiopathic apraxia How to do - light a match Ideational apraxia What to do - loss of understanding of purpose of objects Constructional apraxia Dressing apraxia Hemineglect Loss of spatial awareness
What are cerebellar signs?
Dyskiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia Past pointing
What symptoms fit with a radiculopathy?
Unilateral, single myotome, single dermatome (reflex), LMN.
What symptoms fit with a peripheral nerve lesion?
Unilateral motor and sensory deficits with PN, LMN.
What symptoms fit with a myelopathy?
Bilateral, motor and sensory level, UMN.
What symptoms fit with a peripheral neuropathy?
Glove and stocking disruption.
