Neuruo Flashcards
CNS
Brain (stem and cerebellum) and spinal cord
PNS
cranial nerves, spinal and peripheral nerves
Frontal lobe
motor cortex, reasoning memory, speaking, emotions
Parietal lobe
sensory cortex, reading, understanding spacial relationships
Occipital
vision
Cerebellum
balance, coordination, fine muscle control
brain stem
breathing, bp, HR, swallowing, body temp, digestion
Temporal lobe
understanding language, behavior, memory hearing
Spinal vertebrae
cervical- 7
Thoracic- 12
Lumbar- 5
Sacral- 5
Sensory pathways
Spinothalamic tract
Posterior column
Spinothalamic tract
crude touch, pain, temp
travel from periphery to spinal cord and cross to contralateral side BEFORE continuing to brain
Posterior column
vibration, proprioception, fine touch
Travel from periphery to spinal cord and stay on the SAME SIDE until reaching the brain stem, then cross
Motor pathway
UMN originate in pre-central gyrus (primary motor) and crosses contra-lateral in the medulla
Axons descend to synapse with anterior horn of LMN in PNS
Ataxic
gait that lacks normal coordination
Gait that lacks coordination and stability is due to
cerebellar disease, loss of positions sense or intoxication
Steppage gait
patient drags foot or lifts them high, then foot slaps floor; due to tibialis anterior and toe extensor weakness; LMN/peripheral nerve injury
Spastic Hemiparesis
drag toe, circle leg stiffly outward and forward (circumduction), or lean trunk to contralateral side to clear affected leg during walking; affected arm is flexed, immobile and held close to the side, with elbow, wrists and interphalangeal joints flexed;
affected leg extensors are spastic, ankles are plantar flexed and inverted
When do you see spastic hemiparesis
stroke
Steppage gait is seen with
LMN/peripheral nerve injury
Scissors gait
patients advance each leg slowly and thigh tend to cross; stiff gait and short steps
May look like they’re walking through water
Scissors gait
Scissors gait is seen with
spinal cord disease and spasticity disorders (cerebral palsy)
Sensory ataxia
unsteady gait and wide based stance; throw feet forward and outward, first bring down heel then toes with DOUBLE TAP; watch ground; usually have assistive device
Sensory ataxia gait is due to
Loss of proprioception (polyneuropathy, posterior column damage)
Parkinsonian Gait
Stooped posture with head, arm hip and knee flexion; shuffling, short steps; slow to start; decreased arm swing and stiff turns
Parkinsonian gait
due to basal ganglia abnormalities (Parkinson’s disease)
Coordination requires
motor
cerebellar
vestibular
sensory
Romberg Test
position sense; stand with feet together, eyes closed; abnormal = unable to maintain upright posture
(+) Romberg could mean
dorsal column disease (can do with eyes open but not closed); cerebellar ataxia (can’t balance w/ or w/o eyes open)
Pronator drift
standing with eyes closed, elevate arms to shoulder level with palms up; firmly tap on arm and patient should bring arm back up;
Abrnomal = unable to keep arms at should heigh and/or arm probates/drifts down
Cause of pronator drift
UMN lesion = possible stroke
heel to shin test
Place heel at opposite knee, slide down leg then back up; should be able to keep contact with opposite leg
(+) heel to shin test
cerebellar disease (hell overshoots need, or foot oscillates side to side); Position sense absent (heel lifts too high)
(+) Finger-to-nose test
intentional tremor- multiple sclerosis
(+) Rapid alternating movement
cerebellar disease: slow, clumsy, irregular movement = dysdiadochokinesis
Dysdiadochokinesis
slow, clumsy, irregular movements
A&O x 4
person, place, time, situation
Cranial nerves
I: olfactory II: Optic III: Oculomotor IV: Trochlear V: Trigeminal VI: Abducens VII: Facial VIII: Acoustic IX: Glossopharyngeal X: Vagus XI: Spinal XII: Hypoglossal
Olfactory (CN I)
Function: smell
Test: smell familiar scent
Abnormal: anosmia (head trauma, parkinson disease)
Optic (CN II)
Function: Vision
Test: visual field, acuity, funuscopic, pupillary light reflex
Abnormal: visual field defect secondary to retinal emboli, optic neuritis, pituitary tumor, stroke
Oculomotor (CN III)
Function: eye movement
Test: EOM’s, pupillary light reflex
Abnormal: vertical and horizontal diplopia; ptosis = CN III palsy
Trochlear (CN IV)
Functioin: Superior oblique, downward and internal rotation of eye
Test: EOM’s
Abnormal: vertical diplopia
Trigeminal (V)
Function: Motor- temporal, masseter and lateral pterygoids
Sensory: 3 divisions
Test: clench jaw and lateral jaw movement , check facial expression
Abnormal: trigeminal neuralgia
Abducens (VI)
Function: lateral rectus, lateral deviation of the eye
Test: EOM’s
Abnormal: Horizontal diplopia, esotropia
Facial (VII)
Function: motor- facial movements; sensory: taste anterior tongue
Test: funny faces
Abnormal:
peripheral- bell’s palsy (entire one side)
central- cerebral infarct (spares forehead)
Acoustic (VIII)
Function: hearing and balance
Test: gross hearing, gait
Abnormal: disequilibrium, vertigo, nystagmus
Glossopharyngeal (IX)
Funciton: motor: pharynx, Sensory: posterior tongue
Test: gag reflex
Abnormal: no gag reflex, loss of taste to posterior 1/3 of tongue
Vagus (X)
Motor: palate, pharynx, larynx
Sensory: pharynx, larynx
Cardiac, thorax and abdomen
Test: palate elevation, quality of “ah” and uvula midline
Abnormal: hoarseness, dyspnea, dysarthria, loss of gag reflex
Spinal (XI)
Function: SCM and trap
Test: shoulder shrug and head rotation
Abnormal: trap weakness, atrophy and fasciculations = scapular winging
Scapular winging is indicative of
Spinal nerve problem
Hypoglossal (XII)
Funciton: tongue movement
Test: wag tongue
Abnormal: central lesion = tongue deviates away
Peripheral lesion = tongue deviates to weak side
Anesthesia
absence of touch sensation
Hypoesthesia
Decreased sensation to touch
Hyperesthesia
Increases sensitivity to touch
Allodynia
pain elicited from non-painful stimulus
Analgesia
absence of pain sensation
Hypoalgesia
decrease in pain awareness
Hyperalgesia
Increased sensitivity to pain
Lateral upper arm dermatome
C5
Radial forearm and thumb
C6
Middle Finger
C7
Ring and little finger
C8
Ulnar forearm
T1
Nipple line
T4
Umbilicus
T10
Inguinal region
L1
Anterior/proximal thigh
L3
Knee/medial skin
L4
Lateral shin, dorsal foot to great toe
L5
Lateral and plantar foot
S1
Stereognosis
ask patient to shut eyes and recognize familiar object in hand
Graphesthesia
number identification in hand
Normal two-point discrimination
<5 mm on finger bads
Static tremor
seen at rest; Parkinson disease (pill-rolling tremor)
Postural tremor
seen when affected area maintains posture (Hyperthyroid, anxiety, fatigue, benign essential)
Intention tremor
absent at rest, appear with movement; Multiple sclerosis
Pin-rolling tremor
Parkinson’s
Tic
brief, repetitive, twitching
What disorders are seen with Tics
tourette syndrome, medications
Dystonia
Twisted posture of large body parts
Dystonia is associated with
meds, spasmodic torticollis
Dyskinesias
bizarre, rhythmic, repetitive movement
Dyskinesias associated with
parkinson disease, psychoses, meds
Akathisia
inability to sit still; due to meds (antipsychotics, compazine)
Chorea
brief, jerky, rapid, unpredictable movements; associated with Huntington disease, rheumatic fever
Athetosis
slow, twisting, writhing movement; cerebral palsy
Hypotonia/flaccidity of muscles
central and peripheral causes
Spasticity of muscles
increased muscle tone, velocity dependent; central corticospinal tract disease
Rigidity
increased resistance throughout ROM; Cog-wheel rigidity– Parkinson’s disease
Muscle Strength Grading
0- no muscle contraction 1- visible contraction, no movement 2- joint motion, but not against gravity 3- movement against gravity only 4- movement with some resistance 5- full strength with full resistance
Shoulder Abduction
C5, axillary nerve
Elbow flexion
C5, C6; musculocutaneous
Elbow extension
C6, C7; radial
Wrist extension
C6, C7; radial
Wrist felxion
C7, C8; median
Finger abduction
C8, T1; ulnar
Thumb opposition
C8, T1; median
Test for Radial nerve
make fist
Test for ulnar nerve
spread fingers against resistance
Test for median nerve
okay sign
Hip flexion
L2,3; femoral
Hip extension
L4, 5; gluteal
Knee extension
L3,4; femoral
Knee flexion
L5, S1; sciatic
Ankle dorsiflexion
L4, 5; peroneal
Ankle plantar flexion
S1; plantar
Reflex scales
0- no response \+1- diminished \+2- normal \+3- increased \+4- hyperactive, associated with clonus
Hypoactive DTR
diminished or absent
disease of spinal nerve roots or peripheral nerves (LMN)
Hyperactive DTR
brisk and can be associated with clonus; CNS lesions along descending corticospinal tract (UMN)
LMN findings
hypoactive
weakness
atrophy
fasciculations
UMN findings
Hyperactive
weakness
spasticity
positive babinski
Biceps DTR tests
C5,6
Brachioradialis DTR tests
C5,6
Triceps DTR tests
C6, 7
Patella DTR tests
L4
Achilles DTR tests
S1
Clonus
forced dorsiflexion of foot; evaluate for rhythmic oscillations; can be normal if bilateral; if abnormal, check at wrist
Abnormal clonus is due to
UMN disease
Babinski sign
L5, S1
Normal for toes to flex
Abnormal: great toe extends and other toes fan out (CNS lesion affecting cotricospinal tract)
Superficial abdominal reflex
draw towards belly button from each quadrant;
Normal: muscle contracts toward umbilicus
Abnormal: central and peripheral pathologies
Cremasteric Reflex
stroke proximal medial thigh;
normal: ipsilateral testicle to rise
Abnormal: UMN, LMN; L1,L2 nerve injury; ilioinguinal injury s/p hernia repair
Brudzinski
Flex patient’s neck
Normal = remain relaxed
Abnormal: hip and knee flexion (meningeal sign)
Nuchal rigidity
Place hands beind patien’s head and flex head toward chest;
Normal: easy motion
Abnormal: pain and resistance indicating potential meningeal irritation
Kernig sign
Flex patient’s hip and knee, then straighten knee;
Normal: may have tightness in hamstring
Abnormal = pain pain and resistance indicating meningeal irritation
