Nevrologisk undersøkelse - Amboss Flashcards
What is the mental status examination?
A key component of any neurological examination assessing various aspects of a patient’s mental state
It involves evaluating appearance, behavior, cognition, mood, speech, thought processes, and more.
List the components assessed in a mental status examination.
- Appearance and behavior
- Sensorium and cognition
- Mood and affect
- Speech
- Thought process
- Thought content
- Perceptual disturbances
- Insight and judgment
Each component provides insight into the patient’s mental state.
What is the focus of the mental status examination in emergency settings?
Assessment of orientation and level of consciousness using standardized scales
An example of a standardized scale is the Glasgow coma scale.
True or False: The mental status examination is only necessary for patients with known neurological disorders.
False
It is a key component of any neurological examination regardless of the patient’s history.
Fill in the blank: A more focused mental status examination is performed in the workup of specific _______.
[neurological disorders and symptoms]
What standardized scale is commonly used to assess level of consciousness in emergency settings?
Glasgow coma scale
This scale helps to evaluate a patient’s responsiveness and cognitive function.
What is the significance of insight and judgment in the mental status examination?
They provide insight into the patient’s awareness of their condition and decision-making capabilities
These elements can indicate the severity and impact of mental disorders.
What is aphasia?
The inability to either form or understand language not attributed to the motor ability to produce speech.
Aphasia is a communication disorder that affects a person’s ability to process language, often due to brain damage.
What typically causes aphasia?
Damage to different areas of the dominant hemisphere (usually left).
The left hemisphere of the brain is commonly associated with language processing in right-handed individuals and many left-handed individuals.
True or False: Aphasia affects motor ability to produce speech.
False
Aphasia specifically relates to language comprehension and formulation, not the motor skills required for speech.
Hva er Brocas afasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hva er Wernickes afasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hva er global afasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hva er assosioativ afasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hva er anomisk afasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hvilke tre typer transkortikale afasier skiller man mellom?
Transkortikal motorafasi
Transkortikal sensorisk afasi
Transkortikal blandet afasi
Hva kjennetegner transkortikal motorafasi?
Lokalisasjon av lesjon, type og kliniske trekk
Hva kjennetegner transkortikal sensorisk afasi?
Hva kjennetegner transkortikal blandet afasi?
Fyll inn
Types of Aphasia
The different types of aphasia can be divided by the presence of good or poor comprehension (red versus blue), good or poor repetition (top three versus bottom three), as well as nonfluent or fluent (light grey versus dark grey).
Hvorfor utfører man us. av hjernenervene?
The cranial nerve examination is used to identify problems with the cranial nerves by physical examination.
Hvordan tester man n.olfactorius?
Hjernenerve I
Hva tester man ved us. av n.opticus?
Hjernenerve II
Hvordan tester man synsskarphet?
Hvordan tester man fargesynet?
Hvordan tester man synsfeltet til pas.?
Hvordan undersøker man papillen?
Øyet
Hvordan tester man nn.oculomotorius, trochlearis et abducens?
Pupillerefleks
Bevegelse av øynene
Visuell akkomodasjon:
- Akkommodasjon er en prosess som øker lysbrytingen i øyet og dermed gjør det mulig å lese liten skrift og se enda mindre objekter klart på nært hold.
Øyelokks ptose:
- M.levator palpebrae superior dysfunksjon
Hvordan tester man pupillerefleksen?
Hva er skjer ved test av pupillerefleksen?
Fyll inn
Pupillary light reflex
The afferent pathway (blue tract) is initiated when light hits the retina:
- Retinal photoreceptors → ipsilateral optic nerve → nuclei of bilateral pretectal areas (nasal fibers of the optic nerve cross to the contralateral side at the optic chiasma)
The efferent pathway (green tract) transmits neural impulses to the iris sphincter muscle:
- Nuclei of pretectal area → bilateral Edinger Westphal nuclei (parasympathetic preganglionic nucleus of the oculomotor nerve) → bilateral oculomotor nerves (synapse at the ciliary ganglion) → bilateral iris sphincter muscle (and ciliary muscle) → bilateral pupillary constriction (and accomodation).
Shining a light into one eye causes constriction of the ipsilateral pupil (direct pupillary reflex) as well as that of the contralateral pupil (indirect or consensual pupillary reflex).
Hvordan tester man pas. øyebevegelser?
Hvordan klassifiseres nystagmus?
Characterization of nystagmus by direction
In jerk nystagmus, there is a slow drift phase followed by a fast corrective phase.
The name of the nystagmus is determined by the direction of movement in the fast phase (left horizontal, right horizontal, downbeat, upbeat, clockwise, or counterclockwise).
Hvordan er den kliniske testingen av ekstraokulære musklene?
Clinical testing of the extraocular muscles
A quick clinical examination of extraocular muscle function can be performed by asking the patient to follow the examiner’s finger with the eyes while keeping the head immobile. Tracing the letter “H” in the air (dark grey arrows) will prompt the patient to move through the 6 cardinal positions of gaze. In these positions, a single muscle is the primary mover for each eye.
Some examiners find it beneficial to return to the center between each cardinal position, drawing a star shape (dark grey horizontal arrow plus light grey arrows), while others combine the complete “H” and diagonal movements.
Note that for all muscles except the lateral- and medial recti, the directions in which these muscles are tested clinically (shown here) differ from the direction they would move the eyeball if acting in isolation. The difference arises because eye movements are the result of complex interactions between several extraocular muscles. Therefore, the movement used to test a particular muscle clinically is the movement that most effectively excludes the participation of other muscles. For example, while the superior oblique (SO) depresses and abducts the eye when acting in isolation, depression is also produced by the inferior rectus (IR), and abduction is also produced by the lateral rectus (LR). However, due to their different points of insertion, the IR is the more efficient depressor of the eye in abduction, while the SO is the more efficient depressor in adduction. Looking down and inwards, therefore, allows the isolated clinical examination of the SO (as shown here). Similar principles apply to the movements used for clinical testing of the IR, SR, and IO.
Hvordan tester man akkomodasjonen?
Nevrologisk us.
Hvordan tester man m.levator palpebrae?
Hvilke us. gjør man når ved testing av n.trigeminus?
Følesanser i ansiktet
Muskelfunksjon
Hvordan tester man sansene i ansiktet?
Fyll inn
Hvordan tester man ansiktets tyggemuskler?
Hjernenerveus.
Hvilke us. gjør man når man tester n.facialis?
Motorfunksjon:
- Ansiktets mimiske uttrykk
Smakssans
Hvordan tester man ut mimikken til pas.?
Hvordan tester man ut smakssansen til pas.?
Hvordan kan man skille mellom sentral og perifer facialisparese?
Examination findings in facial nerve palsy
Symptoms in central facial palsy are caused by a contralateral upper motor neuron (UMN) lesion. Because muscles responsible for eyelid and forehead movements are innervated by upper motor neuron fibers from both hemispheres, their function is preserved in central facial palsy. In peripheral facial palsy, damage to lower motor neuron (LMN) fibers results in ipsilateral paralysis of all facial muscles. Because sensory and autonomic fibers join the lower motor neuron fibers of the facial nerve in its peripheral course, peripheral facial palsies can also manifest with non-motoric symptoms.
Hvilke us. gjør man ved testing av n.vestibulocochlearis?
Hørselstest
Vestibulocochlear refleks:
A brainstem reflex elicited by activating the vestibular system (e.g., via head movement or caloric stimulation). Normally, the eyes move in the opposite direction to the head movement/caloric stimulation with warm water to stabilize the image in the center of the visual field. The reflex is mediated by the afferent sensory pathway of CN VIII and the efferent motor pathway of the contralateral CN VI and the ipsilateral CN III.
Balansetester
VIII
Hvordan tester man hørselen til pas.?
Hvordan kan man us. den vestibulocochleare refleksen?
Head impulse test:
A maneuver to examine the vestibuloocular reflex and clinically differentiate between peripheral and central causes of acute vestibular syndrome. Considered abnormal if the patient is unable to maintain central visual fixation, in which case a corrective saccade (quick eye movement) occurs to fixate on the target again. This indicates a deficient vestibuloocular reflex on the side of the head turn.
Hvordan kan man teste balansen til pas.?
Hvordan kan man undersøke pasientens nn.glossopharengeus et vagus?
Hva ser man på ved å undersøke ganen til pas.?
Hjernenerver?
Hvordan tester man HN IX og X hver for seg?
Hvordan tester man n.accessorius
Hvordan tester man n.hypoglossus?
Ved pupillerefleksen, hva er hhv.:
- Afferente leddet
- Efferente leddet
- Undersøkelsesteknikk
- Normale funn
Ved kornea, konjunktiva- og lakrimasjonsrefleksen, hva er hhv.:
- Afferent ledd
- Efferent ledd
- Undersøkelsesteknikk
- Normale funn
Hva “Jaw jerk” refleksen, hva er hhv.:
- Afferent ledd
- Efferent ledd
- Undersøkelsesteknikk
- Normale funn
Ved brekningsrefleksen, hva er hhv.:
- Afferent ledd
- Efferent ledd
- Undersøkelsesteknikk
- Normale funn
Ved hosterefleksen, hva er hhv.:
- Afferent ledd
- Efferent ledd
- Undersøkelsesteknikk
- Normale funn
Hvordan definerer man øvre- og nedremotornevronskader?
Hvordan ser man forskjellen mellom en sentral- og perifer nerveskade ved å se på muskler?
Fasciculation
A twitching of muscle caused by involuntary, asynchronous contraction of muscle fascicles within a single motor unit (i.e., all fascicles supplied by a single motor neuron).
Usually benign but can signify a lower motor neuron lesion when accompanied by other motor deficits.
Hva karakteriserer hhv. sentral skade fra perifer skade?
Hva er spastisitet?
Hva er klonus?
Spasticity
A physical finding of increased, involuntary, velocity-dependent muscle tone, which causes stiffness, and/or tightness of the muscles and manifests as resistance to movement. Occurs following damage to the primary motor cortex or the corticospinal tract (e.g., stroke, neurodegenerative disease, cerebral palsy).
Clonus
A series of rapid, rhythmic, involuntary muscular contractions.
Hva skjer ved blærefunksjonen ved sentral skade vs. perifer?
Hvordan er Babinskis tegn ved hhv. sentral- og perifer skade?
Hva er vanlige etiologier til sentrale symptomer?
Hva med perifere skader?
Hvilke funn kan man gjøre ved inspeksjon av muskulatur?
Hva er myoklonus?
Beskrivelse og årsak
Hva er asterixis?
Beskrivelse og årsak
Hva er akatisi?
Beskrivelse og årsak
Hva er atetose?
Hva er chorea?
Beskrivelse og årsak
Hva er dystoni?
Beskrivelse og årsak
Hva skiller man tremor på?
Hvile
Intensjon
Postural
Hva kjennetegner de ulike formene for tremor?
Beskrivelse og årsak
Hva er balisme?
Beskrivelse og årsak
Hva er tics?
Beskrivelse og årsak
Hvordan klassifiserer man kraft?
Muskelus. ved nevro
Hva er pronator drift test?
Hvorfor utføres dype reflekser?
Hvilke reflekser tester C5-C6?
Hvilke reflekser tester C7-C8?
Hvilke reflekser tester L2-L4?
Hvilke reflekser tester L5?
Hvilke tester S1-S2?
Hvordan graderes reflekser?
Hvordan er det fysiologiske grunnlaget for reflekser?
Stretch reflex
Striking the patellar tendon results in two reflexes that occur simultaneously:
(a) Monosynaptic reflex: Stretching of the patellar tendon is detected by muscle spindles in the quadriceps femoris muscle. An impulse is passed to the spinal cord via somatic afferent (Ia) fibers of pseudounipolar neurons, the somata of which are located in the dorsal root ganglion. In the anterior horn, the afferent neurons synapse directly with α motor neurons that innervate the same muscle and thus cause contraction.
(b) Polysynaptic reflex: The afferent neurons synapse with inhibitory interneurons in a different segment of the spinal cord. These interneurons then inhibit the α motor neurons of the antagonistic muscle.
