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NTPE > NM > Flashcards

NM Flashcards

1
Q

What sulcus separates the fronal and parietal lobe?

A

central

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2
Q

What sulcus separates the parietal lobe from the frontal and temporal lobes?

A

lateral central fissure

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3
Q

Where is the primary vestibular area located in the brain?

A

temporal loe

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4
Q

What is the insula responsible for?

A

visceral functions

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5
Q

What is the function of the limbic system?

A
  • basic feeding
  • aggression
  • endocrine aspects of sexual response
  • memory
  • motivation
  • learning
  • instincts and emotions
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6
Q

What makes up white matter?

A

myelinated axons

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7
Q

What circuit in the basal ganglia functions with saccadic eye movements?

A

oculomotor circuit (caudate loop)

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8
Q

What circuit in the basal ganglia leads to an increase in ventral lateral nucelus and supplemental motor area activity?

A

motor loop

  • functions to scale amplitude and velocity
  • reinforced selected patterm and suppresses conflicting pattern
  • movement preparation
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9
Q

What does the thalamus do?

A

sensory and motor relay

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10
Q

What sensory nuclei are NOT included in the thalamus?

A

olfactory

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11
Q

What does the subthalamus do?

A

assissts in controlling functional pathways for motor, sensory, and reticular formation

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12
Q

what does the hypothalamus do?

A
  • controls the ANS and neuroendocrine systems
  • maintains homeostasis (temperaure, eating/drinking, sexual ehavior, emotion)
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13
Q

what makes up the epithalamus? What do they do?

A
  1. habenular nuclei: integrate olfactory, visceral, and somatic afferent pathways
  2. pineal gland: secretes hormones that influence the pituitary gland and other organs — circadian rhythm
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14
Q

What is another name for the midbrain?

A

mesencephalon

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15
Q

What part of the midbrain contains ALL ascending tracts and some descending tracts?

A

tegmentum (posterior portion)

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16
Q

What tract originates at the red nucleus?

A

rubrospinal tract

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17
Q

What is the rubrospinal tract important for?

A

coordination

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18
Q

What CNs are located in the tegmentum of the midbrain?

A

CN III and IV

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19
Q

What does the superior peduncle of the midbrain connect?

A

midbrain and cerebellum

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20
Q

What does the substantia nigra do?

A

nucleus that connects the basal ganglia and cortex for motor control and muscle tone

location: midbrain

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21
Q

What is the superior colliculus a relay station for?

Midbrain

A

vision/visual reflexes

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22
Q

What is the inferior colliculus a relay station for?

A

hearing/auditory reflexes

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23
Q

What part of the midbrain is important for pain and reflex modulation?

A

periaqueductal gray

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24
Q

What are midline raphe nuclei important for?

location: pons

A

modulation of pain and controlling arousal

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25
Q

What CN nuclei are found in the tegmentum of the pons?

A
  1. V
  2. VI
  3. VII
  4. VIII
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26
Q

What part of the brainstem contains relay nuclei of the dorsal columns (gracilis and cuneatus)?

A

medulla oblongata

Fibers cross to give rise to the medial lemniscus

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27
Q

What does the inferior cerebellar peduncle found in the medulla oblongata relay?

A

relays the dorsospinocerebellar tract to the cerebellum

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28
Q

Where does the medial longitudinal fsaciculus originate? What is it important for?

A

a. vestibular nuclei and extends to the upper Cx spinal cord
b. head movement and gaze stabilization (vestibuloocular reflex)

Location: medulla oblongata

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29
Q

What is the olivary nuclear complex important for?

A

voluntary movement control

(location: medulla oblongata) - connects the cerebellum to the brainstem

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30
Q

What CN nuclei does the medulla oblongata contain?

A

CN VIII, IX, X

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31
Q

Where is the Reticular activating system (RAS) found?

A

anterior portion of the brainstem

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32
Q

What do the 4 nuclei of the RAS system produce?

A
  1. serotonin
  2. noepinephrine
  3. ACh

assists with attention, arousal, and muscle tone modulation

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33
Q

What results if the RAS is damaged?

A
  1. dysfunctional circadian rhythm
  2. impaired arousal
  3. impaired attention
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34
Q

What does the flocculonodular lobe regulate?

Vestibulocerebbellar lobe, archicerebellum

A
  1. equilibrium
  2. muscle tone regulation
  3. assists in coordination of vestibuloocular reflex
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35
Q

What does the spinocerebellum do?

rostral cerebellum, paleocerebellum, anterior lobe

A
  1. posture
  2. controls voluntary movements
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36
Q

What does the cerebrocerebellum do?

neocerebellum, lateral cerebellar hemispheres, posterior lobe

A

smooth coordination of voluntary movements - ensures accurate force, direction, and extent of the movement

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37
Q

What part of the cerebellum is important for motor learning, sequencing of movement, and visually triggered movements?

A

cerebrocerebellum

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38
Q

What do the portions of the central gray matter within the spinal cord contain? Each are different.

A

anterior horns: motor - efferent fibers
–> alpha motor neurons- muscles
–> gamma motor neurons- muscle spindles

posterior horns: sensory - afferent fibers

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39
Q

Where are lateral horns of the spinal cord found? What does it contain?

A

a. thoracic and upper lumar segments.

b. contains preganglionic fibers of the ANS

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40
Q

What are the 4 primary ascending columns of white matter? What tracts are included in each?

A
  1. dorsal columns/medial lemniscal system (fasciculus cuneatus and fasciculus gracilis)
  2. spinothalamic tracts (anterior and lateral ascending tracts)
  3. Spinocerebellar tracts (dorsal spinocerebellar tract, ventrospinocerebellar tract)
  4. spinoreticular tracts
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41
Q

What is the function of the dorsal columns/medial lemniscal system?

A

convey sensations of proprioception, vibration, and tactile discrimination

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42
Q

What is the function of the fasciculus cuneatus?

Lateral portion of dorsal columns

A

sensations of proprioception, vibbration, and tactile discrimination of the UEs (lateral tract)

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43
Q

What is the function of the fasciculus gracilis?

Medial portion of dorsal columns

A

sensation of proprioception, vibration, and tactile discrimination within the LEs

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44
Q

What is the pathway of the dorsal columns? Where is the medial lemniscus created?

A

Ascend to medulla –> cross over creating the medial lemniscus (lemniscal decussation) –> thalamus –> somatosensory cortex

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45
Q

What is the function of the lateral spinothalamic tract?

A

sensation of pain and temperature

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46
Q

What is the function of the anterior spinothalamic tract?

A

crude touch

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47
Q

What is lassauer’s tract? What tracts make this possible?

A

anterior and lateral spinothalamic tracts ascend 1-2 ipsilateral spinal cord segments and then penetrate the grey matter of the thalamus –> cross –> ascend into the cortex

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48
Q

What is the function of the spinocerebellar tracts?

dorsal spinocerebellar tract, ventrospinocerebellar tract

A

conveys proprioception information from muscle spindles, GTO, touch receptors, and pressure receptors for control of voluntary movements

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49
Q

The —– spinocerebellar tract ascends ipsilaterally to the inferior cerebellar peduncle

A

dorsal spinocerebellar tract

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50
Q

The —- spinocerebellar tract ascends controllaterally and ipsilaterally to the superior cerebellar peduncle

A

ventrospinocerebellar tract

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51
Q

What is the function of the spinoreticular tract?

A

conveys deep and chronic pain to the reticular formation (found in brainstem) via diffuse, polysynaptic pathways

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52
Q

What are the 4 descending tracts?

A
  1. corticospinal
  2. vestibulospinal
  3. rubrospinal
  4. tectospinal
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53
Q

what is the corticospinal tract important for?

A

voluntary motor control

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54
Q

What is the pathway of the corticospinal tract?

A

primary motor cortex –> cross in the medulla (pyramidal decussation) –> travel via lateral corticospinal tract to the anterior horn cells

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55
Q

What percent of fibers from the corticospinal tract do not cross in the medulla? Where do they go?

A

approx. 10% of fibers do not cross and instead travel in the anterior corticospinal tract to the cervical and upper thoracic spine.

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56
Q

Where do the vestibulospinal tracts arise from?

A

vestibular nucleus

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57
Q

What are the vestibulospinal tracts important for?

A
  1. muscle tone
  2. antigravity muscles
  3. postural reflexes
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58
Q

The vestibulospinal tract fibers that travel laterally (are/are not) crossed.

A

not crossed

Only the medial vestibulospinal tract contains crossed fibers

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59
Q

Where does the rubrospinal tract originate?

A

red nucleus

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60
Q

What are the rubrospinal tracts important for?

A

motor functioning

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61
Q

Where does the reticulospinal tract originate?

A

reticular formation of the brainstem

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62
Q

What portions of the spinal cord do reticulospinal tracts travel in?

A

anterior and lateral

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63
Q

What portion of the spinal cord do the rubrospinal tracts travel down?

A

lateral

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64
Q

Where does the tectospinal tract originate from?

A

superior colliculus (midbrain)

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65
Q

What are the tectospinal tracts important for?

A

head-turning in response to stimuli

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66
Q

What does the ANS innervate?

A

involuntary structures:
- smooth muscle
- heart
- glands

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67
Q

What is the role of the ANS?

A

maintaining homeostasis within the body

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68
Q

What spinal levels are included in the sympathetic portion of the ANS?

A

C8-L2

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69
Q

What does the sympathetic nervous system provide when initiated?

A
  1. fight-or-flight response
  2. increases HR and BP
  3. constricts peripheral blood vessels
  4. redistributes blood
  5. inhibits peristalsis
  6. relaxes airways
  7. stimulates release of epinephrine and noepinephrine from the adrenal medulla
  8. relaxes urinary bladder
  9. widespread effects

thoracolumbar region

Peristalsis: the involuntary constriction and relaxation of the muscles of the intestine and other structures

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70
Q

What spinal levels are included in the parasympathetic system?

A
  1. CN III
  2. CN VII
  3. CN IX
  4. CN X
  5. S2-S4

craniosacral regions

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71
Q

What does the parasympathetic system do when initiated?

A
  1. conserves and restores homeostasis
  2. decreases HR and BP
  3. increases perstalsis
  4. increases glandular activity
  5. constricts airways
  6. stimulates contraction of the bladder
  7. localized effects
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72
Q

What meningeal space contains CSF, cisterns, and major arteries?

A

subarachnoid space

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73
Q

Where is CSF produced?

A

choroid plexuses in the ventricles

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74
Q

What type of cells is the BBB associated with?

A

capillary endothelial cells

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75
Q

What percent of body weight is the brain?

A

2% with 18% of total blood volume

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76
Q

What do the vertebral arteries arise from? What do they form when they unite?

A

a. subclavian arteries
b. basilar artery - then branch off to form two posterior cerebral arteries

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77
Q

What does the vertebroasilar system arteries supply?

A
  1. cerebellum
  2. brainstem
  3. occipital lobe
  4. thalamus
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78
Q

What forms the circle of willis?

A

anterior and posterior communicating arteries that connect the two anterior and posterior cerebral arteries

posterior communicating artery also connects the middle cerebral artery

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79
Q

(true/false) Neuroglia (support cells) transmit signals

A

FALSE

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80
Q

What are neuroglia useful for?

A

myelin production and neuronal support

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81
Q

What is the resting membrane potential? Which side of the membrane is a positive charge? Negative charge?

A

a. -70 mV
b. outside: positive charge
c. Inside: negative charge

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82
Q

What causes an action potential?

A

Increased sodium permiability into the cell accompanied by outflow of potassium causing depolarization

approx. +35 mV inside of the membrane when occurring

follows the all-or-none rule

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83
Q

(true/false) conduction velocity is proportional to the axon diameter and degree of myelination

A

true

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84
Q

What causes repolarization of a cell?

A

activation of potassium channels

potassium being moved inside membrane

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85
Q

Describe saltatory conduction.

A

Nerve impulses jump between the nodes of ranvier

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86
Q

Identify the type of fiber:

  • large diameter
  • myelinated
  • fast conduction
  • alpha, beta, delta, gamma fibers dependent on amount of myelination and diameter
A

A fibers

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87
Q

What are A-alpha fibers responsible for?

A
  • proprioception
  • somatic motor input
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88
Q

What are A-Beta fibers responsible for?

A

touch and pressure

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89
Q

What are A-delta fibers responsible for?

A
  • fast/sharp/localized pain
  • temperature
  • crude touch
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90
Q

What are A-gamma motor fibers responsible for?

A

motor input to muscle spindles

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91
Q

Identify the type of fiber:

  • small diameter
  • myelinated
  • decreased conduction
  • preganglionic autonomic
A

B fibers

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92
Q

Identify the type of fiber:

  • smallest fiber
  • unmyelinated
  • slow conduction
  • polymodal fibers that respond to mechanical, chemical, and thermal stimuli
A

C fibers

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93
Q

What are the pure sensory CNs?

A

CN I, II, VIII

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94
Q

What are the pure motor CNs?

A

CN III, IV, VI, XI, XII

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95
Q

What are the mixed CNs?

A

CN V, VII, IX, X

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96
Q

What CNs carry parasympathetic nerve fibers?

A

CN III, VII, IX, X

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97
Q

What 3 tests are used for CN II?

A
  1. visual acuity
  2. snellen eye chart (central vision)
  3. confrontation test (peripheral vision)
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98
Q

What test is used for CN III?

A

pupillary response

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99
Q

What does CN III provide?

A
  1. convergence
  2. accommodation
  3. pupillary reflex
  4. movement: up/down, in, elevates eyelid

CN II has afferent reponse… CN III has efferent response

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100
Q

What movements does CN IV provide?

A

turns ADD eye downward

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101
Q

What are the sensory locations of CN V?

A
  • face
  • cornea
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102
Q

What muscles do CN V innervate?

A
  • temporal muscle
  • masseter
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103
Q

What are the 3 tests for CN V?

A
  1. pain and light touch at jaw, forehead, and cheeks
  2. corneal reflex
  3. palpation w/ teeth clenched
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104
Q

What are the sensory locations of CN VII?

A

Taste of anterior 2/3 of tongue

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105
Q

What 2 tests are used for CN VII?

A
  1. facial expressions
  2. taste on the anterior and lateral aspects of the tongue (using a cotton swab)
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106
Q

What 4 tests can be used for CN VIII?

A
  1. Rinne’s test
  2. VOR
  3. auditory acuity
  4. Weber’s test
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107
Q

Describe how to perform the Weber’s test. What is it used to test?

A

a. place tuning form on the middle of the head and see if the patient can hear the sound equally on both sides

b. CN VIII - lateralization

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108
Q

Describe how to perform the Rinne’s test. What is it used to test?

A

a. tuning fork is placed on the mastoid bone and then close to the ear canal… sound should be heard longer in the air than on bone.

b. CN VIII - air and bone conduction

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109
Q

What does the glossopharyngeal nerve provide?

CN IX

A
  • taste on posterior 1/3 of tongue
  • sensory of pharynx
  • sensory of middle ear
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110
Q

What are tests used for CN IX?

A

taste on the posterior 1/3 of tongue

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111
Q

What do CN IX and X provide?

A
  1. phonation
  2. swallowing
  3. gag reflex
  4. palatal control
  5. control of pharynx

  • “ah” test to observe palate movement and uvular movement (should remain at midline)
  • stimulating back of the throat
  • listen to voice quality
  • observe swallowing
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112
Q

What does CN XI provide?

A
  • trapezius movement
  • SCM movement

1.Test with examination of bulk/strength 2. SCM movement while in supine

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113
Q

What does CN XII provide?

A

movement of the tongue

Tests: listen to articulation, resting and active tongue positioning

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114
Q

What CN is reponsible for chewing?

A

CN V

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115
Q

What CN is reponsible for swallowing?

A

CN IX and X

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116
Q

What CN is responsible for the alimentary tract, heart, BVs, and lungs?

A

CN IX and X

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117
Q

(true/false) there is no dorsal root for C1.

A

True

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118
Q

What is anosmia?

A

inability to detect smells

also seen with frontal lobe lesions

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119
Q

A person presents with anosmia…. what CN is affected?

A

CN I

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120
Q

What is myopia?

A

Impaired far vision

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121
Q

What is presbyopia?

A

Impaired near vision

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122
Q

What CN is affected when exotropia or anisocoria are observed?

A

CN III

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123
Q

What is anisocoria?

A

Unequal pupils

124
Q

A person presents with ptosis and/or dilated pupils… what CN is affected?

A

CN III

125
Q

A patient presents with loss of ipsilateral corneal reflex… what CN is affected?

A

CN V

126
Q

Describe sensorineural loss.

A

loss of sound in the “good ear”

127
Q

Describe conductive hearing loss.

A

Sound of a tuning fork heard through the bone is equal to or longer than when in the air

128
Q

Describe dysphonia.

A

voice dysfunction: hoarseness, slurring

129
Q

Hoarseness in a person’s voice denotes what?

A

vocal cord paralysis

130
Q

Altered nasal quality in a person’s voice denotes what?

A

weak palate

131
Q

What is dysphagia?

A

Difficulty swallowing

132
Q

A pt presents with dysphonia and/or dysarthria… what CN is affected?

A

CN IX and/or X

133
Q

A pt presents with an absent gag reflex… what CN is damaged?

A

CN IX

134
Q

A pt presents with paralysis of their palate (unable to elevate)… what CN is damaged?

A

CN X

135
Q

A pt presents with unilateral paralysis of their palate… what CN is damaged?

A

CN IX and/or X

136
Q

What CN(s) are possibly damaged when a patient presents with dysarthria?

A

CN IX, X, and/or XII

137
Q

A UMN lesion affecting CN XII results in what?

A

mild to moderate contralateral weakness of the tongue - can be transient

138
Q

A LMN lesion affecting CN XII results in what?

A
  • paralysis
  • atrophy
  • fasciculations of the tongue on the involved side
  • deviation of protrusion is towards the weak side
139
Q

(true/false) Bilateral supranuclear/UMN lesions (pseudobulbar palsy) can cause moderate-severe loss of tongue function

A

True

Affects CN XII

140
Q

(anterior/posterior) rami join at the root of the limbs to create a plexus.

A

Anterior rami

141
Q

What nerves create the cervical plexus?

A

C1-C4

142
Q

What nerves create the lumbosacral plexus?

A

T12-L4

143
Q

What CNS structure is critical for maintaining autonomous rhythmic movements (swallowing, chewing, walking)?

A

brainstem

144
Q

what is remote memory?

A

long-term memory

145
Q

What is a popular, brief, screening test for cognitive dysfunction that includes screening items for orientation, registration, attention/calculation, recall, and language?

A

MMSE

146
Q

What is a MMSE score of 21-24 indicative of?

A

mild cognitive impairment

147
Q

What is a MMSE score of 16-20 indicative of?

A

moderate cognitive impairment

148
Q

What is a MMSE score <15 indicative of?

A

severe impairment

149
Q

(true/false) the MMSE is not a stand-alone tool for dx of cognitive impairment

A

true

150
Q

What does the Ranchos los amigos scale assess?

A

cognitive recovery from a TBI

151
Q

How many levels are there on the ranchos los amigos scale?

A

8

Level 1-8

1: no response
2-3: decreased response
4-6: confusion
7-8: appropriate response

152
Q

(true/false) Patients may plateau at any level of the ranchos los amigos scale.

A

true

153
Q

What portion of the brain causes non-fluent aphasia/expressive aphasia?

A

Broca’s area

impaired motor capabilities of speech

154
Q

What portion of the brain causes fluent/receptive aphasia?

A

Wernicke’s area

impaired auditory comprehension

155
Q

What is conduction/association aphasia?

A

word finding issues and problems with repeating phrases due to damage of the association nerve fibers (arcuate fasciculus) that connect broca’s area and wernicke’s area.

156
Q

What level of O2 sat is required for those with CNS damage?

A

> 94%

157
Q

Describe cheyenne stokes respiration.

A

Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations.

accompanies depression of frontal loe and diencephalic dysfunction

158
Q

Describe apneustic breathing.

A

prolonged inspiration

accompanies damage to the upper pons

159
Q

Elevated body temperatures can be indicative of damage to what structures?

A

Brainstem or hypothalamus

160
Q

What are the s/s of meningeal irritation/infection?

A
  • impaired neck mobility
  • visual discomfort
  • altered consciousness
  • severe HA/N/V
  • altered vital signs
  • generalized weakness
161
Q

What are the s/s of increased ICP/cerebral edema, and brain herniation?

A
  • altered consciousness
  • altered vital signs (increased systolic BP, widening pulse pressure, bradypnea, apnea, cheyene-stokes respiration, fever, and bradycardia)
  • HA
    -Vomiting
  • pupillary changes
  • motor dysfunction
  • Sz activity
162
Q

Those with large fiber neuropathy have what sensory losses?

A
  • decreased balance
  • decreased coordination
163
Q

Those with small fiber neuropathy have what sensory losses?

A

decreased sensations of pain

164
Q

Those with small AND large fiber neuropathy have what sensory losses?

A
  • parasthesia
  • loss of protective sensation
  • decreased balance
  • decreased coordination
165
Q

What is homonymous hemianopsia?

A

loss of 1/2 of visual field in each eye

166
Q

The lesion causing homonymous hemianopsia is (ipsilateral/contralateral) to the side of the impaired visual field.

A

contralateral

ex: right lesion = bilateral left visual field loss

167
Q

What is bitemporal hemianopsia?

A

loss of the outer half of both visual fields (loss of peripheral vision)

168
Q

Where is the lesion location that causes bitemporal hemianopsia?

A

optic chiasm

169
Q

A GCS score of 1-8 is indicative of what?

A

Severe brain injury

170
Q

A GCS score of 9-12 is indicative of what?

A

moderate brain injury

171
Q

A GCS score of 13-15 is indicative of what?

A

mild brain injury

172
Q

What does the GCS test?

A
  1. motor response
  2. eye opening
  3. verbal response

Assesses acute concussions/TBI

173
Q

The CRSR is used to assess what?

Coma recovery scale- revised

A

brainstem reflexes, consciousness, functioning

174
Q

Description:

Pt is unable to identify body parts or their relationship to each other

A

somatrognosia (body scheme disorder)

175
Q

Description:

severe denial, neglect, or lack of awareness to severity of condition

A

anosognosia

176
Q

What is agnosia?

A

pt is unable to recognize familiar objects

177
Q

What is apraxia?

A

inability to perform voluntary, learned, movements in the absence of loss of sensation, strength, coordination, attention, or comprehension

178
Q

Describe ideomotor apraxia.

A

patient cannot perform the task on command but can perform it when alone

179
Q

Describe ideational apraxia.

A

patient cannot perform a task at all (both on their own and with command)

180
Q

What causes apraxia?

A

Damage to the prelateral frontal cortex and somatosensory association cortex

181
Q

What is the MAS used for? How many grades are there?

A

a. grading spasticity
b. 6 grades

0: no increase in muscle tone

1: slight increase in muscle tone w/ minimal resistance at end of PROM

1+ : slight increase in muscce tome with minimal resistance through less than 1/2 of PROM

2: more marked increase in muscle tone through most of PROM

3: considerable increase in muscle tone, PROM is difficult

4: rigidity in FLX or EXT

182
Q

Where does PD occur in the CNS?

A

basal ganglia: subcortical gray

183
Q

(true/false) sensation is not affected in those with PD

A

true

184
Q

Describe leadpipe rigidity. What diagnosis commonly has this?

A

a. uniform increased resistance to movement

b. PD

185
Q

Describe cogwheel rigidity. What diagnosis commonly has this?

A

a. rachet-like resistance to movement

b. PD

186
Q

(true/false) rigidity is not velocity-dependent

A

true

187
Q

What DTRs will you see in those with PD?

A

normal but may be decreased

188
Q

(true/false) spasticity is not velocity dependent

A

false (it is velocity dependent)

189
Q

What DTRs are seen in those who experienced a stroke?

A

hyperreflexia

190
Q

What DTRs are seen in those with a cerebellar lesion?

A

normal or decreased

191
Q

What involuntary movements are seen in those with a stroke?

A

spasms

192
Q

What involuntary movements are seen in those with PD?

A

essential tremor

193
Q

What involuntary movements are seen in those with cerebellar lesions?

A

none

194
Q

What involuntary movement is seen in those with SCI?

A

spasms

195
Q

Describe postural control/stability in those with cerebellar lesions.

A
  • truncal ataxia
  • dysequilibrium
196
Q

Describe voluntary movements of those with stroke.

A

dyssynergic: abnormal timing, coactivation, activation, and fatigue- unable to associate muscles together for complex movements

197
Q

What DTRs will you see in those with SCI?

A

hyperreflexia

198
Q

definition

Muscle strength is impacted from one nerve

ex: carpal tunnel

A

mononeuropathy

199
Q

definition

Muscles from a specific myotome are affected

A

radiculopathy

200
Q

definition

Distal muscle strength is initially observed and then progresses to proximal muscles

A

polyneuropathy

201
Q

definition

posturing seen in comatose patients with brainstem lesions between the superior colliculus and vestibular nucleus

A

decerebrate ridigity/posturing

Results in increased tone and sustained posturing in rigid EXT of all limbs, trunk, and neck

202
Q

definition

posturing seen in comatose patients with lesions above the superior colliculus

A

decorticate rigidity/posturing

Results in increased tone and sustained posturing of the UEs in FLX and the LEs in EXT

203
Q

What is opisthotonos?

A

prolonged, severe, spasms of muscles causing the head, back, and heels to arch backward; arms and hands are held in rigid FLX

204
Q

What diagnoses is opisthotonos commonly seen in?

A
  • severe meningitis
  • tetanus
  • epilepsy
  • strychinine poisoning
205
Q

How do you test abdominal reflexes (T6-L2)? What should be observed with a neurologically intact individual?

A

Perform lateral –> medial scratching in all 4 quadrants

Should observe movement of the umbilicus in the direction of the stimulation

206
Q

Describe how to perform cesmasteric reflex (L1/L2). What should be observed in neurologically intact individuals?

A

stroking the skin of the proximal and medial thigh

observation: elevation of the testicle

–> reflex is absent in those with SCI and corticospinal lesions

207
Q

What are the following examples of? Where do they originate?

  • tics
  • chorea
  • athetosis
  • tremor
A

a. Extrapyramidal disorders
b. basal ganglia

208
Q

definition

slow, irregular, twisting, sinuous movements occuring especially in UEs

A

athetosis

209
Q

(true/false) intention tremors occur when voluntary movement is attempted in those with cerebellar disorders

A

true

210
Q

What are the following examples of?
- epileptic sz
- tonic/clonic convulsive movements

A

cortical disorders

211
Q

You primarily see (proximal/distal) weakness of extremities when myopathy is present

A

proximal

212
Q

definition

impaired ability to judge distance or ROM

A

dysmetria

213
Q

What do the following tests assess?
- sensorty organization test (SOT)
- clinical test for sensory interaction in balance (CTSIB)
- modified clinical test of sensory interaction on balance (CTSIB)

A

balance and postural stability

214
Q

Describe pusher’s syndrome.

A

Leaning to the weak side

215
Q

Describe ataxia

A

wide-bbased gait with uncoordinated movements

216
Q

What can improve ataxic gait in those with polyneuropathy?

A

looking down

looking down does not improve ataxic gait in those with cerebellar dx

217
Q

What are the 5 tests that have strong evidence for patients with acute, chronic, and chronic-progressive neurological conditions?

A
  1. BBS
  2. activities-specific balance confidence (ABC)
  3. FGA
  4. 10mWT
  5. 6mWT
218
Q

What time is considered as normal for frail/elderly patients when performing the TUG?

A

11-20 seconds

Younder adults commonly perform in under 10 seconds

219
Q

What time on the TUG is indicative of an increased risk of falls?

A

time > 20 seconds

> 30 seconds indicative of high risk of falls

220
Q

What score on the tinetti/POMA tests are indicative of a high fall risk?

A

score < 19

221
Q

What score on the Tinneti/POMA test is considered as a moderate risk of falls?

A

19-24

222
Q

What score on the tinetti/POMA test is considered as normal/minimal fall risk?

A

25-28

223
Q

What score on the DGI is indicative of safe ambulation?

A

22-24

total score: 24

224
Q

What score on the DGI is indicative of fall risk?

A

score <19

225
Q

Describe myopathic gait.

A

hyperlordosis and compensated trendelenburg on the WB limb

cause: pelvic girdle and proximal muscle weakness

226
Q

What diagnostic imaging is useful for detection of abnormal changes in tissue density?

A

CT

ex: cerebral edema (w/in 3 days post-stroke), cerebral infarction (w/in 3-5 days post-stroke), acute brain bleeds

227
Q

When diagnosing an acute stroke, what diagnostic imaging tool can be used to administer TPA (clot-busting drug) in the absence of hemorrhage within 3-4.5 hours of the thromboembolic stroke?

A

CT

228
Q

What diagnostic imaging tool allows for imaging of the spinal cord, nerve roots, and meninges?

A

CT myelography

229
Q

What diagnostic imaging tool is often used in patients with metal or suspected scar tissue in the area of imaging?

A

CT myelography

230
Q

What are complications of CT myelography?

A
  • allergic reaction to dye
  • irritation of meninges
231
Q

What diagnostic test is most sensitive for detecting an acute stroke?

A

MRI

Allows detection of cerebral edema within 30 minutes after the vascular occlusion
Allows detection of infarction within 2-6 hours

232
Q

What is the primary imaging tool used for examination of tumors, demyelination, and vascular abnormalities?

A

MRI

232
Q

What does an MRA do?

A

Images arteries within the brbain to identify vascular abnormalities with increased sensitivity and decreased risk

233
Q

What are contraindications of MRI/MRA?

A

pacemakers, metal

234
Q

What imaging tool allows for visualization of axons, pathways, and microstructural characteristics of water?

A

Diffuse tensor imaging (DTI)

235
Q

(true/false) MRI has radiation exposure.

A

FALSE

236
Q

(true/false) DTI does not use radiation

A

true

237
Q

what diagnostic imaging technique examines changes in deoxygenated Hgb and contrast agent?

A

functional MRI

provides good spatial resolution to identify active areas of cortex

238
Q

What diagnostic imaging tool is used for patients who are at risk for stroke?

A

Cartoid/verteral artery doppler ultrasound

239
Q

When does abnormal spontaneous EMG activity occur after a peripheral nerve injury/compression and correlates with Wallerian degeneration?

A

7-21 days after

240
Q

What does an EEG do?

A

measures electrical activity within the brain - collects information on the timing and firing of the neurons in the brain (temporal resolution)

241
Q

Where are lumbar punctures made?

A

below L1-L2

can measure ICP along with analyzing CSF

242
Q

What is normal volume of CSF in an adult?

A

90-150 mL

243
Q

What is normal volume of CSF in a child?

A

60-100 mL

244
Q

Wht is the normal pressure of CSF in an adult?

A

90-180 mmHg H2O

10-100 mmHg H20 in children

245
Q

What is the normal level of protein in CSF for an adult?

A

15-45 mg/dL

15-100 mg/dL in neonates

246
Q

Elevated CSF proteins can be indicative of what diagnoses?

A

tumors and/or inflammation

247
Q

What causes decreased pressure of CSF?

A

leaking CSF, subarachnoid block circulatory collapse, or severe dehydration

248
Q

What type of stroke occurs in 80% of CVA cases?

A

ischemic strokes

249
Q

What are the types of ischemic strokes? What is the MOI?

A
  1. cerebral thrombosis: blood clot or thrombbus within the cerebral arteries or their branches
  2. cerebral embolism: free-floating matter that can produce occlusion and infarction within the cerebral arteries
250
Q

What causes a hemorrhagic stroke?

A

abnormal bleeding caused y the rupture of a blood vessel

20% of cases

251
Q

What is a TIA?

A

temporary period of CVA symptoms resulting from decreased blood supply to the brain (< 24 hours)

252
Q

(true/false) TIA causes permanent damage

A

false

253
Q

What are risk factors for CVA?

A
  1. DM
  2. CVD
  3. HTN
  4. TIA
  5. atherosclerosis
254
Q

What is the precursor of a major stroke in more than 1/3 of patients?

A

TIA

255
Q

When does irreversible anoxic damage to the brain occur?

A

after 4-6 minutes

256
Q

(true/false) controlling secondary cell death is critical for mgmt of stroke, TBI, and SCI

A

true

257
Q

(true/false) occlusions proximal to the anterior communicating artery produces maximal deficits due to collateral circulation (circle of willis)

A

false (minimal deficits)

258
Q

What part of the brain does the ACA supply?

A

anterior 2/3 of the middle cerebral cortex

259
Q

What part of the brain does the MCA supply?

A
  1. lateral cerebral cortex
  2. basal ganglia
  3. internal capsule
260
Q

What are the characteristics of MCA syndrome?

internal capsule and cortex lesion

A

Primary characteristics:
- contralateral hemiplegia of the face, UE> LE
- contralateral hemisensory loss, UE >LE
- homonymous hemianopsia

–> other characteristics that can help localize but not always present
- aphasia (dominate hemisphere)
- perceptual deficit (non-dominate hemisphere)
- loss of conjugate gaze to contralateral side
- sensory ataxia

261
Q

What are the characteristics of ACA syndrome?

cortex and internal capsule lesions

A

Primary characteristics:
- contralateral hemiplegia, LE>UE
- contralateral hemisensory loss, LE>UE
- urinary incontinence
- problems with bimanual tasks
- apraxia

–> other characteristics that can help localize but are not always present
- akinesia (decreased mobility)
- mutism

262
Q

What are the characteristics of PCA syndrome?

primary visual cortex, occipital lobe lesions

A

Primary characteristics:
- contralateral sensory loss
- involuntary movements
- transient contralateral hemiparesis
- homonymous hemianopsia

–>other characteristics that can help localize but ae not always present:
- visual agnosia
- memory deficit
- dyslexia
- central/thalamic pain
- Weber’s syndrome
- CN III palsy

263
Q

What are the characteristics of a lacunar stroke?

internal capsule lesion-posterior limb

A

contralateral hemiplegia

“pure motor stroke”

264
Q

What are the characteristics of a midbrain lesion?

A
  • contralateral hemiplegia
  • possible contralateral CN III palsy
265
Q

What are the characteristics of medial pontine syndrome?

occlusion of paramedian branch of basilar artery

A
  • ipsilateral cerebellar ataxia
  • ipsilateral nystagmus
  • ipsilateral paralysis of conjugate gaze
  • diplopia
  • contralateral hemiparesis
  • contralateral hemisensory loss
266
Q

What are the characteristics of lateral pontine syndrome?

occlusion of anterior infereior cerebellar artery

A
  • ipsilateral ataxia
  • ipsilateral vertigo and nystagmus
  • ipsilateral facial paralysis
  • ipsilateral paralysis of conjugate gaze
  • ipsilateral deafness/tinnitis
  • ipsilateral impaired facial sensation
  • contralateral impaired sensation of pain and temperature
267
Q

What are the characteristics of medial medullary syndrome?

occlusion of vertebral artery, medullary branch

A
  • ipsilateral paralysis of tongue
  • contralateral hemiplegia
  • contralateral impaired sensation
268
Q

What are the characteristics of lateral medullary (wallenberg’s) syndrome?

occlusion of posterior inferior cerebellar artery/vertebral artery

A
  • ipsilateral ataxia
  • ipsilateral vertigo and nystagmus
  • ipsilateral sensory loss of UE, Trunk, or LE
  • bilateral loss of facial pain and temperature

characteristics that may be present:
- Horner’s syndrome (miosis, ptosis, decreased sweating)
- dysphagia
- impaired speech

269
Q

Where are the lesion(s) located when Lacunar (pure motor) stroke is suspected?

A
  • internal capsule- posterior limb
  • pons
  • pyramids
270
Q

Where are the lesion(s) located when medial pontine syndrome is suspected?

A
  • occlusion of paramedial branch of basilar artery
271
Q

Where are the lesion(s) located when lateral pontine syndrome is suspected?

A

occlusion of anterior inferior cerebellar artery

272
Q

Where are the lesion(s) located when medial medullary syndrome is suspected?

A

occlusion of vertebral artery, medullary branch

273
Q

Where are the lesion(s) located when lateral medullary (wallenerg’s) syndrome is suspected?

A

occlusion of posterior inferior cerebellar artery/vertebral artery

274
Q

Those with (left/right) hemisphere lesions are typically impulsive, quick, and indifferent; poor judgement and safety

A

right hemisphere (left hemiplegia)

275
Q

Those with (left/right) hemisphere lesions are typically slow, cautious, hesitant, and insecure; often aware of impairments and become frustrated

A

Left hemisphere (right hemiplegia)

276
Q

When using the postural assessment scale for stroke patients, are higher or lower scores indicating better trunk control?

A

higher scores

277
Q

When using the fugl-meyer assessment of motor performance, are higher or lower scores indicative of better motor performance?

A

higher score

278
Q

When using the trunk impairment scale, are higher or lower scores indicative of better trunk control?

A

lower scores

279
Q

TBI definition

injury at point of impact and opposite point of impact

A

coup-contracoup injury

280
Q

TBI definition

disruption and tearing of axons and small lood vessels from shear-strain of angular acceleration resulting in neuronal death and petechial hemorrhages

A

diffuse axonal injury

281
Q

TBI recovery stage

marked by return of sleep-wake cycles and normalization of vegetative functions (respiration, digestion, BP control)

A

vegetative state (unresponsive wakefulness syndrome)

282
Q

Persistent vegetative state is determined if a patient remains in vegetative state for ________ after a TBI.

A

1+ year(s)

283
Q

TBI recovery stage

Patient is not vegetative and does show signs of fluctuating awareness

A

minimally responsive (mute responsiveness)

284
Q

TBI recovery stage

patient mainly has a disturbance of attention mechanisms; all cognitive operations are affected and the patient is unable to form new memories; altered arousal

A

confusional state

285
Q

TBI recovery stage

confusion is clearing and some memory is possible; pt has significant cognitive problems and has limited insight; frequent uninhibited social behaviors

A

emerging independence

286
Q

TBI recovery stage

pt is increasing independence ut still does have cognitive difficulties (problem solving, reasoning, etc) along with behavioral and social problems

A

intellectual/social competence

287
Q

(true/false) a patient can plateau at any recovery stage from a diffuse axonal injury/TBI

A

true

288
Q

What is sympathetic storming? What is the cause?

A

Result of hypothalamic stimulation for the SNS with an increase in circulating corticoids and catecholamines

s/s:
- minimal alertness
- altered level of consciousness
- dystonia
- tachycardia
- HTN
- hyperthermia
- diaphoresis
- agitation

289
Q

definition

persistent post-concussion symptoms lasting 3+ months

rare after just one concussion

A

post-concussion syndrome

  • s/s can include post-traumatic sz, increased risk of depression, and/or mild cognitive impairment
290
Q

definition

progressive neurodegenerative brain disease resulting from repetitive head trauma

A

CTE (chronic traumatic encephalopathy)

291
Q

What are the s/s of CTE?

A
  • recurrent HA and dizziness
  • cognitive impairments
  • mood/behavioral disturbance
  • impaired judgement/impulse control
  • movement disorders
292
Q

What are the s/s of epilepsy?

A
  • altered consciousness
  • sensory phenomena
  • autonomic phenomena
  • cognitive phenomena
293
Q

definition

characterized by sudden attack of anxiety, tachycardia, sweating, etc

A

autonomic phenomena

294
Q

definition

characterized by sudden failure of comprehension, inabbility to communicate, intrusion of thought, illusions/hallucinations, and affective disturbances (fear, anger, hate, etc)

A

cognitive phenomena

295
Q

What are common causes of epilepsy?

A
  1. acquired brain disease, trauma, tumor, stroke
  2. degenerative brain diseases (alzheimer’s dementia, amyloidosis)
  3. developmental brain defect (decreased O2 at birth)
  4. drug OD
  5. drug withdrawal
  6. electrolyte disorders
  7. hyperthermia
  8. infection
  9. pregnancy complications (eclampsia)
296
Q

What areas in the brain are involved with generalized sz?

A

all areas

“Grand mal sz”

297
Q

how long do generalized sz commonly last?

A

2-5 minutes

298
Q

What is a petit mal sz?

A

sx that can occur 1+ times per day
- posture is maintained
- repetitive blinking
- small movements
- lasts a few seconds

299
Q

Diagnosis

type of seizure where the person appears dazed or confused, not fully alert or unconscious – type of focal/partial sz

A

complex partial sz

300
Q

Diagnosis

sz characterized by episodic changes in bbehavior, with complex hallucinations, automatisms, altered cognitive and emotional functioning, preceded by aura – type of focal/partial sz

A

temporal lobe sz

301
Q

What is a simple or complex partial sz that evolves into a general sz?

A

secondarily generalized sz

302
Q

What are the characteristics of a vestibulocerebellar lesion?

flodulonoccular lobe/archicerebellum

A
  • ocular dysmetria
  • poor smooth pursuit
  • VOR dysfunction
  • impaired hand-eye coordination
  • gait and trunk ataxia
  • Wide BOS
  • poor postural control
303
Q

What are the characteristics of a spinocerebellum lesion?

paleocerebellum/rostral cerebellum/anterior lobe

A
  • hypotonia/weakness/fatigue
  • trunk ataxia (increased sway, wide BOS, static postural tremor, high guard arm position, dysequilibrium)
  • ataxic gait
304
Q

What are the characteristics of a neocerebellum lesion?

posterior lobe

A

Ipsilateral
- intention tremor
- dysdiadochokinesia
- dysmetria
- dyssynergia

305
Q

definition

voluntary, irregular oscillatory movements

A

intention tremor

306
Q

What group of diagnoses are the following tests appropriate for?
- Scale for assessment and rating f ataxia (SARA)
- dizziness handicap inventory (DHI)
- modified fatigue impact scale (MFIS)
- balance assessments
- functional gait tests
- FIM

A

cerebellar disorders

NTPE (13 decks)

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