Numbness And Tingling Flashcards
FAST exam
. For stroke . Face droops . Arm weakness . Speech difficulty . Time
Parenthesia
. Distorted sensation, tingling
Anesthesia
. Loss of sensation
Hyperesthesia
. Too much sensation
Allodynia
. Pain w/ innocuous stimulus
What to ask for history numbness
. Duration
. Distribution
. Good neuro ROS
. Check for muscle weakness/atrophy, skin, pulses, edema
. Interrelationships of nervous system
. Receiving sensory stimuli from environment
. Identifying/ integrating adaptive processes for maintenance
. Integrating responses of CNS/Endocrine system
. Controlling cognitive/voluntary behavioral processes
Frontal lobe functions
. Voluntary skeletal movement . Repetitive movement . Working memory . Judgement . Behavior . Broca’s area
Broca’s area
. Language production
. Aphasia: patient knows what they want to say but can’t formulate speech
. Stuttering
Parietal lobe functions
. Processes sensory data
. Assists w/ processing of tactile sensation
. Proprioception
. Complex purposeful motor movement
Occipital lobe functions
. Interpretation and perception of visual data
. Recognition of color, shapes, and faces
Temporal lobe functions
. Emotional responses/ memory
. Integration of taste and smell
. Interpretation of speech (wernicke’s)
Wernicke’s area
. Sup. Temporal gyrus
. Comprehension and understanding of written and spoken language
. Difficulty processing incoming speech in your head (receptive aphasia)
Upper motor neurons
. Originate in motor region of cerebral cortex or brain stem
Lower motor neurons
. Originate in grey columns of spinal cord, ant. Nerve roots or CN nuclei of brainstem
Upper motor nerve lesions symptoms
. Weakness
. Reflexes inc.
. Tone inc.
Lower motor neuron lesion symptoms
. Weakness . Atrophy . Fasciculations . Reflexes dec. . Tone dec.
Things to ask for seizure history
. Sequence of events . Symptoms . Aura . LOC . Muscle activity . Postictal state . Assoc. events (time, sleep, stress, frequency) . Meds/drugs/alcohol
History to ask related to gait
. A lance/falls
. Leg strength
Questions to ask about weakness/paresthia
. Onset
. Character
. Assoc. symptoms
. Concurrent illness
Big risk factors for CVA
. High cholesterol
. High bp
. DM
Important things in family medical history when patient has numbness/tingling
. Alcohol . Hereditary disease . Mental retardation . Epilepsy/headaches . Alzheimer’s disease . Weakness/gait disorders . Medical/metabolic disorders
CN III/IV/VI examination
. Inspect eyelids for symmetry
. Inspect pupils for size/equality
. Test consensual response/accommodation
. Test extraocular eye movements
How to test CN V
. Test pain/sensation
. Corneal reflexes
. Motor: symmetry, palpate jaw for strength/tone in muscles
How to test CN VII
. Motor: make faces for facial expression mm.
. Sensory: tongue for salt/sweet
How to test VN IX
. Test tongue for sour/bitter
. Test gag reflex
how to test CN X
. Inspect palate/uvula (say AHH to see rise)
. Swallowing
. Guttural speech sounds
How to test CN XII
. Inspect tongue for atrophy/symmetry/tremor
. Test tongue strength
. Evaluate lingual sounds l, t, d, n
Cerebellar function
. Coordination and fine motor skills
. Movements: thumb-finger, finger-nose, finger-nose-finger, heel chin
. Balance equilibrium: observe gait, rhomberg, stand on one foot
. Rapid alternating movements
How many neurons are lost per minute in ischemia?
1.9 million neurons
. Brain ages 3.8 yrs
Cortical sensory functions
. Higher order cortical discriminatory sensory functions
. Graphesthesia: number identification
. Sterognosis (identification of object by feeling it)
. Tactile extinction (simultaneous stimuli test by touching each side
. 2 point discrimination: test w/ caliper, 2 sterile needles
. Point location: identify area touched on them
Primary sensory functions
. Superficial touch
. Superficial pain and temperature
. Deep pressure/vibration and joint position
Examine all sensory function for ___
. Symmetry and differences . Patient’s interpretation of sensation . Discrimination . Location . Note impairment using dermatomal chart
Superficial reflexes
. Upper/lower abdominal
. Cremasteric
. Plantar: babinski reflex (fanning of toes)
Muscle stretch response
. Muscle initially stretched
. Afferent signals are sent to spinal cord
. Interneuron connects afferent and efferent fibers
. Efferent signals sent to mm. To cause contraction
Grading of deep reflexes
. 0: absent . 1: dec. but present . 2: normal . 3: hyperreflexsive, brisk and excessive . 4: hyperreflexsive, w/ clonus
Deep reflexes
. Biceps: C5 . Brachioradialis: C6 . Triceps: C7 . Patellar: L4 . Achilles: S1
Hemiplegia (Early)
. Half of body unresponsive
. Externally rotated high
. Flaccid arm
Decorticate rigidity
. Abnormal flexor response . Internally rotated thigh . Plantar flexed foot . Flexed elbow . Adducted arm . Flexed wrist . Insult lesion close to cerebrum, before midbrain and red nucleus
Decerebrate rigidity
. Abnormal extensor response . Plantar flexed foot . Flexed wrist . Pronated forearm . Extended elbow . Adducted arm . Lesion in red nucleus or below
Mental status
. Assess alert and orientation
. Alert and oriented x3 (person, place, and time)
Muscle bulk
. Atrophy: secondary to PNS disorders
. Hypertrophy: inc. in mm. Bulk w/ normal or inc. strength
. Pseudohypertrophy: inc. bulk w/ diminished strength
Eye opening grading
. 1: wont’ open even to supraorbital pressure
. 2: open w/ pain from sternum/limb/supraorbital pressure
. 3: open to speech, nonspecific response, not necessarily to command
. 4: eyes open normally
Verbal response grading
1: no verbalization
2: moans/groans, no speech
3: intelligible, no sustained sentences
4: converses but confused, disoriented
5: converses and is oriented
GCS
. Glascow coma score
. Mild rating: 13-15
. Moderate: 9-12
. Severe: 8 or less, needs intubation
Motor response grading
1: non response to any pain, limb remains flaccid
2: shoulder adducted and shoulder and forearm internally rotated, extended (decerebrate)
3: withdrawal response or assumption of hemiplegic posture (decorticate)
4: arm withdrawals to pain, shoulder abducts
5: obeys commands
6: can localize pain
Pronator drift
. Stan 20-30 sec w/ eyes closed
. Arms held out straight w/ palms up
. Arm will drift when asked to pronate arm
Oculocephalic reflex
. Doll eye movements
. Lifting up eyelids and being able to move eyes back in forth
. When lost, can’t move eyes
Dysdiadochokinesis
. Occurs in cerebellar disease
. Can’t complete rapid alternating movement
