Oct2 A1,2-SG1 Neuro map

Question 1

what cortex gives

Answer 1

mental status and UMN (cell body there)

Question 2

what brain gives

Answer 2

• CN I: smell
• CN II: vision
• position assessment (receives neuron with cell body in muscle)
• vibration assessment (receives neuron with cell body in skin)
• pain assessment (receives neuron with cell body in periphery: skin or muscle)
• temperature assessment (receives neuron with cell body in periphery: skin or muscle)

Question 3

what brainstem gives

Answer 3

• CN III, IV and VI: EOM
• CN V: face sensation
• CN VII: face muscles
• CN VIII hearing and balance
• CN IX and X: speech and swallowing
• CN XI (SCM and trapezius)
• CN XII : tongue

Question 4

what cerebellum gives

Answer 4

coordination

Question 5

what spinal cord contains

Answer 5

• descending and ascending neurons of pain, temp, pos, vibration
• end of UMN from cortex
• cell body of LMN going to muscle via nerve

Question 6

UMN injury gives what

Answer 6

muscle has

• normal bulk
• increased tone
• increased reflexes
• decreased power

Question 7

LMN injury gives what

Answer 7

muscle has

• decreased bulk
• normal tone
• decreased power
• decreased reflexes

Question 8

how motor info goes from cortex to muscle

Answer 8

1. UMN body in cortex
2. axon goes contralateral after brainstem before spinal cord
3. axon stays contralateral and synapses on cell body of LMN in the spinal cord
4. LMN goes to muscle contralateral where the UMN body was

Question 9

how pain and temperature info goes from skin to the brain

Answer 9

• neuron goes to spinal cord
• crosses to contralateral side when reaches spinal cord
• then goes all the way up to the brain

Question 10

how position and vibration info goes from muscle to brain

Answer 10

• neuron goes to spinal cord and goes to top of spinal cord by staying ipsilateral
• crosses to contralteral side after spinal cord, before brainstem
• then goes all the way up to the brain, in region contralateral to place of position and vibration detection

Question 11

summary of motor, pain, temp, position and vibration mapping

Answer 11

• UMN goes contralateral after brainstem before spinal cord
• position and vibration go contralateral after spinal cord before brainstem
• pain and temperature go contralateral as soon as enter the spinal cord (at same spinal cord level)

Question 12

what bilateral findings indicate (like bilateral numbness of the feet)

Answer 12

lesion in PNS (brainstem and spinal cord) bc there, pathways to and from both sides travel close together
(for bilateral finding to be caused by brain lesion, need big thing affecting both cerebral hemispheres)

Question 13

localization: clumsy, weak leg indicates what

Answer 13

UMN or LMN lesion (weakness exists in lesion of both)

Question 14

localization: urinary frequency meaning

Answer 14

spinal cord

-because coordination of sphincter relaxation and detrusor muscle contraction happens there

Question 15

localization: normal mental status meaning

Answer 15

less likely to be a lesion in the cortex

Question 16

localization: normal cranial nerves on neuro exam indicate what

Answer 16

not brainstem lesion

Question 17

localization: stiffness and circumduction meaning

Answer 17

UMN

-bc the stiffness (can’t flex hip and knee) is caused by increased tone in the leg

Question 18

localization: bilateral increased reflexes of the legs meaning

Answer 18

• increased reflexes = UMN
• bilateral = in spinal cord most likely
• so UMN lesion in spinal cord

Question 19

localization: increased tone on the left leg meaning

Answer 19

UMN lesion

Question 20

what is the TEST for the Babinski sign

Answer 20

scratch the sole of the foot in a hook shape

Question 21

what is a negative Babinski test

Answer 21

a flexor plantar response (all toes do plantar flexion)

Question 22

what is a positive Babinski test (what is a Babinski sign)

Answer 22

an extensor plantar response (the big toe extends/dorsiflexes and the other toes fan out (spce out))

Question 23

when should you worry about a Babinski sign and what does it indicate

Answer 23

• in someone who is older than 2

- indicates UMN lesion

Question 24

why does a Babinski sign not significant in children under 2

Answer 24

it can be a normal response because myelination is not completed in the corticospinal tract and so inhibition isn’t complete yet

Question 25

localization: positive Babinski on left and right

Answer 25

UMN lesion bilaterally so likely in the spinal cord (lesion in the spinal cord causing bilateral UMN lesion)

Question 26

localization: meaning of pinprick (for pain) and temperature sensation decreased over right leg and trunk to a level of approx. T4

Answer 26

-a sensory level at T4 clinically = the lesion can be higher; between C8 and T4. but not above C8 bc then would have arm involvement
-the lesion is on the left cord (bc pain and temp cross immediately as enter cord)
ANSWER: left cord lesion between C8 and T4

Question 27

localization: normal reflexes in the arm meaning

Answer 27

lesion is in the cord below C7

Question 28

localization: impaired vibration and position sensation in the left foot and normal in the right foot, what’s the meaning of that

Answer 28

left cord lesion

Question 29

final location of the lesion considering all the findings in this small group

Answer 29

lesion affecting spinal cord between T4 and C8 (cord levels. meaning not vertebra levels), more on the left side of the cord but with some bilateral involvement
*these findings can be causes, for ex, by a spinal cord tumor on the left side and pushing and displacing things there and on the right side

Question 30

where is vibration and joint position tested normally

Answer 30

only in the toes

Question 31

common finding in spinal cord lesion

Answer 31

bladder symptoms

• LMNs cause bladder to contract
• damage to UMNs of spinal cord controlling these LMNs
• result = spastic bladder