Osteopathic considerations in the neuro patient Flashcards
Components of the Nervous System
- CNS: Brain and Spinal cord
- PNS: Motor and sensory
- ANS: Sympathetic and Parasympathetic
- Enteric: Small and Large intestine
The Prosencephalon becomes?
- Telencephalon –> cerebral hemispheres, Hippocampal formation , BG
- Diencephalon –> Thalamus/Hypothalamus/Subthalamus
The Mesencephalon becomes?
Midbrain
The Rhombencephalon becomes?
- Metencephalon –> Cerebellum, pons
2. Myelencephalon –> Medulla
Lateral Ventricle
- Bilateral
- connect to 3rd by Foramen of Monro
Third Ventricle
- Intrathalamic adhesion
- Connect to 4th by Aqueduct of Sylvius
Fourth Ventricle
- Midline Foramen of Magendie - Bilateral Foramen of Luschka
Components of a Neuro Exam? 7
- Mental Status
- Cranial Nerves
- Motor
- Sensory Reflexes
- Cerebellar Function
- Special Tests
Mental Status Exam Psych aspects? 11
- Appearance,
- Behavior,
- Attitude,
- Mood,
- Affect,
- Speech,
- Thought/thought process
- Content,
- Perception,
- Judgment,
- Insight
Mental status Exam Neurological aspects? 6
- Attention & Concentration
- Language
- Memory (Short & Long Term)
- Calculation
- Abstraction
- Praxis
Mini Mental State Examination
- screens for dementia
-
Anatomy:
Olfactory Nerve?
Cribiform plate (ethmoid bone)
Anatomy:
Optic Nerve?
Optic Canal (sphenoid)
Anatomy:
What passes through the superior orbital fissure? What bone is it found in?
- CN III, IV, VI, and Ophthalmic division of V
- sphenoid
What passes through the foramen rotundum?
Maxillary division of CN V
What passes through foramen ovale?
Mandibular Division of CN V
What passes through the internal auditory meatus? What bone is this found in?
- CN VII, VIII
- Temporal
What passes through the Jugular Foramen?
CN IX, X, XI
What passes through the Hypoglossal Canal? Course of canal and what does this nerve meet up wit?
- CN XII
- in the occipital bone: the canal goes around the foramen magnum, through the occipital condyles allowing CN XII to meet up with C1 nerve
Motor Components of the nervous system
- Anterior to Central Sulcus, Precentral Gyrus (Motor Cortex)
- Anterior spinal cord (Corticospinal Tract)
General Assessment of Motor Component
- Assess muscle tone
- Assess strength (5/5)
- Observe for Fasciculations, Dystonias, Chorea, Ballismus
Where does the corticospinal tract originate and decussate?
Origin: Motor cortex
Dec: Medulla
What are the 3 components of the sensory portion and what to they include?
- Exteroceptive: External environment
- Interoceptive: Blood Pressure, Chemical gradients
- Proprioceptive: Orientation, position in space of the body
Primary Modalities of the Sensory System? What information do they carry? Where do they decussate?
Where do they converge?
- Posterior Columns: Light Touch, Proprioception and Vibration; Dec: medulla
- Spinothalamic Tracts (Ant & Lat): Pain (Itch/Tickle) and Temperature: Dec: the spinal cord level
- Both converge on Ventral Posterior Thalamus
What are the Secondary/Cortical Modalities of the Sensory System? What do they require?
- 2 Point Discrimination
- Stereognosis
- Graphesthesia
- Tactile Localization
- Requires Parietal Cortex
Reflexes of the Nervous System
- UE
- LE
- Primitive: rooting, glabellar, grasp
Testing Cerebellar Function?
- gait
- Rapidly alternating movements
- finger to nose
- heel to shin
What is Disdiadokokinesis?
Inability to perform rapid alternating movements
What is dysmetria?
inability to perform coordinated movements (failed finger to nose or heel to shin)
Special tests? what do the test for?
- Babinski (plantar) - upper motor neuron impairment
- Hoffman’s Test (UE equivalent for Babinski) - tapping the nail on the third or forth finger. A positive Hoffman’s is the involuntary flexing of the end of the thumb and index finger
- Hoover’s (Malingering)
Concept of Somatic Dysfunction in Neurology
- Based on Segmental Facilitation
- Motor neuron pools in spinal cord segments related to areas of somatic dysfunction were maintained in a state of facilitation.
- Chronically hyperresponsive to impulses from any source in the body (proprioceptive/nociceptive)
- Maintain hypertonic muscles innervated by these segments
- Spinal cord is an organizer and active participant in the disease process
Axoplasmic Flow: Direction? Impaired by?
- Bidirectional: Anterograde/Retrograde
- Impaired by:
1. Primary Disease of the Neuron
2. Mechanical deformation of nerve (entrapment, stretch)
How does Somatic Dysfunction in Neurology effect the Patients response to OMT?
Neuroendocrine mechanisms Affect/Emotions MSK
Sustained Patterns of excitability results in?
Increased Afferent result in?
- Learned Behavior
2. Somatic/Sympathetic Efferent of Facilitated segment
