Osteopathic Neurology

Question 1

Nervous system

Answer 1

Central Nervous System
- Brain and Spinal Cord

Peripheral Nervous System

• Motor
• Sensory

Autonomic Nervous System
- Sympathetic, Parasympathetic

Enteric
- Small and Large Intestine

Question 2

Cranial Neuroanatomy - Overview

Answer 2

Prosencephalon
- Cerebral hemispheres
- Hippocampal formation
- Basal Ganglia
-
 Thalamus/Hypothalamus/Subthalamus

Mesencephalon (Midbrain)

Rhombencephalon

• Pons
• Cerebellum
• Medulla

Question 3

Test question–

Answer 3

know slide number 5, the finer differentiation of the 3 primary vesicles

Question 4

Ventricles

Answer 4

Lateral

• Bilateral
• Connect to 3rd by Foramen of Monro

Third

• Intrathalamic adhesion
• Connect to 4th by Aqueduct of Sylvius

Fourth

• Midline Foramen of Magendie
• Bilateral Foramen of Luschka

Question 5

Neurologic exam

Answer 5

Mental Status
Cranial Nerves
Motor
Sensory
Reflexes
Cerebellar Function
Special Tests

Question 6

Mental Status examination

Answer 6

This is primarily a psychiatric examination

Appearance, Behavior, Attitude, Mood, Affect, Speech, Thought Content, Thought Process, Perception, Judgment, Insight

Neurologic Aspects

• Attention & Concentration
• Language
• Memory (Short & Long Term)
• Calculation
• Abstraction
• Praxis

Question 7

MMSE

Answer 7

Copyright
Screen for Dementia
<24 = Impairment
Does test many aspects of executive functioning

Question 8

Cranial Nerve relevant anatomy

Answer 8

Cribiform plate - Olfactory nerves
Optic Canal - Optic nerve
Superior Orbital Fissure - III, IV, VI, Ophthalmic V
Foramen Rotundum - Maxillary V
Foramen Ovale - Mandibular V
Internal Auditory Meatus - VII, VIII
Jugular Foramen - IX, X, XI
Hypoglossal Canal - XII

Question 9

Motor

Answer 9

Anterior to Central Sulcus, Precentral Gyrus (Motor Cortex)
Anterior spinal cord (Corticospinal Tract)
Recite nerve root to yourself as testing
Assess muscle tone
Assess strength (5/5)
Observe for Fasciculations, Dystonias, Chorea, Ballismus

Question 10

Sensory

Answer 10

Exteroceptive

• External environment
• Recite nerve roots to yourself during examination

Interoceptive
- Blood Pressure, Chemical gradients

Proprioceptive
- Orientation, position in space of the body

Question 11

Sensory modalities

Answer 11

Primary Modalities

• Posterior Columns: Light Touch, Proprioception and Vibration
• Spinothalamic Tracts (Ant & Lat): Pain (Itch/Tickle) and Temperature
• Both converge on Ventral Posterior Thalamus

Secondary/Cortical Modalities (Requires Parietal Cortex)

• 2 Point Discrimination
• Stereognosis
• Graphesthesia
• Tactile Localization

Question 12

Reflexes

Answer 12

Recite nerve root levels to yourself while testing

Upper Extremity
Lower Extremity
Primitive
- Rooting
- Glabellar
- Grasp

Question 13

Cerebellar Function

Answer 13

Gait
Rapidly Alternating Movements
Finger to Nose
Heel to Shin

Question 14

Special tests

Answer 14

Plantar (Babinski)
- Upper motor neuro impairment

Hoffman’s (UE equivalent for Babinski)

Hoover’s (Malingering)

Question 15

Concept of somatic dysfunction in neurology

Answer 15

Based on Segmental Facilitation

J. Stedman Denslow DO- Defined in 1940’s

• 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

Question 16

neuroendocrine issues and axoplasmic flow

Answer 16

Axoplasmic Flow

• Anterograde/Retrograde
• Impaired by:
• — Primary disease of the neuron
• — Mechanical deformation of nerve (entrapment, stretch)

Neuroendocrine mechanisms ⇄ Affect/Emotions ⇄ MSK
- Effects the patient’s response to OMT

Sustained patterns of excitability → Learned Behavior
- ↑Afferent → Somatic/Sympathetic Efferent of Fasc Seg

Question 17

Headache

Body mind and spirit

Answer 17

Body element- Pain, Vascular changes, Muscle tension, Stroke Risk
Mind element- Difficulty concentrating, Irritability
Spirit element- Relationship & Employment sequelae

Question 18

Traumatic Brain Injury (TBI)

Body Mind Spirit

Answer 18

Body element- Microvascular & Diffuse Axonal injury
Mind element- Memory problems, Personality changes
Spirit element- Relationship & Employment sequelae

Question 19

Stroke

Body Mind Spirit

Answer 19

Body element- Ischemia, Hemorrhage, Sensory/Motor Loss, Activities of Daily Living
Mind element- Communication, Depression
Spirit element- Loss of Purpose

Question 20

Multiple Sclerosis

Body Mind Spirit

Answer 20

Body element- Demyelination, Paresis, Paresthesia, Vision Loss
Mind element- Fear, Cognitive Impairment, Depression
Spirit element- Disability, Mortality

Question 21

Alzheimer’s Disease

Body Mind spririt

Answer 21

Body element- Plaques, Neurofibrillary Tangles, Atrophy
Mind element- Memory problems
Spirit element- Personality changes, Relationship loss

Question 22

Structure & Function Reciprocally Interrelated

Answer 22

Primary goal in neurology is localization of disease

• Brain, Spinal Cord, Peripheral Nerves, Neuromuscular Junction or Muscles
• Genuinely searching for Causes not just Symptoms

Question 23

Headache

structure/ function

Answer 23

Muscle Tension→Strain→C Fiber activation→Pain
Vascular Dilation→Trigeminal Sensory→Pain
Facilitated Trigeminal & Cervical Sensory Nerves→Pain
Pain-Spasm-Pain Cycle

Question 24

TBI structure/ function

Answer 24

Diffuse axonal injury/Hippocampal volume loss→Neuronal dysfunction→Cognitive Impairment (memory)
Hypoactive frontal cortex→Irritability/Impulsivity
Cranial bone strain→↓Motion→Headache/Cognitive Impairment

Question 25

Stroke

structure/ function

Answer 25

Neuronal Death→Paresis/Cognitive Deficits

Decreased self care→Malnutrition, Diseases poorly controlled

Question 26

Multiple Sclerosis

structure/ function

Answer 26

Demyelination→Reduced Neuronal Conductivity→Paresis, Memory Problems

Auto-Immune Response→Chronic Inflammation→ Degeneration→Paresthesias

Question 27

Alzheimer’s Disease

structure/ function

Answer 27

Plaques/Tangles→Neuronal Death→Cognitive Dysfunction

Fronto-temporal Cortical Loss→Disinhibition/Memory Loss

Question 28

Headache

self-healing/ self regulation

Answer 28

Nocioceptive Feedback Systems
Vascular Tone
Chronic Pain Medication Use

Question 29

Self-Healing and Self-regulating systems: Traumatic Brain Injury

Answer 29

Reabsorption of Irreparably Injured Neuronal Tissue
Neuronal Regeneration
Disinhibition

Question 30

Self-Healing and Self-regulating systems- Stroke

Answer 30

Volume Loss (Don’t Use it, You Lose it)
Blood Flow Dynamic Changes
Inflammatory Cascade

Question 31

Self-Healing and Self-regulating systems: Multiple Sclerosis

Answer 31

Compensatory Neuronal Pathway Activation
Accessory Muscle Activation
Inflammatory Cascade

Question 32

Self-Healing and Self-regulating systems: Alzheimer’s Disease

Answer 32

Reabsorption of Irreparable Neuronal Tissue

Disinhibition

Question 33

OMM and Neurology

Answer 33

OMT + Medication Reduced Pain and Disability in Patients with Migraines

OMT > Triptan in Decreasing Migraine Severity

OMT + Exercise ↑Strength and Ambulation in Patients with Multiple Sclerosis

OMT + Relaxation Exercises ↑HA Free Days

OMT ↓ Tension Headache Frequency

OMT ↑ Stride Length, Cadence and Limb Velocity in Patients with Parkinson’s

OMT ↓ Muscle Rigidity and Pain in Patient with Stiff Person Syndrome

Question 34

Summary

Answer 34

Localization is the Goal of the Neurologic Examination

Approach Each Patient Through the Osteopathic Principles