Osteopathic Neurology Flashcards
Nervous system
Central Nervous System
- Brain and Spinal Cord
Peripheral Nervous System
- Motor
- Sensory
Autonomic Nervous System
- Sympathetic, Parasympathetic
Enteric
- Small and Large Intestine
Cranial Neuroanatomy - Overview
Prosencephalon - Cerebral hemispheres - Hippocampal formation - Basal Ganglia - Thalamus/Hypothalamus/Subthalamus
Mesencephalon (Midbrain)
Rhombencephalon
- Pons
- Cerebellum
- Medulla
Test question–
know slide number 5, the finer differentiation of the 3 primary vesicles
Ventricles
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
Neurologic exam
Mental Status Cranial Nerves Motor Sensory Reflexes Cerebellar Function Special Tests
Mental Status examination
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
MMSE
Copyright
Screen for Dementia
<24 = Impairment
Does test many aspects of executive functioning
Cranial Nerve relevant anatomy
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
Motor
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
Sensory
Exteroceptive
- External environment
- Recite nerve roots to yourself during examination
Interoceptive
- Blood Pressure, Chemical gradients
Proprioceptive
- Orientation, position in space of the body
Sensory modalities
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
Reflexes
Recite nerve root levels to yourself while testing
Upper Extremity Lower Extremity Primitive - Rooting - Glabellar - Grasp
Cerebellar Function
Gait
Rapidly Alternating Movements
Finger to Nose
Heel to Shin
Special tests
Plantar (Babinski)
- Upper motor neuro impairment
Hoffman’s (UE equivalent for Babinski)
Hoover’s (Malingering)
Concept of somatic dysfunction in neurology
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
neuroendocrine issues and axoplasmic flow
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
Headache
Body mind and spirit
Body element- Pain, Vascular changes, Muscle tension, Stroke Risk
Mind element- Difficulty concentrating, Irritability
Spirit element- Relationship & Employment sequelae
Traumatic Brain Injury (TBI)
Body Mind Spirit
Body element- Microvascular & Diffuse Axonal injury
Mind element- Memory problems, Personality changes
Spirit element- Relationship & Employment sequelae
Stroke
Body Mind Spirit
Body element- Ischemia, Hemorrhage, Sensory/Motor Loss, Activities of Daily Living
Mind element- Communication, Depression
Spirit element- Loss of Purpose
Multiple Sclerosis
Body Mind Spirit
Body element- Demyelination, Paresis, Paresthesia, Vision Loss
Mind element- Fear, Cognitive Impairment, Depression
Spirit element- Disability, Mortality
Alzheimer’s Disease
Body Mind spririt
Body element- Plaques, Neurofibrillary Tangles, Atrophy
Mind element- Memory problems
Spirit element- Personality changes, Relationship loss
Structure & Function Reciprocally Interrelated
Primary goal in neurology is localization of disease
- Brain, Spinal Cord, Peripheral Nerves, Neuromuscular Junction or Muscles
- Genuinely searching for Causes not just Symptoms
Headache
structure/ function
Muscle Tension→Strain→C Fiber activation→Pain
Vascular Dilation→Trigeminal Sensory→Pain
Facilitated Trigeminal & Cervical Sensory Nerves→Pain
Pain-Spasm-Pain Cycle
TBI structure/ function
Diffuse axonal injury/Hippocampal volume loss→Neuronal dysfunction→Cognitive Impairment (memory)
Hypoactive frontal cortex→Irritability/Impulsivity
Cranial bone strain→↓Motion→Headache/Cognitive Impairment
Stroke
structure/ function
Neuronal Death→Paresis/Cognitive Deficits
Decreased self care→Malnutrition, Diseases poorly controlled
Multiple Sclerosis
structure/ function
Demyelination→Reduced Neuronal Conductivity→Paresis, Memory Problems
Auto-Immune Response→Chronic Inflammation→ Degeneration→Paresthesias
Alzheimer’s Disease
structure/ function
Plaques/Tangles→Neuronal Death→Cognitive Dysfunction
Fronto-temporal Cortical Loss→Disinhibition/Memory Loss
Headache
self-healing/ self regulation
Nocioceptive Feedback Systems
Vascular Tone
Chronic Pain Medication Use
Self-Healing and Self-regulating systems: Traumatic Brain Injury
Reabsorption of Irreparably Injured Neuronal Tissue
Neuronal Regeneration
Disinhibition
Self-Healing and Self-regulating systems- Stroke
Volume Loss (Don’t Use it, You Lose it)
Blood Flow Dynamic Changes
Inflammatory Cascade
Self-Healing and Self-regulating systems: Multiple Sclerosis
Compensatory Neuronal Pathway Activation
Accessory Muscle Activation
Inflammatory Cascade
Self-Healing and Self-regulating systems: Alzheimer’s Disease
Reabsorption of Irreparable Neuronal Tissue
Disinhibition
OMM and Neurology
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
Summary
Localization is the Goal of the Neurologic Examination
Approach Each Patient Through the Osteopathic Principles
