Quiz 2 - Neuro I Flashcards
the frontal lobe contains the? which is what?
the frontal lobe contains the:
Primary motor area
PRECENTRAL GYRUS
the parietal lobe contains the ? which is what?
primary sensory area
POSTCENTRAL GYRUS
The cerebellum is attached to the brain stem by?
3 cerebellar peduncles
what are gyri? fissures? and sulci?
gyri - buldges
fissures - large indentations
sulci - small indentations
which CNs are sensory, motor or mixed?
CN I, II, VIII - sensory
CN III, IV, VI, XI, XII - motor
CN V, VII, IX, X - mixed
Which tracts decussate, what do they sense, where do they cross over?
ASCENDING: spinothalamic tract (pain/temp) - cross immediately.
posterior column (proprioception) - cross at junction of spinal cord and brain stem
stepwise approach to the neurologic patient?
Where is the lesion?
Location, singular or multifocal (metastatic dx, ms, multiple diseases)?
is it confined to the nervous system or is it part of a systemic disorder?
what part of the nervous system is affected?
What is the lesion? (tumor, infection, hemorrhage)
What is the importance in asking for neurological history?
essential in order to localize symptoms
may need family member support in teasing out the ONSET
in PMhx - what different systems do we need to assess and why? what about environmental?
cardio - htn, cvd - assesses stroke risk
neuro - previous stroke? TIAs? psychiatric illness
endocrine - DM
hepatobiliary - liver!! could disrupt metabolism, causing systemic issues
trauma - TBI? MVA? Concussions?
systemic issues - CA? may be metastasis
HEAVY METALS - issue for neuro complaints (not something to jump to first)
in FHx - what are important question to ask?
alzheimers?
parkinsons?
CVD?
what are the important SHx questions to assess?
smoking**, alcohol, drugs
sexual hx (neurosyphilis)
diet (gluten)
hobbies (exposure to heavy metals, solvents)
What ROS questions should be considered in the neurological patient?
Are you experiencing ANY PAIN?
HEENT
headaches, visual changes, dizziness
NEURO
tremor, weakness/sensory loss, LOC
what mental status acronym is important to know and what does it stand for? this test is also known as?
FOGS
- Family story of memory loss
- Orientation - time, month, day, year
- General Information - president of the US?
- Spelling - spell the word “world” forwards and backwards
this is your mini mental status exam (MMSE)
if you see hyper-reflexia where is your lesion
upper motor neuron
if you see hypo-reflexia where is the lesion?
lower motor neuron
what is the 3rd most common cause of death and most common cause of neurological disability - how do they present depending on supply? how do they present - generally?
cerebrovascular accident (STROKE)
anterior supply (2/3 of the brain, internal carotid) - unilateral sxs
posterior supply (1/3 of the brain, vertebrobasilar) - unilateral or bilateral, more likely to affect consciousness
generally, present SUDDENLY; CONTRALATERAL limbs, facial paralysis; confusion; h/a
What are the different types of stroke? what are their ssx?
ISCHEMIC TYPES (80%)
- thrombic, MOST COMMON - atherosclerotic plaques, sites of turbulent blood flow, slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
- emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
- lacunar - ataxia, DM, poorly controlled HTN
- transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN
HEMORRHAGIC TYPES (20%)
- intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
- subarachnoid Hemorrhage - SUDDEN sever H/A with LOC, severe neurological deficits
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
What are the different types of stroke? what are their ssx?
ischemic (80%)
- thrombic, MOST COMMON - slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
- emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
- lacunar - ataxia, DM, poorly controlled HTN
- transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN
hemorrhagic (20%)
- intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
- subarachnoid Hemorrhage - SUDDEN severe H/A with LOC, severe neurological deficits
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
which CN is helpful in assessing a frontal lobe lesion?
CN I tested - change in personality may also be present
what are key tests, assessing upper motor neuron weakness?
Drift of Upper Extremity
- hands in front, palms up held flat 15-30 seconds. (+), palm rotates in and pronate midline
Hand Grasp and Toe Dorsiflexion
- weakness is commonly seen in UMN lesion
what are the two tests for meningeal irritation and how are they performed?
kernig
- (+) straightening of lower extremity causes low back pain
brudzinski
- (+) - supine pt, passively flex pt’s head, hips will involuntarily flex
