Rosen's Correlations Flashcards
What is Occam’s Razor?
Among competing hypotheses, the one with the fewest assumptions should be selected.
Basically, the simplest solution is best. Find the unifying lesion.
What does a B12 deficiency affect?
Posterior and lateral columns in the spinal cord
For each time course, identify the appropriate lesion: Seconds-Minutes Hours-Days Weeks-Months Months-Years
Vascular
Infection
Neoplasm
Degenerative (demyelinating)
CN V examination
open mouth, lesion causes less opening on affected side
CN VII examination
observation of face, taste
CN VIII examination
Acoustic via Weber test
Vestibular via caloric/rotational stimuli or Baraney test
CN IX examination
gag reflex
CN X examination
palatal and pharyngeal paralysis
CN XI examination
SCM and trapezius muscles
CN XII examination
tongue deviation to side of LMN lesion and atrophy
\+/- for UMN lesion: Weakness Atrophy Spasticity Reflexes Pathological reflexes Fasciculations
Weakness: +
Atrophy: - (maybe some atrophy of disuse)
Spasticity: + (initial flaccid, becomes spastic)
Reflexes: +
Pathological reflexes: + (Babinski)
Fasciculations: -
\+/- for LMN lesion: Weakness Atrophy Spasticity Reflexes Pathological reflexes Fasciculations
Weakness: + Atrophy: + Spasticity: - (flaccid weakness) Reflexes: - Pathological reflexes: - Fasciculations: + (only when anterior horn cell is involved)
Some questions to ask during a neurological history:
- Most important thing: timeline of current illness (started, what illness was like)
- Other problems? (diabetes, thyroid disease)
- What makes it worse/better? (particularly good for headaches)
- Hypertension, heart disease, diabetes, lung disease (he always checks for)
- Neurological problems in family?
- Smoking, medications, recreational drugs
Some physical examination points:
- Evaluating walking when they don’t know (before/after)
- Facial expressions
- People often gesture with hands (absence of hand gestures, only using one hand, etc.)
- Oriented to time, place, person (work it into conversation, or wait a few minutes into conversation)
- Memory test – 3 cities (ask 5 minutes later; grade out of 3)
- President, VP, previous president – general knowledge/awareness
- Get idea of patient affect, appearance
How to test for receptive aphasia?
Doing series of tasks that don’t require words, getting progressively harder (opening/closing eyes/mouth, show left hand, put left hand on nose, put left hand on right ear)
Some symptoms of MS:
nystagmus, titubation, impaired check, impaired rebound, static tremor, intention tremor
How do you treat hemiballismus?
Thorazine (otherwise die of exhaustion/dehydration)
What is Jacksonian epilepsy (or seizures/march)?
Seizure with focal start and then localizes to different cortical areas
Seizures start in a certain place (like arm) but move to include face, leg, trunk
Lesion in FEF – eyes deviate _________
Seizure in FEF – eyes deviate ________
ipsilaterally
contralaterally
What is Todd’s paralysis?
Results from metabolic depression of the region affected by a seizure
What is palinopsia?
persistent or recurrence of a visual image after the stimulus has been removed
- Hallucinatory- fully formed image; damage to posterior temporal area
- Illusory- not completely formed image, like green dots, or specs; damage to occipital area
What is the palmomental reflex?
Jaw deviation contralateral following pen touching the hand
Associated with bifrontal cortical release signs
In the frontal lobe (FEF)…
After stroke, look where eyes are deviated (toward lesion). During a seizure, patient looks AWAY from the lesion.
Just make sure you know!
