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Neuro > SA Neuro Exam > Flashcards

SA Neuro Exam Flashcards

1
Q

Does the size of the lesion correlate well with severity of dz in neuro?

A

no, speed of onset more telling of severity

- eg. slow growing tumour, brain can compensate for a long time

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2
Q

When localizing the lesion, what different options do we have?

A 
> Brain
- Forebrain
- Brainstem
- Cerebellum 
> Spinal cord
- C1-C5
- C6-T2
- T3-L3
- L4-Cd 
> Neuromuscular
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3
Q

What are the 2 main aims of the neuro exam?

A
  1. Is the patient neurologically normal or abnormal?

2. Localisation

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4
Q

What should be done before the neuro exam? Which parts hould be left until the end?

A
  • full PE and musculoskeletal exam

- leave noxious parts to the end

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5
Q

What are the 8 parts of the neuro exam?

A
  1. Mentation
  2. Posture
  3. Gait
  4. Postural Reactions
  5. Spinal Reflexes
  6. Cranial Nerves
  7. Palpation
  8. Nociception
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6
Q

How is mentation described?

A 
> Level 
- alert
- obtunded
- stupor
- coma (unresponsive to pain) 
> quality 
- appropriate
- innapropriate (compulsion, dementia/delerium)
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7
Q

What can be looked at to judge posture?

A
  1. Hed position
    - tilt (vestibular disease)
    - turn (forebrain disease)
  2. Limb position
    - wide base (proprioceptive loss)
    - narrow base (weakness)
    - v weight bearing (pain)
  3. Body
    - Decerebrate (both pairs of limbs spastic extension, neck dorsally stretched out, not fully concious)
    - Decerebellate (forelimbs extended, hid limbs flexed, neck slightly up, concious)
    - Shiff-Sherrington (spinal cord lesion, concious, forelimbs normal but stiff, voluntary control still present and withdrawal, hindlimbs paralysed and no withdrawal reflex)
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8
Q

What can be assessed when looking at gait?

A 
> Normal or abnormal? 
> Limbs affected? 
- paresis
- ataxia
- lameness
- combination
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9
Q

What is paresis? What are the 2 forms? What should also be assesed when looking at potential paresis?

A

> decreased voluntary movement

  • UMN or LMN (NOT based on severity)
  • Also assess postural reactions, spinal reflexes and muscle tone
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10
Q

How can UMN paresis be identified?

A
  • UMN = ^ muscle tone and spinal reflexes caudal to the lesion
  • stride length normal/increased
  • spasticity
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11
Q

How can LMN paresis be identified?

A
  • LMN = v muscle tone and decrease/loss of spinal reflexes in limbs with a reflex arc containing the lesion
  • stride length normal/decreased, stiff, bunny hopping, +- collapse
    +- ataxia (sensory) knuckling and slappy gait
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12
Q

Signs of sesnroy/proprioceptive/spinal ataxia

A
  • wide based stance
  • ^ stride length
  • swaying/floating gait
  • knuckling
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13
Q

Signs of cerebellar ataxia

A
  • disorder of rate and range of movement
  • hypermetria
  • intention tremor
  • postural tremor
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14
Q

Signs of vestibular taxia

A 
> unilateral 
- falling/leaning/circling
- head tilt
> bilateral 
- wide excursions of the head 
\+- tilt 
- crouched posture 
> strabismus and nystagmus
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15
Q

What do postural reactions require to be intact?

A
  • proprioceptive AND motor systems
  • similar pathways to gait
  • senstivie but non-specific
  • interpret with gait, spinal reflexes and muscle tone
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16
Q

How do sensory tracts relate to the brain?

A
  • ipsilateral sensory tract to midbrain, then crosses to forebrain of contralateral side
  • eg. absent paw positioning reflex on L = R forebrain lesion
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17
Q

Give examples of postural reactions

A
  • hopping
  • wheelbarrow
  • hemiwalking
  • placing (tactile/visual)
  • extensor postural thrust
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18
Q

What nerve does biceps tendon spinal reflex test?

A

Musculocutaneous n. C6-8

19
Q

What nerve does triceps tendon spinal reflex test?

A

Radial n. C7-T2

20
Q

What nerve does patellar tendon spinal reflex test?

A

Femoral n. L4-6

21
Q

What nerve does gastroc tendon spinal reflex test?

A

Sciatic n. L6-S2

22
Q

What nerve does thoracic limb withdrawal reflex test?

A

Multiple nn C6-T2

23
Q

What nerve does pelvic limb withdrawal reflex test?

A

Sciatic n. L6-S2

24
Q

What nerve does perineal reflex test? What should happen with this test?

A

Pudendal n. S1-3

- bilateral response to a unilateral stimulus

25
Q

Cutaneous trunci

A

Look up

26
Q

What do decreased/absent spinal reflexes indicate?

A
  • lesion within the reflex arc
  • physcial limitation of movement (joint fibrosis, muscle contracture)
  • excitement/fear
  • spinal shock (complete loss of reflexes caudal to the lesion which gradually return over few days )
27
Q

What do increased/exaggerated spinal reflexes indicate?

A
  • lesion to UMN pathways cranial to spinal cord segment tested
  • excitement/fear
  • pseudohyperreflexia d/t loss of antagonism
28
Q

What are the cranial nerves?

A 
1- olfactory
2- optic
3- occulomotor
4- trochlear
5- trigeminal
6- abducens
7- facial 
8- vestibulocochlear
9- glossopharyngeal 
10- vagus
11- accessory (trapezius m.)
12- hypoglossal
29
Q

What must be remembered when testing cranial nerves?

A

Afferent and efferent pathways differ

30
Q

How do sharks differ from most animals?

A

10 cranial nerves as caudal 2 not encorporated into skull

31
Q

How can the optic nerve (II) be tested?

A
  • vision (II -> forebrain)
  • menace (II -> forebrain -> cerebellum -> brainstem -> VII)
  • PLR (II -> brainstem -> III) Direct and consensual
  • Fundic exam
32
Q

What is Horner’s syndrome?

A

> Sympathetic denervation of the orbit

  • miosis
  • ptosis
  • enopthalmus
  • hyperaemia
33
Q

What do III, IV and VI nn. do?

A

> III (oculomotor) IV (trochelar) VI (abducens)

  • motor to extraocular mm
  • strabismus eye position (VIII -> central vestibular/brainstem -> III, IV, VI)
  • nystagmus eye movement (VIII -> central vestibular/brainstem -> III, IV, VI)
34
Q

What does CN V provide?

A

> facial sensation
- palpebral reflex (V-> brainstem -> VII blink)
- corneal reflex (V-> brainstrem -> VI globe retraction)
motor mm. mastication
- atrophy and inability to close jaw

35
Q

What does CN VII provide?

A

> motor to muscles of facial expression
-facial paralysis/paresis, asymetry
- palpebral reflex (V-> brainstem -> VII)
- menace (II-> forebrain -> cerebellum -> brainstem -> VII)
autonomic innervation of lacrimal glands
- STT

36
Q

What does CN VIII provide?

A 
(vestibulocochlear) 
> cochlear 
- auditory
> vestibular
- ataxia
- head tilt
- strabismus
- abnormal nystagmus
(physiological nystagmus VIII -> brainstem -> III, IV, VI)
37
Q

What do IX and X provide?

A

(glossopharyngeal and vagus)

  • sensory and motor to pharynx
  • gag reflex (IX and X -> brainstem -> IX and X)
  • change in bark and swallowing
38
Q

What does CN XII provide?

A

> motor to tongue

  • paresis of tongue
  • atrophy/assymetry
39
Q

Which speices is CN XI important in?

A

fish

otherwsie not

40
Q

What can you find on palpation?

A
  • swelling and atrophy
  • deep pain
    > focal or diffuse?
41
Q

What is nociception?

A

Concious perception of pain
- receptors -> brain
> superficial (skin) and deep (bone periosteum)

42
Q

Does limb withdrawal indicate pain?

A

NO!!!!

- behavioural changes yelp or attempts to bite you indicate pain!

43
Q

How can nociceptive testing be carried out methodically?

A

Cutaneous autonomous zones for each nerve on the limbs, trunk and head

44
Q

Can all lesions be explained with one lesion?

A

Remember lesion can be focal, diffuse or multifocal

Neuro (30 decks)

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