The abnormal neuro exam Flashcards
Components of a neuro exam
- Mental Status Exam
- Cranial Nerves
- Cerebellum
- Strengths
- Deep tendon reflexes
- Sensory testing
- Gait
Components of the mental Status Exam
LOL AMEN
Level of consciousness
Orientation
Language
Attention
Memory
Executive/intellectual function
non-dominant hemisphere
Alert definition
Fully awake without stimulation, and able to cooperate in a history and physical exam
Lethargic definition
Patient prefers to sleep, but will stay awake with minimal verbal or physical stimualtion
Stuporous definition
Patient requires repeated physical stimulation to stay awake
Comatose definition
A sleep like state in which the patient CANNOT be awakened. No further mental status testing is possible
Causes of abnormal level of consciousness
- The pt has a new problems such as a decline in function of an organ system
- A new medication has produced an adverse effect
- Bacterial infection has spread to the blood
- Pts hematocrit, glucose, or partial pressure of oxygen has declined or the partial pressure of CO2 has risen
How to test for orientation
Person, place, and date
Aphasia means _____ is damaged
A patient’s dominant hemisphere
Broca’s aphasia
Frontal lobe
Usually accompanied by hemiplegia, retained understanding, brief ‘telegraphic’ output
Wernicke’s aphasia
Superior temporal lobe
- fluent, poor understanding
Anomia
Inability to name objects
Agraphia
Limitations in writing
Dysarthria
Slurred or thick speach
Apraxia
Loss of skilled movements and gestures
- Partial damage to the dominant lobe, resulting in the loss of complex, multi-step actions- pts cannot carry out these tasks, even though they have sufficient motor and sensory function
Likely due to damage to connections b/w different sites in the cerebral cortex
Gestmann syndrome
Damage to the angular gyrus of the dominant parietal lobe
- Acalcula
- Agraphia
- Inability to distinguish the left and right sides of the pt
- Inability to distinguish the individual fingers
How is attention evaluated?
- Do the months (or the days of the week) forward and then backwards
- Serial sevens, subtracting seven starting from 100
- Read a series of letters, asking the patient to raise his hand when he hears the letter “A”
- Have the patient spell “WORLD” forwards and backwards
Delirium
Acute confusional state
- Suggests a diffuse systemic problem is affecting large sections of the brain
- Presents either as a hyper-reactivity to environmental stimulation or extreme sleepiness
Delirium causes
- Sepsis
- New medications
- Alcohol withdrawal
Who is more prone to delirium?
Demented patients
Where does memory localize to?
B/L medial temporal lobe damage –> hippocampus
Anterograde
Recent memory, or the ability to store new information up to a few days
Retrograde
More distant memories including autobiographical or historical
Executive function
Includes the important functions of insight, judgment, and making important decisions
- Verbal fluency- ask the pt to name as many members of a category as they can
- Healthy pts can name 20 or more in a minute, demented elderly pts wil name less than 12
The loss of executive function is diagnostic of?
Dementia
Parietal lobe functions
- Visual-spatial skills
- Constructions
- Awareness of one’s own body or the environment, especially to the left visual field
Temporal lobe damage results in?
Loss of musical abilities and a tendency to psychiatric disturbances such as psychosis, depression, bipolar disorder, and anxiety
Occipital lobe damage results in?
Left homonymous hemianopia and prosopagnosia
- Inability to recognize faces
Hemispatial neglect
not appreciating that there are people or objects in the left side of the room or on the left side of a drawing or photograph, in spite of preserved vision
Anosognosia
the inability to recognize hemiparesis in a patient’s left arm or left leg; very common immediately after a stroke
Dressing agnosia
inability to button clothes or put an arm in a sleeve on the left side, or to shave or put on make up on the left side of the face
Prosopagnosia
Inability to recognize familiar faces, congenital or acquired
Cranial nerves
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Acoustic (Now called Vestibulo-Cochlear)
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
Abnormal pupil reactions results from?
Problem with afferent CN II and efferent CN III
What does lack of constructional skills indicate?
A problem in the nondominant (right) parietal lobe
- Can be tested by having the pt draw a clock
- May also reveal hemispatial neglect
