The Nervous System Flashcards
An involuntary response that may involve as few as two neurons
Reflex
Most common movement disorder
tremors
Low-frequency unilateral resting tremor, rigidity, and bradykinesia are signs of:
Parkinson disease
High-frequency, bilateral, upper extremity tremors that occur with both limb movement and sustained posture and subside when the limb in relaxed; head, voice, and leg tremor may also be present
Essential tremors
Common or Concerning symptoms - Neurological history
- headache - dizziness or vertigo - weakness (generalized, proximal, or distal) - numbness, abnormal or absent sensation - fainting or blacking out (near syncope and syncope) - seizures - tremors or involuntary movements
Stroke is the _________ leading cause of death in the US and a leading cause of ______ ______ ___________.
4th
long term disability
What is the ABCD2 scoring system used to predict?
incidence of ischemic stroke within 2, 7 and 90 days after a TIA
What does the mnemonic ABCD2 stand for?
A-Age >/= 60 years
B-Blood pressure (initial) >/= 140/90
C- Clinical features of focal weakness or impaired speech without focal weakness
D- Duration 10 to 59 minutes or >/= 60 minutes
D- Diabetes
A 76-year old patient arrives at the office with his wife with complaints of episodes of slurred speech, word-finding difficulties and numbness in his arm. The first priority in management is: a) tell him to take an aspirin right away b) order a CT scan c) send him to the ER d) perform and EKG
C - send him to the ER ASA is incorrect if you are concerned for stroke and you are not sure if it is hemorrhagic of ischemic CT scan is reasonable, but should be done emergently upon admit to the ER EKG would be applicable for chest pan
What is the first symptoms seen in the majority of Parkinson’s patients? a) intention tremor b) bradykinesia c) rest tremor d) rigidity
C- rest tremor asymmetric tremor at rest is usually seen in one hand as a presenting symptoms for PD. Intention tremor is also know as essential tremor and presents symmetrically in a different population. The other symptoms are seen later in the disease
How often is a stroke caused by cerbrovascular ischemia?
87%
How often is a stroke caused by hemorrhage?
13%
Difficulty speaking - difficulty forming words
Dysarthria
Impaired speech
Dysphasia
Inability to perform a previously learned action
Apraxia
The patient is unable to form words that are understandable yet can speak in single-work responses
Expressive aphasia
The patient is unable to comprehend the spoken word and can speak but may not make sense
Receptive aphasia
Loss of half of the visual field
Homonymous hemianopsia
This gait and posture abnormality is seen in corticospinal tract leasions that cause poor control of flexor muscles during the swing phase (from stroke for example)
- affected arm is flex, immobile and heald close to the side with elbow, wrists, and interphalageal joints flexed
- affected leg extensors are spastic; ankles are plantar-flexed and inverted
- patients may drag toe, circle leg stiffly outward and forward, or lean trunk to contralateral side to clear affected leg during walking
Spastic Hemiparesis
Loss of speech
Aphasia
Paralysis of the face, arm, and leg on the same side due to a lesion in the opposite hemisphere
Hemiplegia
Staggering, unsteady gait and inability to keep feet together - feeling off balance
Ataxia or disequilibrium
Relating to or denoting the side of the body opposite to that on which a particular structure or condition occurs
Contralateral
Clinical finding: Oculomotor deficits and/or ataxia with cross sensory/motor deficits Vascular territory involved:
Posterior circulation - basilar artery
Contralateral face, arm > leg weakness, sensory loss, visual field loss, apraxia, aphasia (left), or neglect (right) Vascular territory involved:
Anterior circulation - middle cerebral artery (MCA)
Clinic finding: Contralateral visual field loss Vascular territory involved:
Posterior circulation - posterior cerebral artery (PCA)
Clinical finding: Contralateral leg weakness Vascular territory involved:
Anterior circulation - anterior cerebral artery (ACA)
In this gait abnormality, the gait is stiff. Patients advance each leg slowly, and the thighs tend to cross forward on each other at each step
- Steps are short
- Patients appear to be walking through water, and there may be compensating sway of the trunk away from the side of the advancing leg
- Seen in all spasticity disorders, most commonly cerebral palsy
Scissors Gait
Clinical finding: Contralateral motor or sensory deficit without cortical signs Vascular territory involved:
Anterior circulation - middle cerebral artery (MCA)
Clinical finding: Contralateral visual field loss Vascular territory involved:
Posterior circulation - posterior cerebral artery (PCA)
An unpleasant sensation in the legs, especially at night, that gets worse with rest and improves with movement of the symptomatic limb(s)
Restless leg syndrome Reversible causes: pregnancy, renal disease, iron deficiency
A spinning sensation accompanied by nystagmus and ataxia
Vertigo
Rhythmic oscillatory of a body part resulting from the contraction of opposing muscle groups
Tremor
In this disorder, strong emotion such as fear or pain, prolonged standing, or a hot humid environment leads to reflex withdrawal of sympathetic tone and increased vagal tone causing a drop in blood pressure and heart rate and loss of consciousness
Vasovagal syncope (the common faint)
In a patient with hypovolemia, standing up can cause a gravitational redistribution and pooling of 300-800mL blood to the lower extremities leading to a significant drop of blood pressure and loss of consciousness
Orthostatic hypotension (drop in SBP of >/= 20mm HG or in DBP of >/= 10mm HG within 3 minutes of standing)
In a patient experiencing a severe paroxysm coughing, this neurally mediated response possibly from reflex vasopressor-bradycardia leads to cerebral hypo-perfusion and possibly increased CSF pressure and loss of consciousness
Cough syncope
In this gait abnormality the posture is stooped, with flexion of head, arms, hips, and knees
- patients are slow getting started
- steps are short and shuffling, with involuntary hastening (festination)
- arm swings are decreased, and patients turn around stiffly-“all in one piece”
- postural control is poor (anteropulsion or retropulsion)
Parkinsonian Gait
Absent strength
paralysis or plegia
4 ways to assess a patient’s gait
- walk across the room (observe)
- walk heel-to-toe (Tandem walking)
- walk on toes, then heels
- hop in place on each foot in turn
- shallow knee bend
Seen in foot drop this gait abnormality is usually secondary to peripheral motor unit disease
- patients either drag the feet or lift them high, with knees flexed and bring them down with a slap onto the floor
- patients cannot walk on their heels
- gait may involve one or both legs
- tibialis anterior and toe extensors are weak
Steppage gait
In this gait abnormality, the gait is staggering and unsteady with feet wide appar and exagerated difficulty on turns
- patients cannot stand steadily with feet together, whether eyes are open or closed
- other cerebellar signs are present such as dysmetria, nystagmus, and intention tremor
Cerebellar Ataxia
In this gait abnormality, the gait is unstead and wide based (feel wide apart
- patients throw their feel forward and outward and bring them down, first on the heels and then on the toes, with a double tapping sound
- patients watch the ground for guidance when walking
- with eyes closed, patients cannot stand steadily with feet together (positive Romberg sign), and the staggering gait worsens
Sensory Ataxia
A transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction
TIA (transient ischemic attack)
Steps are short and shuffling, with involuntary hastening. Patients are slow getting started. Posture is stooped, with flexion of head, arms, hips, and knees
Parkinson disease
