WEEK 1: Clinical Localization [Dr Salonga] Flashcards
speech disorder vs receptive language disorder vs expressive disorder
Speech d/o - difficulty producing sounds, as well as disorders of voice quality. (stuttering)
Receptive Language D/o - difficulty comprehending what is said.
expressive disorder - difficulty using spoken language
most severe form of aphasia: cannot comprehend and cannot express
global aphasia
type of aphasia where there is difficulty retrieving desired words: it’s on the tip of my tongue
anomic aphasia
level of sensorium would indicate lesion along the course of
ARAS ( ascending reticular activating system)
dysfunction of the extrapyramidal motor system of the basal ganglia woould lead to what symptoms? (2)
excessive involuntary movements (positive symptoms) slow movements ( negative symptoms)
sustained abnormal postures of limbs, neck, trunk, tongue or fixed upward deviation of the eyes
dystonia
classifications of dystonia?
Focal, multifocal, segmental, hemidystonia, generalized dystonia
blown pupils would indicate?
temporal lobe herniation with third nerve compression - , patient is likely comatose
triad of horner syndrome?
ptosis, miosis, anhidrosis on the same side.
may isa pa eh, enopthalmos
what causes the ptosis in horner syndrome?
paresis of Mueller muscle
how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in early diencephalic?
Pupillary: normal at first then constrict;
responds to doll eye maneuver;
localizes to pain
how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in late diencephalic?
smaller pupil, then constricts;
responds to doll eye maneuver;
decorticate
how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in midbrain?
dilated pupil and negative pupillary reflex;
responds to caloric testing;
decerebrate positioning
how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in pons/upper medulla?
dilated pupil and negative pupillary reflex
negative caloric testing
no response to pain.
Rinne’s test is used to?
compare perception of sound via bone and air. in normal ear, air>bone
Weber test how?
put tuning fork in the forehead. Normally, patient hears sound equally in both ears.
in unilateral cerebellar disease, if there is problem in balance there is deviation to the side of lesion or contrralateral?
side of the lesion
kernig’s sign how to elicit?
flexing the patient’s hip 90 degrees extend the patient’s knee (K for knee)
Brudzinski how to elicit?
flex the patient’s neck then the sign will be flexion of the pt’s hips and knees,
the primary study of choice in the evaluation of an acute change in mental status, focal neurologic findings, acute trauma to the brain and spine, suspected subarachnoid hemorrhage, and conducting hearing loss.
CT Scan
more sensitive in the detection of early disease associated with increased water content.
MRI
superior in the posterior fossa due to beam hardening artifacts in the latter modality.
MR
used primarily for the detection of extracranial metastatic disease
FDG-PET (fluoro deoxy glucose) Positron Emission Tomography
indicated for evaluating intracranial small vessel pathology (such as vasculitis) for assessing vascular malformations and anuerysms
catheter angiography
carries the greatest risk of morbidity of all diagnostic imaging procedures
angiography
tests are complimentary in the evaluation of patients with peripheral nerve and muscle diseases.
EMG and NCV
Steps in the diagnosis of neurologic disorders?
(ACPED) anatomic dx clinical dx or syndromic dx patho dx etiologic dx diagnostics
The question of “where” the lesion is should first be answered
before determining the possible etiology. T or F?
T
Loss of meaning to perception
agnosia
difficulty producing sounds as well as disorders of voice quality.
speech disorder
perfect score in MMSE
30
<25 there is some concern, pt should be followed up
20 - means that there is a cognitive impairment
in weber’s test, what should be the result?
If a patient has a unilateral sensorineural hearing loss, the sound will lateralise – move to the good ear. If a patient has unilateral conductive hearing loss, the tuning fork sound would be heard loudest in the affected ear. (SUCA)
If the patient falls over both with eyes closed and opened, then there is a problem in
proprioception
This is the first function to be lost in alcoholic cerebellar cortical degeneration
tandem walking
characteristic of cerebellar dysfunction It results in the individual pronouncing each syllable separately
slurrerd staccato
_______ nystagmus this is associated more with cerebellar;
if it is________ on one side it is mostly associated with vestibular.
vertical;
horizontal
positive sign in pronator drift?
Observe the hands / arm for signs of pronation / movement
• A slow upward drift in one arm is suggestive of a lesion in the contralateral cerebellum
positive test in rebound phenomenon?
Positive test: Their arm shoots up above the position it originally was (this is suggestive of cerebellar disease)
is used primarily for the detection of extracranial metastatic disease
FDG PET
carries the greatest risk of morbidity of all diagnostic imaging procedures,
Cather angiography
