Week 11- Neuro Flashcards
4 regions of brain:
Cerebrum, diencephalon, brainstem, cerebellum
Aggregation of neuronal cell bodies:
Gray matter
Neuronal axons that are coated with myelin:
White matter
These allow nerve impulses to travel more quickly:
Myelin sheaths
Sections of spine:
Cervical c1-c8
Thoracic t1-t12
Sacral s1-s5
Coccygeal
The brain and the spinal cord:
CNS
Cranial nerves and the peripheral nerves:
PNS
The corticospinal tract, the basal ganglia system, the cerebellar system:
Motor pathways
Reflexes, conscious sensation, body position, regulate autonomic functions:
Sensory pathways
Muscle stretch reflexes (deep tendon reflexes):
Reflexes
Common or concerning neuro symptoms:
HA, dizziness
Primary HA:
Migraine, cluster, and trigemjnal autonomic cpehalgias
Red flags for HAs:
Sudden/thunderclap
New onset after 50
Fever/stiff neck
Worst HA of my life- subarachnoid hemorrhage
Dull HA increased by coughing
Recurring in the same position- Tumor/abscess
Migraine (pound)
Pins and needles:
Paresthesias
Distorted sensations:
Dysesthesias
A rhythmic oscillatory movement of a body part resulting from contraction of opposing muscle groups:
Tremors
An infarction of CNS tissue
Cerebrovascular ischemia
Transient episode of neuro dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction:
TIA
ABDC2 for stroke:
Age greater/equal to 60
BP greater than/equal to 140/90
Clinical features of focal weakness, impaired speech without focal weakness
Duration 10-59 minutes of greater/equal to 60 minutes
Diabetes
This causes visual field cuts and contra lateral hemiparesis and sensory deficits:
Occlusion of the middle cerebral artery
This causes aphasia:
Occlusion of the left middle cerebral artery
This cause neglect or inattention to the opposite side of the body:
Occlusion of the right middle cerebral artery
Warning signs of stroke:
Face drooping
Arm weakness
Speech difficulty
Time to call
Modifiable risk factors for stroke:
HTN Smoking Dyslipidemia Diabetes Weight, diet, nutrition Physical activity Alcohol use
Disease specific risk factors for stroke:
Afib
CAD
OSA
Most common, slowly progressive, often asymptomatic, risk factor for ulcerations, arthropathy, and amputation:
Distal symmetric polyneuropathy
Unilateral thigh pain and proximal lower extremity weakness:
Autonomic dysfunction, mononeuropathies, and polyradiculopathies
Diabetic foot exam should include:
Pin prick sensation
Ankle reflexes
Vibration perception
Plantar light touch sensation (semmes-weinstein monofilament)
This often causes burning electrical pain in the lower extremities, often at night:
Distal symmetric polyneuropathy
Reactivation of latent varicella within the sensory ganglia that causes painful, unilateral vesicular rashes in dermatomal distribution:
Herpes zoster
Multifactoral syndrome, acute confusional state marked by sudden onset, fluctuating course, inattention and at time, changing level of consciousness:
Delirium
Declines in memory and cognitive ability that interfere with ADLs
Dementia
This is more common in individuals with medical conditions:
Depression
Components of a neuro exam:
Mental status Cranial nerves Motor system Sensory system Deep tendon, abdominal and plantar reflexes
CN1 (olfactory) function is ___ and to test ___.
Sense of smell
Present with a non-irritating odor
Loss of smell may come with:
Head trauma, smoking, aging, cocaine use, Parkinson’s
CN II is the:
Optic nerve
CN II (optic) function is ___ and is tested by ____.
Vision
Visual acuity, visual fields by confrontation, pupillary light reaction, near response
CN III is the :
Oculomotor nerve
CN III (oculomotor) function is___ and is tested by ____.
Pupillary constriction, opening the eye (lid elevation) and most EOMs
Pupillary light reaction, near response (constriction and accommodation), EOMs, convergence
Abnormal pupillary constriction
Anisocoria- CN III palsy
Ptosis plus opthomoplegia:
Intracranial aneurysm (awake) Transtentorial herniation (comatose)
If anisocoria worsens in the darkness, the small pupil has abnormal dilation and can be related to:
Horner syndrome or simple anisocoria
CN IV is called:
Trochlear
CN IV (trochlear) function:
Downward, internal rotation of the eye
CN IV (trochlear) test:
EOMs, convergence
Binocular diplopia in CN IV neuropathy caused by:
MG, trauma, thyroid opthalmopathy
CN V is called:
Trigeminal
CN V ( trigeminal) function:
Motor-temporal and masseter muscles (jaw clenching, lateral pterygoids)
Sensory- facial (ophthalmic, maxillary, mandibular
CN V (trigeminal) test:
Motor- clench teeth,open jaw, move side to side
Sensory- pain on forehead, cheeks, and chin
Corneal reflex- touch cornea with cotton
Unilateral jaw weakness caused:
Pontine lesions
Bilateral jaw weakness caused by:
Bilateral hermispheric diagnosis
Ipsilateral facial and body sensory loss from contra lateral cortical or thatlmic lesions caused by:
Stroke
Blinking absent on both sides with:
CN V lesions
CN VI is called:
Abducens
Abducens function:
Lateral deviation of the eye
CN VI (abducens) test:
Six cardinal fields of gaze, convergence
Nystagmus May be associated with:
Cerebellar diagnosis
CN VII is called:
Facial
CN VII (facial) function:
Motor- facial movements (expression, closing the eye, closing the mouth)
Sensory- taste for salty, sweet, sour, and bitter; sensation from the ear
Blinking absent one the side of weakness in:
Lesions of CN VII
CN VII (facial) test:
Raise eyebrows, frown, close both eyes tightly, try to open them, show both upper and lower teeth, smile, puff out both cheeks
Flattening of the nasolabial fold and drooping of the lower eyelid suggest:
Facial weakness
CN VIII is called:
Acoustic
CN VIII (acoustic) function:
Hearing (cochlear division) and balance (vestibular division)
CN VIII (acoustic) test:
Whispered voice test, Rinne, Weber
Vertigo with hearing loss and nystagmus:
Meniere disease
CN IX is called:
Glossopharyngeal
CN IX (glossopharyngeal) function:
Motor- pharynx
Sensory- posterior portions of the eardrum, the pharynx, and the posterior tongue
CN IX (glossopharyngeal) test:
Difficulty swallowing, movement of the soft palate and the pharynx (symmetric), uvula midline
Hoarseness caused by:
Vocal cord paralysis
Dysphagia caused by
pharyngeal or palatal weakness
CN X is called:
Vague
CN X (vagus) function:
Motor- palate, pharynx, and larynx
Sensory- pharynx and larynx
CN X (vagus) test:
Difficulty swallowing, movement of the soft palate and the pharynx (symmetric), uvula midline
CN XI is called:
Spinal accessory
CN XI (spinal accessory) function:
Motor- SCM and upper portion of the trapezius
I’m
CN XI (spinal accessory) test:
Look for atrophy or fasciculations, shrug against resistance, turn head to each side against hand, observe for contraction of the opposite SCM and note the force of the movement against your hand
CN XII is called:
Hypoglossal
CN XII (hypoglossal) function:
Motor- tongue
CN XII (hypoglossal) test:
Tongue protrude midline, move tongue side to side and note symmetry
Proprioception is:
Body position
Ability to identify an object by feeling it:
Stereogenosis
Number identification when a number is drawn on patients palm:
Graphesthesia
Two-point discrimination is:
Two ends of opened paper clip, or two pins, touch a finger pad simultaneously; find the minimal distance at which a person can discriminate the two points: normal is <5mm on the finer pad
+4 grade for reflexes is:
Very brisk, hyperactive with clonus
If reflexes are hyperactive, follow up with:
Ankle clonus test
Ankle clonus test:
Support the knee partially flexed
Dorsiflex and plantarflex the foot while encouraging patient to relax
Look for rhythmic oscillations-CNS disease
Oculocephalic reflex is the:
Doll’s eye movements- hold eyes open, turn head quickly from side to side- eyes should move to opposite side that head is turned
Ice water into the ear canal; intact brainstem, eyes will deviate toward ear being tested:
Oculovestibular relfex
