week 7: neurological sys and mental health Flashcards
CNS
brain
spinal cord
Brain: Cerebral cortex
frontal lobe
parietal lobe
occipital lobe
temporal lobe
bronca’s area
wernicke’s area
cerebral cortex: frontal lobe
Personality, behaviour, emotions, intellect, voluntary movement (precentral gyrus)
cerebral cortex: parietal lobe
sensations
cerebral cortex: occipital lobe
vision
cerebral cortex: temporal lobe
auditory, smell, taste
cerebral cortex: broca’s area
in frontal lobe, controls speech production
expressive aphasia: person can’t talk, produces garbled sound
cerebral cortex: wernicke’s area
top of temporal lobe, controls speech comprehension
receptive aphasia: person can’t understand language
basal ganglia
Bands of grey matter deep in brain; has motor function
thalamus
Primary relay system of the brain; messages btwn/ brain and spinal cord
Hypothalamus
Controls vital, homeostatic functions (heart rate, temp, BP), autonomic response and pituitary gland
cerebellum
Motor coordination, equilibrium (body balance), muscle tone
brainstem + components
Central core of the brain, nerve fibres, cranial nerves
Midbrain: Most anterior; merges into thalamus/hypothalamus, has motor neurons/tracts
Pons: Has ascending/descending fibre tracts (messages to/from brain/body)
Medulla Oblongata: Continuation of spinal cord; also has ascending/descending tracts but also vital autonomic centres (respiratory, cardiac, GI), cranial nerves
If this breaks, you’re dead
spinal cord
Has ascending and descending tracts; connects to the cranial nerves
Sends messages/sensations from the body to the brain, reacts in motor ways
Looks like a butterfly in cross section, mediates reflexes
pathways of CNS**
Sensory Pathways: Sends messages to the brain; afferent fibres
Spinothalamic Tract: Deals with crude/light touch; pain and temperature
Posterior/Dorsal Columns: Deals with finely localized touch (stereognosis, identifying objects by touch without looking); position (in 3D space), vibration
Motor Pathways:Sends messages from the brain; efferent fibres
Pyramidal Tract: Fine voluntary movement (writing)
Extrapyramidal Tract: Gross voluntary movement (walking)
Cerebellar System: Coordination and Posture (subconscious)
PNS
Peripheral Nervous System:
Reflex Arc: Basic defense mechanisms of the nervous system; involuntary, unconscious
Deep Tendon (Myotatic): Ex., knee jerk/patellar, biceps, achilles, triceps
Superficial: Ex., corneal reflex, abdominal
Visceral (Organic): Pupillary response/light accommodation
Pathological: Abnormal; ex., seeing Babinski reflex in adults
I Olfactory
Sensory
Smell - Only tested if smell is lost; close one nostril and sniff two different, familiar smells, change nostril between smells
II Optic
Sensory
Visual acuity, fields, optic disc
III Oculomotor
Motor
Eyelids, Pupillary light response, field of gaze
IV Trochlear
Motor
Inward/Down Eye movements; III, IV, VI tested together
V Trigeminal
Both
Jaw muscles, touch forehead/cheek/chin
VI Abducens
Motor
Lateral eye movement
VII Facial
Both
Facial muscles, tastes
VIII Acoustic or Vestibulocochlear
Sensory
Hearing and Balance
IX Glossopharyngeal
Both
Pharynx (swallowing, speaking), gag reflex, taste of back tongue
X Vagus
Both
Heart, breathing, pharynx/larynx (talking, swallowing), test w/ IX
XI Spinal Accessory
Motor
Shrugging shoulders, head rotation (trapezius, sternomastoid)
XII Hypoglossal
Motor
Tongue movement
mnemonic and function
Mnemonic: “Oh Oh Oh To Touch And Feel A/Virgin Girl’s Vagina And Hymen”
Function: “Some Say Marry Money But My Brother Says Big Brains/Butts/Boobs Matter More
spinal nerves
Spinal Nerves: There are 31 pairs and each innervate a dermatome (an area of skin); used for sensory (feeling, afferent) and motor (moving that part of the body, efferent).
8 Cervical: In general, head and arms
12 Thoracic: In general, torso and some of the arms
5 Lumbar: In general, the legs
5 Sacral: In general, the bowel/bladder/sexual
1 Coccygeal: No idea what it does tbh
Useful to know the dermatomes for neuro, epidurals,
autonomic nervous system
Part of the nervous system that deals with involuntary homeostasis
Sympathetic (Fight or Flight)
Parasympathetic (Rest and Digest)
tremors
Involuntary shaking, vibrating, trembling
paralysis
Loss of motor function as a result of neurological lesion, innervation problems
paresis
Weakness of voluntary movements/impaired movement
dysmetria
Incoordination; Inability to control the RoM of muscles
paraesthesia
Abnormal numbness or tingling feeling
dysphagia
Difficulty swallowing
dysarthria
Difficulty forming words (ex., expressive aphasia)
dysphasia
Difficulty with language comprehension (ex., receptive aphasia)
syncope
Sudden loss of strength, temporary loss of consciousness (fainting), lack of brain blood p
vertigo
Sensation of rotational spinning (vs. dizziness = swimming feeling)
mental health subjective data
Be aware of any mental health diagnoses; they affect the neurological exam
ex., decreased LoC = depression, schizophrenia = inability to react to pain
Any childhood diseases/surgeries/traumas (i.e., concussions)
Childhood abuse? “Have you ever suffered from any childhood abuse”
It’s better to ask than assume
Chronic Illnesses
Functional Assessment: Nutrition, Sleep, Activity, Elimination, Interpersonal Relationships, Self Esteem, Spirituality, Coping/Stress Mgmt, Substance Abuse
Screen for suicidal/homicidal ideation
Have you ever thought about killing yourself or have made a plan?
Have you thought about hurting yourself or anyone else?
Note if the patient expresses sadness, hopelessness, despair
Refer to more qualified HCP at a hospital
neurological subjective
headaches
head injuries
lightheaded, dizzy, faint, or have vertigo
seizures
shakes or tremors
weakness
coordination
numbness or tingling
diff swallowing
problem speaking
stroke, spinal cord injury, meningitis, encephalitis, congenital defects
environmental/occupational hazards
meds
alcohol
mood-altering drugs
objective data: optic cranial nerve
Visual Acuity (Snellen Chart) - Letter chart
Confrontation: Go to patient’s eye level; cover one eye; compares yours and patient’s peripheral vision — Patient says “now” when they can see your finger, from side, above, below
objective data: oculomotor cranial nerve
PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation
“I’m gonna shine a light in your eye”, then “Focus on my finger, look at the wall”
Palpebral fissure/Upper Eyelid droop (Ptosis) (slide finger down)
objective data: cranial nerve oculomotor, trochlear, abducens (motor)
Cardinal directions of eye movement
Can you see my fingers in your periphery; follow finger without moving head
Shine light in eye to test for dilation
objective: cranial nerve trigeminal
Sense: Light touch (cotton wisp) forehead, cheek, chin bilaterally;
Motor: Palpate clenched jaw (TMJ)
objective: facial (motor) cranial nerve
Facial Expressions - Smile, Frown,Close eyes tight, lift eyebrows, show teeth
Puff Cheeks (and press in cheeks)
Not tested: Taste test
objective: cranial nerve acoustic/vestibulocochlear
Whispered voice test (no tuning fork)
1/2 meter, arms length away from one ear, other is covered: Whisper a two syllable word ”firetruck, baseball, sunscreen” and get them to repeat it back; repeat bilaterally
objective: cranial nerve glossopharyngeal, X vagus
Depress tongue, Say “ahh” to see uvula, test gag reflex (don’t), see movement of soft palate & tonsillar pillars - uvula, soft palate moves up, tonsils medially
objective: cranial nerve - spinal accessory
(Motor): Head rotation (sternomastoid) and Shoulder shrug (trapezius) against resistance
objective: cranial nerves - hypoglossal (motor)
Tongue thrust out, strength/symmetry, lingual “light, tight, dynamite”
cerebellar balance tests
Gait: Normal Walking
Tandem Walking (Heel to Toe): Trying to walk in a straight line from heel to toe
Romberg Test: Eyes closed, feet together for 20 seconds; positive if they fall
cerebellar coordination and skilled movements
Rapid Alternating Movements: Patting knees with front/back of hands, thumb to finger touch
Finger to Finger Test: Touch your nose, touch my finger (and I move my finger)
Finger to Nose Test: Close eyes, stretch out arms, touch nose alternating
Heel-to-Shin Test: Taking your heel and sliding it down your opposite shin
sensory system/reflexes
Pain: Sharp vs. Dull point (broken tongue depressor) - Ask them if they feel “sharp/dull”
Light Touch: Using a cotton ball, touch skin: Say “now/yes” when you feel it
Vibration: Using a tuning fork on arm, shin bones
Position Sense: Eyes closed, moving arm/fingers/toes up or down
Stereognosis: Recognizing an object while eyes are closed (ex., key, pencil, coin)
Graphesthesia: Draw a number on their hand and get them to tell you what number (ex. 7)
2-Point Discrimination: Two pinpoints on skin (ex., paperclips) and see how close it gets
Most sensitive: Fingertips, Least sensitive: Upper arms, thighs, back
Extinction: Touch both sides of body at same point, state how many sensations felt/where
Point Location: Point to where you were touched
reflexes
Graded from 0-4+ where 2 is normal
Bicep (C5/C6)
Support arm at forearm; strike on thumb to hit biceps tendon (biceps contract, forearm flex)
Tricep (C7/C8)
Support arm and let dangle above elbow; hit tricep tendon (swings out)
Brachioradialis (not tested)
quadriceps (L2-L4)
Patellar Reflex; leg dangling or if supine supporting leg; hit patellar tendon for knee jerk (swings out)
achilles (L5-S2)
Knee flexed, externally rotated, foot dorsiflexed, strike achilles tendon
You’ll feel plantar flexion
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole
Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best
Eye Opening: /4
Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None
Motor Response: /6
Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation ->
-> Flexes extremities in response to pain -> Flexes body entirely -> No response
Verbal Response: /5
Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response
Can also assess pupil size, dilation, other neuro parts
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole
Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best
Eye Opening: /4
Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None
Motor Response: /6
Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation ->
-> Flexes extremities in response to pain -> Flexes body entirely -> No response
Verbal Response: /5
Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response
Can also assess pupil size, dilation, other neuro parts
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole
Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best
Eye Opening: /4
Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None
Motor Response: /6
Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation ->
-> Flexes extremities in response to pain -> Flexes body entirely -> No response
Verbal Response: /5
Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response
Can also assess pupil size, dilation, other neuro parts
stroke
In general, refers to a loss of oxygen in the brain, corresponding cell death; two types
Ischemic Stroke: Refers to a blood clot that prevents blood flow to the brain
Treated with blood thinner/clot buster
Hemorrhagic Stroke: Refers to a burst blood vessel in the brain that prevents oxygen
Blood thinners would kill you; surgical, no intervention
Common signs of stroke: FAST - Face, Arms, Speech, TIme; Severe headache
Get them to a CT scan (computerized tomography) ASAP so they can identify the type of stroke and then treat it appropriately: extremely time sensitive
