208: Neurological System Flashcards
1
Q
Define intracranial regulation.
A
Mechanisms or conditions that impact intracranial processing and function.
2
Q
What is the scope of intracranial regulation?
A
optimal —–> impaired (severe, moderate, mild)
3
Q
What can cause impairment to the brain?
A
- reduced blood flow to the brain
- compromised neurotransmission
- damage to brain tissue
4
Q
What are some population risk factors for intracranial regulation?
A
- Elderly population have a higher risk for degenerative pathology
- injury-related ICR problems are more commonly seen in the adolescent and young adult age group
5
Q
What are some individual risk factors for stroke?
A
- age
- hypertension
- diabetes
- smoking
- obesity
- cardiovascular disease
- genetics
6
Q
What assessments are related to intracranial regulation?
A
- History
- Examination Findings
- Mental Status assessment
- Glasgow coma scale
- Cranial nerves
- Intracranial pressure
- Measurement of cerebral perfusion pressure
- The National Institutes of Health Stroke Scale
7
Q
What are some diagnostic tests used for intracranial regulation?
A
- neuroimaging studies
- skull radiograph
- electroencephalogram
- brain biopsy
- lumbar puncture
8
Q
What are the three components of the Glasgow Coma Scale?
A
- eye opening
- verbal response
- motor response
9
Q
Lobe that contains personality
A
frontal
10
Q
Involuntary nerves, permit quick reaction to potentially damaging situations
A
reflexes
11
Q
Knowing where your body parts are in space even if you are blindfolded
A
proprioception
12
Q
Controls balance and equilibrium
A
cerebellum
13
Q
For example, biceps, triceps, brachioradialis
A
deep tendon reflexes (DTR)
14
Q
Pain, temperature, touch
A
sensory
15
Q
Area of the brain concerned with personality, behaviour, emotions, and intellectual functioning.
A
Frontal lobe
16
Q
What part of the frontal lobe initiates voluntary movement?
A
precentral gyrus
17
Q
Which lobe is the primary centre for sensation?
A
parietal lobe
18
Q
Which lobe is the primary visual receptor centre?
A
occipital lobe
19
Q
Which area of the brain contains the primary auditory reception centre?
A
temporal lobe
20
Q
Which area of the temporal lobe is associated with language comprehension?
A
Wernicke’s area
21
Q
How many pairs of cranial nerves and how many pairs of spinal nerves are there?
A
12 pairs of cranial nerves
31 pairs of spinal nerves
22
Q
What envelopes the CNS and what are they called?
A
meninges (dura, arachnoid and pia mater)
23
Q
What is the purpose of the cerebral cortex (cerebrum)?
A
Centre for human’s highest functioning.
- governing thought, memory, reasoning, sensation and voluntary movement
24
Q
Forms the sub-cortical motor system (extrapyramidal system). Controls automatic associated movements of body, like arms swinging while walking.
A
Basal ganglia
25
The main relay station for the nervous sytem.
Thalamus
26
Major control centre with many vital functions: controlling temperature, heart rate, and blood pressure; regulating sleep and the anterior and posterior pituitary gland; coordinating autonomic nervous system activity and emotional status.
Hypothalamus
27
In occipital region and concerned with motor coordination of voluntary movements, equilibrium, and muscle tone. Coordinates and smoothes movement.
Cerebellum
28
Central core of the brain consisting of mostly nerve fibres.
brain stem
29
What makes up the brain stem?
- midbrain
- pons
- medulla
30
Continuation of spinal cord in the brain. Vital autonomic centres (respiratory, cardiac, gastro-intestinal) as well as nuclei for cranial nerves 8 - 12.
Medulla
31
What does crossed representation refer to?
The left cerebral cortex receives sensory information from, and controls motor function to, the right side of the body, whereas the right cerebral cortex interacts with the left side of the body.
32
What is the spinothalamic tract?
Contains sensory fibres that transmit the sensations of pain, temperature, and crude or light touch.
33
What are the posterior (dorsal) columns?
These fivres conduct the sensations of position, vibration, and finely localized touch.
34
What is position (proprioception)?
the sense of where your body parts are in space and in relation to each other, without looking at them.
35
What does vibration entail?
the ability to feel vibrating objects
36
What does finely localized touch (stereognosis) entails?
the ability to identify familiar objects by touch, without looking.
37
What is the homunculus?
an illustration representing the proportion of the brain responsible for sensations in particular body parts.
38
What do corticospinal fibres mediate?
Voluntary movement, particularly very skilled, discrete, purposeful movements such as writing.
39
What are included in the extrapyramidal tracts and what do they do?
All motor nerve fibres originating in the motor cortex, basal ganglia, brain stem, and spinal cord that are outside the pyramidal tract. Maintain muscle tone and control body movements, esp gross automatic movements.
40
Where are most upper motor neurons found?
CNS
41
Where are most lower motor neurons found?
mostly in the PNS
42
What are the four types of reflexes?
1) deep tendon reflexes (myotatic), such as patellar or knee jerk
2) superficial, such as corneal reflex or abdominal reflext
3) visceral (organic), such as pupillary response to light and accommodation
4) pathological (abnormal), such as the Babinski (extensor plantar) reflex
43
What are the 5 components of the deep tendon reflex?
a) intact sensory nerve
b) a functional synapse in the cord
c) intact motor nerve fibre
d) neuromuscular junction
e) competent muscle
44
What is the breakdown of the spinal nerve pairs into regions?
```
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
```
45
What is dermal segmentation?
the cutaneous distribution of the various spinal nerves
46
What is a dermatome?
A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular nerve.
47
True or false. Dermatomes do not overlap.
False. They do overlap. This is a form of biological insurance; if one is severed, most sensation will continue to be transmitted by the nerve above and below it.
48
Are neurons myelinated in infants?
No. Movement is largely directed by primitive reflexes.
49
How does the process of myelination proceed in infants?
Cephalocaudal order and a proximal-distal order.
50
True or false. Sensation is well developed at birth.
False. It is rudimentary and infants require a larger stimulus. But do not be mistaken, they feel pain.
51
The aging process causes general atrophy and neuron loss. What are some common signs in 65+ year olls associated with this?
- general loss of muscle bulk
- loss of muscle tone in face, in the neck and around the spine
- decreased muscle strength
- impaired fine coordination and agility
- loss of vibratory sense at the ankle
- decrease or absent Achilles reflex
- loss of position sense at the big toe
- pupillary miosis, irregular pupil shape, and decreased pupillary reflexes
- touch and pain sensation, taste, and smell may be diminished
- a general slowing down of movement
- muscle tremors may occur in the hands, head, and jaw, with possible repetitive facial grimacing (dyskinesias)
52
What are some risk factors for stroke?
- low socioeconomic status
- being of First Nation, Inuit, and Metis descent
- being of South Asian and African heritage
- hypertension
- smoking
- diabetes
- cardiovascular disease
- age
- gender (more men than women, but women higher mortality rate)
- low birth weight
53
What are the most common symptoms of stroke?
- sudden weakness or numbness in the face, arms, or legs, especially when it is on one side of the body
- sudden confusion, trouble speaking, or understanding speech
- sudden changes in vision, such as blurry vision or partial or complete loss of vision in one or both eyes
- sudden trouble walking, dizziness, or loss of balance or coordination
- sudden severe headache with no reason or explanation
54
What mnemonic did the Heart and Stroke Foundation of Canada come up with?
FAST
- Face - Is it drooping?
- Arms - can you raise both?
- Speech - Is it slurred or jumbled?
- Time - To call 9-1-1 right away
55
Sudden loss of strength and a temporary loss of consciousness caused by lack of cerebral blood flow, like with low blood pressure.
syncope (fainting)
56
What is vertigo?
Sensation of rotational spinning, caused by neurological disease in the vestibular apparatus in the ear or vestibular nuclei in the brain stem.
57
What is an aura?
Subjective sensation that precedes a seizure; it could be auditory, visual, or motor
58
Involuntary shaking, vibrating, or trembling?
Tremor
59
Weakness of voluntary movements or impaired movement.
paresis
60
Loss of motor function as a result of a lesion in the neurological or muscular system or loss of sensory innervation
paralysis
61
Inability to control the ROM of muscles.
Dysmetria
62
Abnormal sensation, such as burning or tingling
paresthesia
63
difficulty swallowing
dysphagia
64
Difficulty forming words
dysarthria
65
difficulty with language comprehension or expression
aphasia
66
What is nystagmus and if present anywhere other than endpoint gaze, what components need to be measured?
It is a back-and-forth oscillation of the eye. Document:
- pendular movement or jerk
- amplitude (fine, medium or coarse)
- frequency: constant or fades
- plane of movement (horizontal, vertical, rotary, or a combination)
67
What is a fasciculation?
muscle twitch
68
What are neurological characteristics of a newborn?
- very alert, eyes open
- strong, urgent sucking
- normal cry is loud and lusty, possibly even angry
- next 2-3 days sleeping
69
Infants:
- smiles responsively
- recognizes parent's face
2 months
70
Infants:
- babbling begins
- purposeful reach for objects with both hands
- When pulled up from supine, head stays in line with the body and does not flop
4 months
71
Infants:
- one or two words (mama, dada)
- a grasp with fingers and opposing thumb
9 months
72
How do you know an infant's cranial nerves 2,3,4 and6 are working?
- blink reflex with light in eyes
- size, shape, equal-sized pupils
- looking at face or close objects
- eyes follow movement
73
How do you know an infant's cranial nerve 5 is working?
rooting reflex, sucking reflex
74
How do you know an infant's cranial nerve 7 is working?
facial movements symmetrical when crying or smiling
75
How do you know an infant's cranial nerve 8 is working?
```
Moro reflex (until 4 months old); elicited by loud sound; acoustic blink reflex 0 responds to a loud hand clap
Eyes follow sound
```
76
How do you know an infant's cranial nerves 9 and 10 are working?
swallowing, gag reflex
| coordinated sucking and swallowing
77
How do you know an infant's cranial nerve 12 is working?
In response to pinching of nose, infant's mouth opens and tongue rises
78
What position do newborns favour?
flexed position, extremities are symmetrically folded inward, the hips are slightly abducted and fists are tightly flexed.
79
At what age does flexion give way to extension in infants? And no longer hold fists?
2 months old; 3 months old
80
True or false. Babies are normally ambidextrous for the first 18 months.
True
81
What is the Landau reflex in infants?
Baby able to raise the head and arch the back, as in a swan dive. Usually able to do so by 3 months of age and persists until 1.5 years old.
82
What infantile automatisms are present in infants and when do they disappear?
1) rooting reflex (disappears at 3 - 4 months)
2) sucking reflex (disappears at 10 - 12 months)
3) palmar grasp (disappears at 3 - 4 months)
4) Plantar grasp (disappears at 8 - 10 months)
5) Babinski reflex (changes to adult response at 24 months)
6) Tonic neck reflex (appears at 2-3 months and disappears at 4-6 months)
7) Moro reflex (disappears between 1-4 months)
8) Placing reflex (appears 4 days after birth)
9) Stepping reflex (disappears before voluntary walking begins)
83
What characterizes senile tremor?
- benign tremors that include an intention tremor of the hands
- head nodding
- tongue protrusion
84
What is dyskinesias?
Repetitive stereotyped movements in the jaw, lips, or tongue that may accompany senile tremors. No associated rigidity present.
85
Upon increasing intracranial pressure, what is involved in the abbreviated neuro exam?
1) Level of consciousness
2) Motor function
3) Pupillary response
4) Vital signs
86
What are the three areas of the Glasgow Coma Scale?
a) eye opening
b) verbal response
c) motor response
87
Decreased pain sensation.
Hypoalgesia
88
Absence of pain sensation.
Analgesia
89
Increased pain sensation.
Hyperanalgesia
90
Decreased touch sensation.
Hypoaethesia
91
Absent touch sensation
Anaesthesia
92
Increased touch sensation
Hyperaesthesia
93
True or false. You have both sensory and stretch reflexes.
True
94
What is often the first sensation lost?
vibration
95
Astereognosis
Inability to identify objects correctly
96
Rapid, rhythmic contractions of the same muscle.
clonus
97
Exaggerated reflex
hyper-reflexia
98
reduced functioning in a reflex
hyporeflexia
99
What kind of scale are reflexes graded on?
A five-point scale:
4+: Very brisk, hyperactive with clonus, indicative of disease
3+: Brisker than average, may indicate disease
2+ Average, normal
1+: Diminished, low normal
0: No response
100
What is reinforcement used for in the neurological system assessment?
During reflex testing, its a technique that can help relax the muscles and enhance the response. Have the patient perform isometric exercise in a muscle group at a distance from the one being tested.
