Approach to Neuro Exam Flashcards
(31 cards)
Dysarthria vs. Aphasia
- Dysarthria - defective articulation, due to neuro or non neuro issue
- Aphasia - cannot produce or understand speech, neuro issue
Describe what is meant by AxOx4
Alert Oriented to: - Person (x1) - Place (x2) - Time (x3) - Situation (x4)
What is anhedonia? What condition is this associated with?
cannot feel pleasure, assoc w depression
Delirium vs. Dementia
- Delirium - reversible (ex: ICU delirium)
2. Dementia - not reversible (ELIMINATE delirium and depression before dx)
What lesions are assoc with CN III?
ptosis (Horners), pulpillary dilation/asymm, compressive brain stem lesions
What lesions are assoc with CN IV?
- exotropia (eyes drift laterally), weakness downward gaze
- visual diplopia (worse when looking down)
- head tilting (to opp side lesion, do not misdx as torticollis)
What lesions are assoc with CN VI? What diseases is this commonly assoc with?
Dz: SAH, late syphilis, trauma
- medial strabismus (esotropia)
- horizontal diplopia
What lesions are assoc with CN V?
- loss of corneal reflex
- weakness mastic m
- dec sens face
- jaw deviation (toward weak side)
What lesions are assoc with CN VII?
- Bell’s Palsy
- Hyperacusis
- Crocodile tears syndrome - tears while chewing
What lesions are assoc with CN VIII?
- dysequilibrium
- nystagmus
- sensorineural hearing loss
- tinnitus
What lesions are assoc with CN IX?
- loss of gag reflex
- loss of sensation in pharynx and post 1/3 tongue
- slight dysphagia
What lesions area assoc with CN X?
- hoarseness (dysphonia)
- dysphagia
- dyspnea
- loss of gag or cough reflex
- asymm palatal elevation
What lesions are assoc with CN XI?
SCM - difficulty turning head to opp side
Trap - shoulder droop
What lesions are assoc with CN XII?
tongue deviation to weak side
How should you document CN testing?
Ideal: “CN II-XII are intact to testing” - went thru each b/l
Ok: “CN are grossly intact” -talking to pt and havent seen anything that would demonstrate CN are not intact, did not actually test them
Sensory Dermatomes to know
C2 - auricle C3 - earlobe, ant/post neck C6 - radial aspect forearm C8 - 5th digit T4 - nipple T10 - umbilicus L1 - inguinal L4 - patella L5 - anterolateral calf, great toe S5 - perianal area
What 4 modalities should you test during sensory exam?
- Pain - broken tongue depressor
- Temp - test tubes w warm or cold water
- Vibration - tuning fork bony prominences
- Proprioception - move big toe up an down w eyes closed
Sterogenesis
ability to ID objects in hand (discriminative sens)
Graphesthesia
ability to ID numbers written on you hand (discriminative sens)
2 - pt discrimination
can distinguish being touched by one or two points (discriminative sens)
Double simultaneous stimulation (extinction)
ability to feel two locations being touched simultaneously
Patterns of Sensory Loss
- Thalamic - hemisensory all modalities
- Cortical - intact primary sensations, loss of cortical sensations (discrim sens)
- Functional loss- non anatomical distribution (ex: diabetic neuropathy)
Muscle bulk vs. muscle tone
bulk - atrophy, hypertrophy
tone - musc that is relaxed voluntarily retains slight tone
Cerebellar ataxia
staggering, unsteady, feet wide
