Chapter 17 #1 - Neurology - AI Powered Flashcards
(126 cards)
1
Q
Why is an understanding of neurology critical for speech-language pathologists?
A
The central and peripheral nervous systems control structures that produce and modify sound into speech, and language is organized within the brain.
2
Q
What are the two main constructs used to approach problems encountered by speech-language pathologists?
A
Anatomical (Where is the lesion?) and functional (What is the lesion?) constructs.
3
Q
What does the term ‘dysarthria’ refer to?
A
A disorder of speech that affects the motor control of speech.
4
Q
List the components of the central nervous system (CNS).
A
- Cerebral hemispheres
- Subcortical white matter
- Basal ganglia
- Thalami
- Pons
- Medulla
- Cranial nerve nuclei
- Spinal cord
5
Q
What structures are included in the peripheral nervous system (PNS)?
A
- Peripheral nerves
- Neuromuscular junctions
- Muscles
- Sympathetic and parasympathetic nervous systems
6
Q
What role does the frontal lobe play in the brain?
A
Motor control.
7
Q
What is the function of Broca’s area?
A
Generation of speech.
8
Q
What is Wernicke’s area responsible for?
A
Interpretation of spoken and written language.
9
Q
What can damage to higher cortical systems lead to?
A
- Aphasia
- Language apraxia
- Dysprosody
10
Q
What are lower motor neurons (LMNs) responsible for?
A
Innervating skeletal muscles involved in speech production.
11
Q
What are the two main types of motor neurons in the nervous system?
A
- Upper motor neurons (UMNs)
- Lower motor neurons (LMNs)
12
Q
What is the corticobulbar tract’s function?
A
Provides voluntary control over the cranial nerves that produce speech.
13
Q
What is a common effect of a lesion in the corticobulbar tract?
A
Spastic dysarthria.
14
Q
Fill in the blank: The primary somatosensory modalities include _______.
A
[discriminative touch, proprioception, nociception, temperature]
15
Q
What mnemonic is useful for obtaining the history of a speech or language problem?
A
P-Q-R-S-T.
16
Q
What does ‘P’ in the P-Q-R-S-T mnemonic stand for?
A
Precipitating (aggravating) factors and Previous occurrences.
17
Q
What are the components of a neurologic examination?
A
- Mental status
- Cranial nerves
- Motor function
- Sensory function
- Reflexes
- Coordination
- Gait
- Stance
18
Q
What does anosmia refer to?
A
Inability to detect odors.
19
Q
What is the primary function of the optic nerve (CN II)?
A
Conveying visual information from the retina to the brain.
20
Q
How is the optic nerve tested clinically?
A
- Visual acuity with an eye chart
- Visual field testing
21
Q
What is the role of the oculomotor nerve (CN III)?
A
Innervates eye movements and controls pupil constriction.
22
Q
What is the primary function of the trigeminal nerve (CN V)?
A
Provides motor control for jaw movement and sensation to the face.
23
Q
What are the three divisions of the trigeminal nerve (CN V)?
A
The ophthalmic (V1), maxillary (V2), and mandibular (V3) branches.
These branches are involved in sensory and motor functions.
24
Q
What type of sensory information do the trigeminal sensory neurons carrying pain and temperature information process?
A
They descend into the medulla and upper cervical spinal cord as the descending trigeminal tract.
This pathway is crucial for pain and temperature sensation.
25
Which muscles are innervated by the motor fibers of CN V?
The muscles of mastication: the temporalis, masseter, and pterygoids.
## Footnote
These muscles are essential for chewing.
26
What sensory information does the maxillary branch of CN V carry?
* Sensation from the maxilla
* Maxillary teeth
* Mucous membranes of the upper mouth
* Anterior palate
* Nose and nasopharynx
* Inferior portion of the internal auditory meatus
* Midface
## Footnote
This information is important for pronunciation and swallowing.
27
What does the mandibular branch of CN V conduct sensory information from?
* Skin of the cheek
* Lower teeth and jaw
* Mucosal linings of the uvula
* Posterior hard palate
* Nasopharynx
* Skin on the mandible
* Ipsilateral side of the tongue
* Buccal surface of the cheek
## Footnote
This branch plays a key role in sensory perception in the lower face.
28
How can the ophthalmic division of CN V be tested?
With the corneal and nasal tickle reflexes.
## Footnote
Gentle stimulation of the cornea and nostrils should elicit specific reflex responses.
29
What is the significance of the jaw jerk reflex?
It tests the afferent and efferent function of the mandibular division of CN V.
## Footnote
This reflex is important for assessing the function of the trigeminal nerve.
30
What are the motor and sensory components of the Facial Nerve (CN VII)?
* Motor: Innervates muscles of facial expression and stapedius muscle
* Sensory: Innervates taste buds on the anterior two-thirds of the tongue
## Footnote
This nerve plays a crucial role in facial movements and taste sensation.
31
What are the signs of facial muscle weakness due to LMN dysfunction?
* Fewer facial lines and wrinkles
* Placid appearance of the face
* Palpebral fissure wider on the weak side
* Sagging corner of the mouth
* Difficulty with whistling or drinking through a straw
## Footnote
These signs indicate lower motor neuron damage such as in Bell's palsy.
32
In a typical UMN lesion, which facial muscles are generally much weaker?
Muscles below the eyes.
## Footnote
This contrasts with LMN lesions that affect all muscles on the ipsilateral side.
33
What does cranial nerve VIII (Acoustic Nerve) provide innervation for?
The cochlea and the end organs of the vestibular apparatus.
## Footnote
This nerve is essential for hearing and balance.
34
What sensory functions does the Glossopharyngeal Nerve (CN IX) provide?
* Somatic sensation to the middle ear
* Taste to the posterior third of the tongue
## Footnote
This nerve also innervates the stylopharyngeus muscle, which raises and dilates the pharynx.
35
What is the primary function of the Vagus Nerve (CN X)?
It provides motor and sensory innervation to the palate, pharynx, and larynx.
## Footnote
This nerve is crucial for swallowing and phonation.
36
Which branches of the Vagus Nerve are relevant for speech and swallowing?
* Pharyngeal branch
* Superior laryngeal nerve
* Recurrent laryngeal nerve
## Footnote
These branches innervate most muscles involved in speech and swallowing.
37
What is a key clinical test for the function of the Vagus Nerve?
Inspection of the palate while the patient says 'ah' to observe for deviation.
## Footnote
This can indicate unilateral weakness of the palate.
38
What does the Accessory Nerve (CN XI) innervate?
The sternocleidomastoid muscle and the upper part of the trapezius muscle.
## Footnote
This nerve is important for head movement and shoulder elevation.
39
How is the Hypoglossal Nerve (CN XII) functionally tested?
By asking the patient to protrude the tongue.
## Footnote
This tests for muscle strength and coordination of the tongue.
40
What are the effects of a unilateral lesion of CN XII?
* Ipsilateral tongue wasting
* Deviation of the tongue toward the weak side
* Fasciculation
## Footnote
These signs indicate damage to the hypoglossal nerve affecting tongue movement.
41
Which nerve innervates all muscles of the tongue except the palatoglossus?
Hypoglossal nerve (CN XII)
## Footnote
The palatoglossus is innervated by the vagus nerve.
42
What is the primary function of the sensory portion of the hypoglossal nerve?
Concerned chiefly with tactile information
## Footnote
Important for chewing, swallowing, and articulation.
43
What is tested to assess the motor function of CN XII?
Asking the patient to protrude the tongue.
44
What are the signs of unilateral lesions of CN XII?
* Ipsilateral wasting (atrophy or loss of muscle bulk)
* Deviation of the tongue toward the weak side
* Fasciculation
45
How is tongue strength tested?
By asking the patient to push the tongue against the inside of the cheek while the examiner resists the pressure.
46
What happens to tongue movements in UMN lesions?
Tongue movements are slower and weaker, particularly with lateral extension.
47
What may indicate a severe bilateral UMN lesion in the tongue?
The tongue may have relatively good bulk but is essentially immobile with attempted volitional movement.
48
What is the effect of gaging or yawning on tongue movement in patients with severe bilateral UMN lesions?
Greater degrees of tongue movement may become apparent.
49
What difficulties do patients with CN XII dysfunction experience?
* Difficulty with consonant pronunciation
* Varying degrees of dysphagia due to poor coordination of swallowing.
50
What is the main goal of the motor examination?
To assess the function of the motor unit and the various direct and indirect motor pathways.
51
What is indicated by fixed postures across joints during a motor examination?
Long-standing lesions of the upper motor neuron (UMN).
52
What does the presence of hammer toes indicate?
Long-standing lower motor neuron (LMN) loss of toe extensors leading to unopposed toe flexion.
53
How is muscle tone tested during a motor examination?
By passively stretching the muscles.
54
What is hypertonicity and how can it manifest?
Increased muscle tone, which can manifest as spasticity or rigidity.
55
What does a pronator drift indicate?
A subtle corticospinal tract lesion.
56
What is the Medical Research Council's muscle strength scale?
A grading scale for muscle strength from 0 to 5, where 0 = no muscle contraction and 5 = normal strength.
57
What are the primary sensory modalities tested in a sensory examination?
* Detection of light touch
* Pain perception
* Vibration sense
* Proprioception or position sense
58
What is two-point discrimination?
The ability to distinguish whether one or two points of contact are felt on the skin.
59
What is graphesthesia?
The ability to recognize letters or numbers written on the palm or fingertips.
60
What is stereognosis?
The ability to recognize objects placed in the hands by virtue of their shape and texture.
61
What information does the examination of reflexes provide?
Integrity of the nervous system in both horizontal and vertical senses.
62
What is indicated by hyperreflexia?
Increased reflexes below the level of a UMN lesion.
63
What are common signs of acute cerebellar hemisphere lesions?
* Hypotonia
* Ataxia
* Tremor
* Slight weakness
64
What are two common tests of cerebellar function?
* Finger–nose–finger test
* Heel–shin test
65
What characterizes a hemiparetic gait?
The involved leg is slow and weaker, leading to circumduction.
66
What is sensory ataxic gait caused by?
Polyneuropathy or spinal cord disease.
67
What characterizes a Parkinsonian gait?
* Stooped posture
* Shortened steps
* Decreased arm swing
* May festinate
68
What is myopathic gait?
A waddling gait caused by weakness of hip flexors and pelvic girdle muscles.
69
What is the role of neurologic testing?
To refine diagnostic accuracy.
70
What are cornerstone ancillary neurodiagnostic tests?
* Computed tomography (CT)
* Magnetic resonance imaging (MRI)
71
What is electroencephalography (EEG)?
A record of brain electrical activity generated by electrodes on the scalp.
72
What does an EEG reflect?
The activity of the cortex below, specifically the postsynaptic potentials of large vertically oriented pyramidal cells.
73
What are large vertically oriented pyramidal cells associated with?
They can indicate structural or functional abnormalities in underlying white matter or thalamocortical projections
## Footnote
These abnormalities may produce characteristic changes in brain activity.
74
What does a localized 'spike and wave' pattern in EEG suggest?
It can suggest a seizure focus
## Footnote
The electroencephalographer looks for maximal amplitude of spike discharge or phase reversal to localize the focus.
75
What percentage of epileptic patients demonstrate epileptiform EEG activity over time?
At least 90%
## Footnote
This indicates the reliability of EEG in diagnosing epilepsy.
76
Name factors that improve the diagnostic yield of an EEG.
* 24-hour sleep deprivation
* Sleep
* Hyperventilation
* Photic stimulation (strobing lights)
## Footnote
These factors can enhance the visibility of epileptiform activity.
77
What does a 'flat' or isoelectric EEG record indicate?
It may confirm brain death
## Footnote
This condition signifies irreversible cessation of brain function.
78
What are the two parts of a conventional EMG test?
* Nerve conduction study
* Needle exam (electromyogram)
## Footnote
These components assess peripheral motor and sensory nerve functions.
79
What type of fibers are typically measured in nerve conduction studies?
Large myelinated fibers
## Footnote
Smaller myelinated and unmyelinated fibers generate signals that are often too small to record.
80
What happens when the myelin sheath of a nerve fiber is damaged?
Conduction may slow or cease altogether
## Footnote
This condition is known as conduction block.
81
What is axonal neuropathy characterized by in NCS findings?
* Loss of muscle bulk
* Lower amplitude of action potentials
* Normal to slightly shorter terminal latencies
* Normal to slightly slower conduction velocity
## Footnote
The axonal loss affects the number of conduction elements.
82
How does demyelinating neuropathy appear in NCS?
* Prolonged terminal latency
* Slower conduction velocity
* Normal to slightly lower amplitude
## Footnote
This condition shows delay of individual motor unit action potentials.
83
What is myasthenia gravis (MG)?
A disorder of neuromuscular transmission
## Footnote
It is characterized by weakness due to antibody attack on acetylcholine receptors.
84
What is the purpose of repetitive nerve stimulation (RNS) in diagnosing MG?
To measure the amplitude of evoked motor responses
## Footnote
A decrement of greater than 10% is considered pathological.
85
What occurs during excitation-contraction coupling?
A muscle fiber action potential leads to muscle contraction
## Footnote
This process is initiated by the binding of acetylcholine to its receptors.
86
What does the Jolly test measure?
The reduction of amplitude in responses during repetitive stimulation
## Footnote
It helps identify defects in neuromuscular transmission.
87
What is a significant finding in single-fiber EMG for neuromuscular transmission disorders?
Detection of defects with greater sensitivity than standard EMG
## Footnote
It involves monitoring two spike potentials firing simultaneously.
88
What is the typical frequency used in repetitive stimulation tests for myasthenia gravis?
2 Hz
89
What phenomenon is observed with repetitive stimulation in myasthenia gravis?
Marked reduction of amplitude
90
What is the primary purpose of single-fiber EMG?
Detect defects of neuromuscular transmission
91
What is the time variation called when measuring the firing of muscle fibers in single-fiber EMG?
Jitter
92
What does increased jitter indicate in myasthenia gravis?
Reduced reliability of neuromuscular transmission
93
What is the term for when the firing of a second muscle fiber fails altogether?
Blocking
94
What percentage of patients with generalized myasthenia gravis show abnormal SFEMG?
Greater than 95%
95
What does the needle exam (NE) in electromyography assess?
Function of the motor unit
96
What is the typical insertion site for the spinal needle during a lumbar puncture?
L4–L5 disk space
97
What are the common indications for performing a lumbar puncture?
* Meningitis
* Encephalitis
* Meningeal carcinomatosis
* Multiple sclerosis
* Guillain-Barré syndrome
98
What should be measured during a lumbar puncture once cerebrospinal fluid (CSF) flows?
CSF pressure
99
What are the contraindications for performing a lumbar puncture?
* Suspected raised intracranial pressure
* Severe bleeding diathesis
* Infection at the planned site
* Tethered cord
* Suspected complete spinal block
100
What complications are most common after a lumbar puncture?
* Headache
* Backache
* Nerve root or radicular pain
101
What is the purpose of surface EMG (SEMG)?
Record muscle surface activity
102
What is carotid Doppler used to visualize?
Carotid arteries
103
What does transcranial Doppler (TCD) measure?
Cerebral blood flow velocity (CBF-V)
104
True or False: TCD is operator-independent.
False
105
What is a common indication for TCD in children and adolescents?
Screening for risk of ischemic stroke
106
What is delirium?
A transient, usually reversible condition with neurologic and psychiatric symptoms
107
What percentage of hospitalized patients over 70 years old experience delirium?
>30%
108
Which factors are common causes of delirium?
* Drugs
* Infections
109
What percentage of hospitalized patients over 70 years old experience delirium?
>30%
## Footnote
This statistic highlights the prevalence of delirium in older hospitalized patients.
110
What are common causes of delirium in hospitalized patients?
* Drugs
* Infections
## Footnote
Drugs with short half-lives are more commonly associated with delirium.
111
Which over-the-counter medication is known to cause delirium?
Diphenhydramine
## Footnote
This is an antihistamine commonly used for allergies.
112
Fill in the blank: Patients with _______ insufficiency are particularly prone to delirium when taking medications cleared by the kidneys.
renal
## Footnote
Renal insufficiency can worsen the effects of certain medications.
113
What mnemonic can help recall common causes of delirium?
DELIRIUM
## Footnote
Each letter in the mnemonic corresponds to a category of delirium causes.
114
List three clinical manifestations of delirium.
* Impaired level of consciousness
* Change in cognition
* Fluctuating behavior
## Footnote
These symptoms can vary throughout the day.
115
True or False: Delirium can develop over a period of days.
True
## Footnote
The disturbance typically develops over hours to days.
116
What is a key management strategy for delirium?
Identifying and correcting reversible causes
## Footnote
This includes addressing medications and metabolic issues.
117
What should be avoided in the management of patients with delirium?
Physical restraints
## Footnote
Restraints can exacerbate delirium and increase fall-related injuries.
118
What is the estimated cost of Alzheimer’s disease?
$200 billion
## Footnote
This includes both direct and indirect costs associated with the disease.
119
What percentage of dementing illnesses is accounted for by Alzheimer’s disease?
>60%
## Footnote
Alzheimer’s disease is the most common form of dementia.
120
What is mild cognitive impairment (MCI)?
Memory loss beyond normal aging
## Footnote
Individuals with MCI forget meaningful information but retain daily routines.
121
List two risk factors for Alzheimer’s disease.
* Age
* Family history of dementia
## Footnote
Other factors include Down syndrome and history of head trauma.
122
What are two common symptoms of dementia?
* Difficulty learning and retaining information
* Language problems
## Footnote
These symptoms can significantly affect daily functioning.
123
What is the role of cholinesterase inhibitors in Alzheimer’s disease management?
To increase brain levels of ACh
## Footnote
These are used as symptomatic therapy for mild to moderate Alzheimer's.
124
True or False: There is an FDA-approved pharmacologic treatment specifically for delirium.
False
## Footnote
Currently, no specific drugs are approved for delirium treatment.
125
What are some complications associated with delirium?
* Prolonged hospital stay
* Higher risk of pneumonia
* Cognitive dysfunction postoperatively
## Footnote
These complications can significantly impact patient outcomes.
126
What is the hallmark of dementia?
Progressive decline in memory functions
## Footnote
This decline is coupled with impairment in at least one other cognitive domain.
