Cognition & Senses 2: Neuro Clinical Signs

Question 1

important HISTORICAL questions to ask for NEURO dz? (3)

Answer 1

1. WHEN has the patient LAST BEEN NORMAL?
2. PROGRESSION of signs?
3. is it a SINGLE SIGN or GROUP OF SIGNS?

Question 2

if SEIZURES are the PRESENTING COMPLAINT, what are 6 things to ask?

Answer 2

1. any RECOGNIZABLE TRIGGER?
2. TIME OF DAY/ACTIVITY prior to onset?
3. DESCRIPTION of SEIZURE event
4. SINGLE or MULTIPLE seizures?
5. DURATION of SEIZURE & RECOVERY PERIOD?
6. FREQUENCY?

Question 3

if a patient is taking an ANTICONVULSANT for seizures, what MEASUREMENT should we take? how OFTEN?

if a patient comes in for seizures, what question should we ask regarding this?

Answer 3

should do SERUM LEVELS every 6 MONTHS

if a patient is in, ask WHEN SERUM LEVELS WERE LAST TAKEN & VALUES

Question 4

TRUE/FALSE

it’s important to ask about TRAVEL as some NEUROLOGICAL DISEASES are ENDEMIC to certain parts of the world

Answer 4

TRUE

Question 5

what 2 things should we NEVER ASSUME when doing neuro exams?

Answer 5

1. NEVER ASSUME PAST DIAGNOSIS IS CORRECT
2. NEVER ASSUME OWNERS KNOW WHICH RIGHT & LEFT THEY MEAN WHEN DEFINING LESIONS

Question 6

what 3 things will give you adequate neurological localization?

why should we be thorough with neurological exams prior to diagnostics?

Answer 6

1. HISTORY
2. PE
3. NEUROLOGICAL EXAM

diagnostics are INVASIVE & EXPENSIVE, so WANT TO MAKE SURE IT’S NECESSARY

Question 7

TELENCEPHALON DZ

aka? (2 names)

behavior changes? (2)

actions? (3)

deficits? name WHAT they are & if they’re IPSILATERAL or CONTRALATERAL

has ABNORMAL ____ RESPONSE

Answer 7

aka CEREBRUM or FOREBRAIN

behavior changes
1. ALTERED behavior
2. DULL/DEPRESSED/OBTUNDED mentation

actions?
1. COMPULSIVE WALKING/PACING
2. CIRCLING in ONE DIRECTION
3. moving TOWARDS LESION

deficits?
1. CONTRALATERAL VISUAL DEFICITS
2. CONTRALATERAL PROPRIOCEPTIVE DEFICITS/PARESIS

has ABNORMAL MENACE RESPONSE

Question 8

DIENCEPHALON DZ

includes what 2 organs?

what PATHOLOGIES can we see with each ORGAN dysfunction? (2)

2 behavioral changes?

which CRANIAL NERVE is affected?

pathologies/deficits? (3)

action?

Answer 8

includes PITUITARY & THALAMUS

PATHOLOGIES with ORGANS?
1. HYPOTHALAMUS = ALTERED TEMP, APPETITE & THIRST
2. PITUITARY = ENDOCRINE DYSFUNCTION

behavioral changes?
1. ALTERED BEHAVIOR
2. DULL/DEPRESSED/OBTUNDED

CN III AFFECTED

pathologies?
1. SEIZURES
2. PLR & VISUAL DEFICITS
3. CONTRALATERAL PROPRIOCEPTIVE DEFICITS

action? = COMPULSIVE WALKING/CIRCLING

Question 9

MESENCEPHALON DZ

aka?

causes ALTERED ____ & ____

causes a DEFICIT in WHAT REFLEX?

affects what 2 cranial nerves?

2 gait changes?

CONTRALATERAL/IPSILATERAL… (2)

Answer 9

aka MIDBRAIN

causes ALTERED BEHAVIOR & ALERTNESS

causes DEFICIT IN PLR

affects CN III & IV (OCULOMOTOR & TROCHLEAR)

gait changes?
1. ATAXIA
2. PARESIS-PARALYSIS

CONTRALATERAL PROPRIOCEPTIVE DEFICITS & PARESIS

Question 10

VENTRAL MESENCEPHALON DZ

aka? what 2 things are distal to it?

causes ALTERED ____

affects WHAT CRANIAL NERVE?

2 gait changes?

CONTRALATERAL/IPSILATERAL… (2), meaning that CLINICAL SIGNS ARE ON _____ ____

Answer 10

aka PONS; 2 organs distal…
1. MEDULLA
2. SPINAL CORD

causes ALTERED ALERTNESS

affects CN V

gait changes?
1. ATAXIA
2. PARESIS-PARALYSIS

IPSILATERAL PROPRIOCEPTIVE DEFICITS & PARESIS, meaning that CLINICAL SIGNS ARE ON ONE SIDE

Question 11

DORSAL MESENCEPHALON DZ

aka?

mentation?

has _____ ______ deficit

blindness?

3 gait changes? called “___-___”

2 typical clinical signs?

+/- 1 sign?

Answer 11

aka CEREBELLUM

mentation = ALERT

has IPSILATERAL MENACE DEFICIT

NOT BLIND

3 gait changes?
1. HYPERMETRIA
2. DYSMETRIA
3. ATAXIA
–> called “HIGH-STEPPING”

2 typical clinical signs?
1. INTENTION TREMORS
2. SWAYING WHEN STANDING/UNABLE TO STAY STILL

+/- VESTIBULAR SIGNS/HEAD TILT

Question 12

MYENCEPHALON DZ

aka? (2 words)

mentation?

affects CRANIAL NERVES ____-____

3 gait changes?

CONTRALATERAL/IPSILATERAL… (2)

Answer 12

aka MEDULLA OBLONGATA

mentation? = +/- ALTERED ALERTNESS

affects CRANIAL NERVES VI-XII

3 gait changes?
1. ATAXIA
2. PARESIS
3. PARALYSIS

IPSILATERAL PROPRIOCEPTIVE DEFICITS & PARESIS

Question 13

VESTIBULAR APPARATUS DZ…

mentation?

3 common clinical signs?

Answer 13

mentation = +/- ALTERED ALERTNESS

3 common clinical signs?
1. SPONTANEOUS NYSTAGMUS
2. ALTERED POSTURE like HEAD TILT, ROLL, FALL, LEAN
3. ATAXIA

Question 14

UMN/LMN signs?

C1-C5?

Thoracic limbs?

Hindlimbs?

L4-S3?

Answer 14

C1-C5? = UMN

Thoracic limbs? = LMN

Hindlimbs? = UMN

L4-S3? = LMN

Question 15

in LMN dz, what 4 things can we see?

2 are +/-

Answer 15

1. MAJOR GAIT CHANGES = PARESIS-PARALYSIS
2. IPSILATERAL WEAKNESS
3. +/- DECREASED SPINAL REFLEXES
4. +/- DECREASED MUSCLE TONE