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Flashcards in Correlative Neuro Exam Deck (38)
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1

Mental status options

alert, lethargic, stuporous, obtunded, comatose

2

decreased alertness: cause?

dysfunction of b/l cerebral hemispheres or brainstem reticular activating system

3

types of involuntary movements

tremor (resting or essential), myoclonus, chorea, athetosis (slow, writhing mvmt), ballismus, tics, seizures, dystonia (sustained abnormal posture), tardive dyskinesia, akathisia (motor restlessness)

4

asterixis

- have pt stop traffic w/ wrists extended; beats of flexion = asterixis
- possibly caused by metabolic encephalopathy ex: UTI, urosepsis, etc.
- a negative myoclonus; cessation of m. activity

5

possible abnormal speech findings

dysphonia, dysarthria (impaired motor function needed for speech - not a language disorder), fluency, comprehension, repetition, aphasia

6

broca's aphasia

nonfluent, comprehension spared, impaired repetition

7

Wernicke's aphasia

fluent, impaired comprehension and repetition

8

global aphasia

deficits in all language functions

9

conductive aphasia

frequent paraphasic errors (usually phonemic), impaired repetition
phonemic error = substituting a similar word for a sound i.e. saying pish instead of fish

10

transcortical motor aphasia

repetition intact, pt can comprehend but is not fluent

11

transcortical sensory aphasia

pt is fluent and can repeat but impaired comprhension

12

transcortical mixed aphasia

pt can only repeat; no fluency or compehension

13

anomic aphasia

memory deficits; pt can't name the word for a particular item

14

CNI: injury w/ likely cause

injury = anosmia
u/l causes = trauma or tumor
b/l causes = virus, allergy, smoking, trauma
head/face trauma, nose surgery, infections, obstructions, lesions at base of frontal lobe, aging
central anosmia can be caused by alcoholism, Alzheimer's or parkinson's

15

Foster Kennedy Syndrome

S&S: anosmia, i/l optic atrophy, c/l papilledema
associated w/ lesions of anterior skull base or frontal lobe
ex: meningioma arising from olfactory groove

16

anisocuria

- unequal pupils
- sympathetic nervous system and CNIII
- hippus = normal brief oscillations of pupil size in response to light
- if pupils more unequal in dark the small one is the problem eye; if there is more unevenness in the light the dilated one is the problem

17

Marcus-Gunn pupil aka APD

afferent pupil defect = APD
can be seen w/ interruption of optic pathway anterior to optic chiasm
dx via the swinging flashlight test
seen w/ optic n. or retinal disease

18

Adie pupil

- can be u/l or b/l dilated pupil
- lesion is in the ciliary ganglion
- parasympathetic denervation: pupils react poorly to light but ok w/ accommodation; pupils redilate slowly
- common manifestation of Holmes Adie Syndrome = benighn often familial disorder affecting young women
- can be associated w/ depressed DTRs, segmental anhidrosis, orthostatic hypotension, cardiovascular autonomic instability

19

Argyll Robertson Pupil

- aka prostitute's eye = accommodation but no reaction
- small, irregular pupils
- lesion involves descending pupilloconstrictor fibers
- cause = neurosyphilis; could also be from lesions in EWN (ex: MS)

20

CNIII, IV, VI problems

- diplopia
- ptosis = lesion in sympathetics, CNIII, NMJ, or from a m. disorder
- pseudoptosis = redundant skin folds associated w/ aging

21

nystagmus

- involuntary, rapid, rhythmic mvmts of eye = oscillopsia
- named for direction of quick component
- if pathologic causes = meds, peripheral vestibular apparatus, central vestibular pathways, cerebellum
- up to 50% of people have a small degree of nystagmus in extreme gaze

22

Ptosis

- CNIII dysfunction
- eye appears "down and out"
- pupil can be spared or impaired

23

vertical diplopia

- pt may have hypertropia: visual axis of one eye is higher than the other
- head tilt to opposite side improves vision
- could be caused by head trauma; CNIV dysfunction

24

horizontal diplopia

- CNVI dysfunction possibly caused by high ICP
- could have esotropia = eye on one side looks turned in
- head tilt to the same side improves vision

25

face droop

LMN: weakness or paralysis of 1/2 of the face; can be from peripheral n. or brainstem (pons) injury
UMN: weakness of lower quarter of face; lesion above the pons; innervation to forehead is b/l so forehead not affected
- pts won't be able to close eye tightly so be sure to protect it to prevent foreign bodies/corneal abrasions

26

CNVIII: possible dysfunctions and testing options

- vestibulo-ocular reflex
- caloric testing: COWS (nystagmus portion of reaction); inject water into external auditory meatus; cold water = eyes deviate toward injection and nystagmus is opposite; warm water = eyes deviate away from injection and nystagmus is same side

27

CN IX and X

- voice gag reflex tests
- 20% of normal people don't have a gag reflex
- symptoms = hoarseness, swallowing dysfunction, deviation of uvula
- uvula will deviated away from the lesion

28

general definitions: weakness/paresis, paralysis/plegia, hemiparesis, hemiplegia, paraplegia, quadriplegia, incompete quadriplegia

weakness/paresis = diminished strength
paralysis, plegia = absence of strength
hemiparesis = weakness of one side
hemiplegia = paralysis of one side
paraplegia = paralysis of legs
quadriplegia = paralysis of all extremities
incomplete quadriplegia = retention of some upper extremity movement

29

DTRs and levels they test

C5/6 = biceps and brachioradialis
C7/8 = triceps
L3/4 = patellar
S1/2 = achilles

30

possible changes seen in reflexes

hyporeflexia/areflexia, hyperreflexia
symmetric change - could be from polyradiculopahty, peripheral neuropathy, myelopathy
asymmetric change - possibly from radiculopathy, central nervous system pathology