(Enochs + some) Lecture 1: Approach to the Neurologic Patient Flashcards
1
Q
What is the most important thing when it comes to neuro assessments?
A
Change from baseline.
2
Q
What makes up the CNS?
A
- Brain
- Spinal Cord
3
Q
What makes up the PNS?
A
- Autonomic (Symp and Parasymp)
- Somatic
4
Q
Where is Broca’s area?
A
Frontal lobe (dominant side)
Speaking and writing
5
Q
Describe what each lobe does.
A
- Frontal: Decision-making/problem solving, speech (speaking/writing), intelligence, personality, short term memory.
- Parietal: Interpretation and processing of information (language, words, pain, temperature, five senses, spatial and visual perception).
- Temporal Lobe: understand language (wernickes), long and short memory, hearing, organization, processing others emotions
- Occipital: Interpreting vision (color, light, movement)
6
Q
Where is Wernicke’s area?
A
Temporal lobe
Ability to understand speech
7
Q
What is the main purpose of the thalamus?
A
Relaying signals back and forth between CNS and PNS.
also helps regulate sleep, alertness and wakefullness
8
Q
what is the main purpose of the hypothalamus
A
releases hormones associated with the endocrine and sexual system.
also controls hunger, body temp.
9
Q
what is the main purpose of the cerebellum
A
muscle coordination and equilibrium
10
Q
what controls sleep/wake arousal as well as vision, hearing, motor control and temp regulations
A
midbrains
11
Q
What part of the brain controls breathing?
A
Medulla oblongata
also controls heartbeat and vomiting
12
Q
what are the 2 types of matter and what is significant about each of them
A
- white matter - has axons that take info to/from the grey matter
- grey matter - cell bodies of nerves that receive and store impulses
13
Q
What are the 3 meninges?
A
- Dura mater (outermost layer)
- Arachnoid (middle layer)
- Pia mater (innermost layer)
Our blood vessels sit within the subarachnoid space.
these layers act as a barrier to brain and spinal cord against bacteria and other microorganisms
14
Q
wouldnt hurt to label this a bit
A
15
Q
what is CSF
A
- created in choroid plexus (inner lining of ventricles).
- circulates the brain/spinal cord to protect and nourish it.
16
Q
what are the brain ventricles
A
cavities within the brain that contains CSF
* 2 lateral
* third ventricle
* cerebral aqueduct
* fourht ventricle
17
Q
what is controlled by the autonomic nervous system
A
it innervates smooth involuntary muscles of internal organs and glands.
HR, BP, RR, temp
digestion, metabolism, water/electrolyte balance
urination, defecation, production of bodily fluids
sexual response
18
Q
What is controlled by the somatic nervous system
A
- sensory nerve fibers - info from peripheral to CNS
- Motor nerve fibers - impulses for movement from the brain to skeletal muscles
19
Q
Where do I find Upper Motor Neurons and what do they do?
A
- Brain and spinal cord
- Tell the lower motor neurons to relax or contract
20
Q
What happens with an UMN lesion?
A
- Antagonist muscle will remain contracted
- Spasticity
21
Q
what is the job of a lower motor neuron
A
recieves impulses from UMN and transmits it to the muscle cells leading to muscle contraction
22
Q
What happens with a LMN lesion?
A
It will stay relaxed (aka muscle weakness)
Lower lesion lax
23
Q
Lesion Table for Motor Neurons
A
24
Q
What makes up a neuro exam? (5)
A
- Mental Status
- Cranial Nerves
- Motor
- Reflexes
- Sensory
25
What are the 5 levels of consciousness?
1. Alert
2. Lethargy (awakens to verbal or light physical stim)
3. Obtundation (constant stimulation to stay awake)
4. Stupor (vigorous, painful, constant stimulation, does not follow commands.)
5. Coma (no response)
| Sleeping is not altered because if you wake them up, they will become al
## Footnote
ALOSC
26
What is praxis?
Muscle memory (like brushing teeth)
| sounds like practiced
27
What does it mean to write neuro grossly intact?
It is purely off observation.
| Must write CN 2-12 are grossly intact
## Footnote
Do not write no focal neuro deficits unless you tested it specifically.
28
What size are pupils normally?
2-6mm
29
What do pinpoint pupils suggest?
* Opiate OD
* Pontine hemorrhage
30
What do dilated pupils suggest?
* Severe anoxia-ischemia
* Anticholinergic drugs
| Dilated pupils are ALWAYS abnormal
31
What do ovoid, keyhole and irregular pupil shapes suggest?
* ovoid - intermediate phase between fixed/dilated pupil (acute neurologic injury or cataract surg comp.)
* keyhole - sluggish to light caused by coloboma, iridectomy w cataract surg.
* irregular - Traumatic orbital injury
32
What cranial nerve does pupillary reactivity fall under
III - oculomotor
33
What is the hippus phenomenon?
* Alternating dilation and contraction of pupil
* Associated with early signs of brain herniation or seizure activity
34
Abnormal gaits
35
Involuntary movement types
36
What does the romberg test check for?
* Sensory ataxia (swaying but stops when eyes are open)
* Cerebellar ataxia (swaying that persists even when eyes are open)
37
what does a positive pronator drift test suggest
unilateral pronator drift suggests UMN lesion affecting the arm
38
How do you grade ROM?
0-5
5 - active ROM, full strength against resistance
4 - active ROM against gravity and some resistance
3 - active ROM against gravity only
2 - weak contraction insufficient to overcome gravity
1 - minimal movement/muscle contraction
0 - no movement/muscle contraction
| Must test resistance and gravity.
39
What are the 3 kinds of hypertonia?
1. Spasticity: moves freely but then the muscle catches and locks.
2. Rigidity: resistance throughout
3. Clonus: Jerking movement
| Suggestive of an UMN lesion.
40
What is the underlying etiology of hypotonia?
* LMN lesions
* Cerebellar disorders
41
What is paratonia?
* Increased resistance that becomes LESS prominent when you distract the patient.
* Suggested cognitive impairment and mental disorders.
42
Where do reflex sensory fibers synapse?
Anterior horn cell
43
What do increased and decreased DTRs suggest? How are they graded?
* Increased: UMN lesion of brain/spinal cord
* Decreased: LMN lesion of spinal nerve root, spinal nerve, plexus, peripheral nerve
* 0-4 grading, but **2 is normal**
| Lower is lax
44
what spinal nerve level does each tendon reflex correlate to?
45
What does a positive babinski reflex suggest?
* UMN lesion
* CNS disorders
* Alcoholics/postictal periods
| **Normal in children < 2y**
## Footnote
controlled by L5, S1
46
Define agnosia.
* Inability to interpret sensations or recognize things.
* Damage to **occipital or parietal lobes**
| They can feel the sensation, but they can't tell what it exactly is.
## Footnote
A patient will need to feel, smell, see, and do everything in order to try and recognize something.
47
What is aphasia?
Inability to express speech (verbal and written)
48
What are the two primary types of aphasia?
* Broca's aphasia (Normal comprehension, broken words, difficult to speak)
* Wernicke's aphasia (fluent gibberish)
## Footnote
Broca's/expressive: they understand your question and can answer it, but they can't form a complete sentence
Wernicke's: They understand your question, but answer it with a random assortment of words.
49
What is conduction aphasia?
Cannot repeat statements, which worsens with longer duration.
50
What is dysphasia?
**moderate** loss of language impairment, intact comprehension.
51
What is agraphia?
Inability to write that is **not due** to weakness, poor coordination, or neurologic dysfunction of the hand.
## Footnote
Aphasic
Constructional (scattered letters and words)
Apraxic (distorted, slow)
52
What is apraxia?
Inability to perform a learned movement, **in the absence of weakness, sensory loss, or other deficit**
## Footnote
Gait apraxia: difficulty initiating walking, esp. with parkinsons.
Apraxia of eyelids: blepharospasms when asked to open eye
53
What is the MC neurologic cause of muscle atrophy?
Carpal tunnel syndrome
54
What are the 3 common neurologic conditions that can result in hypertrophy?
1. Myotonia congenita
2. Torticollis
3. Dystonias
55
What is dysarthria?
Difficulty articulating sounds or words.
| **Motor function of speech**
56
What causes dysphagia neurologically?
Lower brain dysfunction
57
What is dysphonia?
Changes in quality, volume, or pitch of voice
| parkinson's usually has HYPOphonia
## Footnote
Also has spasmodic dysphonia (high-pitched)
58
What are the two types of ataxia?
* Cerebellar: limbs and gait
* Sensory: lack/worsening of proprioception when eyes are closed.
| Impaired balance/coordination
59
What
is plegia vs paresis?
* Paresis: weakness due to nerve damage/disease
* Plegia: complete paralysis
60
What is akinesia?
Inability to control **voluntary** movement
## Footnote
brady is common in parkinsons and extrapyramidal symptoms. (basal ganglia)
hyperkinesia is seen as tardive dyskinesia (fidgety/restless)
61
What is asterixis?
Inability to sustain a stable posture
| Makes a floppy motion (id watch a vid of it)
## Footnote
Palms forwards and push against them. Patient's hands should start flopping.
62
What are the hyperesthesias?
* Photophobia
* Phonophobia
* Allodynia (light touch causing pain)
63
What is hypoesthesia?
Decreased sensation
| NOT NUMBNESS OR ANESTHESIA
64
What is paresthesia?
Tingling, burning, needles sensation in the skin
65
what are the terms for increased, decreased and lack of pain sensations
* Analgesia - lack of pain sensation
* Hypalgesia - decrease in pain sensation
* Hyperalgesia - exaggerated response to painful stimulus. (Synonymous with allodynia)
66
What is graphesthesia?
Ability to recognize writing on the skin without seeing it visually
| Drawing on the hand
67
What is astereognosis?
Inability to recognize an object by touch alone
68
What is dysmetria?
Difficulty judging distance, speed power
| Finger-to-nose test
69
What is dysdiadochokinesia?
Inability to perform repetitive movements or rapidly alternating movements
| The alternating hands on the thighs thing
## Footnote
Often seen in parkinson's and cerebellar
70
What is the key difference between rigidity and spasticity?
Rigidity is the same degree of resistance consistently.
| Spasticity varies and Stops
71
When can hyperreflexia be considered normal?
If it is symmetrical, could be normal.
72
What common chronic condition is hyporeflexia seen in?
Hypothyroidism
