Exam 2 Flashcards
(156 cards)
1
Q
What are multimodal sensations?
A
Combination of both superficial and deep sensations that are subject to integration with higher cortical functions and memory
2
Q
Where is the association cortex for somatosensory, visual and auditory functions?
A
Inferior parietal lobe
3
Q
The inferior parietal lobe is the association cortex for what 3 multimodal sensations?
A
Somatosensory, visual, and auditory
4
Q
Stereognosis test
A
Patient identifies object in hand
5
Q
Barognosis test
A
Patient assess relative weight of similar shape and size object in hands
6
Q
Topognosis
A
Touch patient on their skin and ask them to point to the spot you just touched
7
Q
Graphognosis
A
Write a letter or number on patients chest, back or palm and have them identify it
8
Q
2 point discrimination and normal measurements
A
Determine at what distance a patient can determine 2-point discrimination
Finger tips: 2-4mm
Dorsum of finger: 4-6mm
Palm: 8-12mm
Dorsum of hand: 20-30mm
9
Q
Somatognosis?
A
Patients ability to know a body part is their own
10
Q
Nosognosis:
A
Ability of patient to know that he is ill
Ex: hemiplegia, patient believes they are healthy
11
Q
Aka for graphognosis
A
Graphesthesia
12
Q
Problems with sterognosis, barognosis, topognosis, graphognosis, 2 point discrimination, somatognosis or nosognosis would indicate an issue where?
A
Association cortex in the inferior parietal lobe
13
Q
Somatic sensation is conscious perception of what 5 things?
A
Touch Pain Temperature Vibration Proprioception
14
Q
What are the two main somatosensory systems?
A
Posterior column pathways
Anterolateral pathway
15
Q
What sensations does the posterior column pathway mediate?
A
Proprioception
Vibration
Fine, discriminative touch
16
Q
What sensations do the anterolateral pathways mediate
A
Pain
Temperature
Crude touch
17
Q
What sensations does the lateral spinothalamic pathway mediate?
A
Superficial pain
Temperature
(Pinch your lateral neck it hurts)
18
Q
What sensations does the anterior spinothalamic tract mediate?
A
Crude touch
Could be very crude and touch your anterior
19
Q
Pathway of posterior columns
A
Stimuli carrie
20
Q
Posterior columns pathway: stimuli is carried by _____ ____ neurons and enter the ____ ______ via the ____ _____ ____. From here it ____ the spinal cord ______ in _____ _____.
A
Primary sensory Spinal cord Dorsal root ganglion Ascends Ipsilaterally Posterior columns
21
Q
After ascending the spinal cord ipsilaterally in posterior columns it synapses in ____ ____ nuclei with secondary axons that then _____ and _____ in the ____ ______. From here it synapses in the _____ and is distributed to ____ ____ _____
A
Posterior column nuclei
Synapse and ascend in the medial lemniscus
Thalamus and is distributed to primary somatosensory cortex
22
Q
What kind of findings are seen in posterior column pathway lesions
A
Ipsilateral
23
Q
Pain, temperature and crude touch are carried by ___ _____ neurons and enter the spinal cord via ___ ___ ____. From here they synapse with ___ ____ neurons immediately in ___ _____ of the spinal column. From here they _______ and ascend in the ____ _____. Then it synapses in the ____ and is distributed to ____ ____ cortex
A
Primary sensory
Dorsal root ganglion
Secondary sensory neurons in gray matter
Deccussate and ascend in the spinothalamic tract
Synapse in thalamus and distribute to somatosensory cortex
24
Q
Sensation with posterior column lesion
A
Tingling, numb
25
Sensation with anterolateral lesions
Sharp, burning, or searing pain
26
Sensory loss can be caused by lesions where
```
Peripheral nerves
Nerve roots
Posterior columns
Anterolateral pathways
Thalamus
Primary somatosensory cortex
```
27
Sensations in spinothalamic tract
Light touch
Sharp
Temperature
28
Sensations in dorsal columns
Vibration
2 point discrimination
Proprioception
29
Superficial sensory examination aka?
Exteroceptive/cutaneous examination
30
What is part of the superficial sensory examination
Light touch
Pain
Temperature
31
What is tested in light touch examination
Anterior spinothalamic tract
Tactile disc of merkle
Testing dermatomes
32
What is a dermotome
Area of skin innervation by a single spinal nerve
33
What does the sharp touch examination test
Lateral spinothalamic tract
34
What does temperature examination test
Lateral spinothalamic tract
Unnecessary if pain is fine—why it is rarely performed
-better at localizing area of dysfunction
35
Allogynia
Painful sensations provoked by normally non-painful stimuli
36
Anesthesia/analgesia
Absence of all sensation/pain
37
Dysethesia
Unpleasant, abnormal, or painful sensation
38
HYPESTHESIA/hypoesthesia
Decreased sensation
39
Hyperesthesia
Increased sensation
40
Paresthesia
Abnormal sensation
41
Myelo-
Spinal cord
42
Radiculo-
Nerve root
43
Neuro-
Nerve
44
General presentation of myelopathy
Pain: neck, arm, lower back, leg
Usually bilateral
Sensation: abnormal pattern
45
General presentation of radiculopathy
NR
Pain: dermatomal
Usually unilateral
Sensation: dermatomal
46
General presentation of neuropathy
Pain: follows nerve distribution
Usually unilateral
Sensation: peripheral nerve distribution
47
Common causes of compression
```
Disc hernation
DJD
Trauma
Inflammatory changes
Tumors
```
48
Posterior cord lesion causes and characteristics
Vibration and position sense loss at injury site and distal
```
Due to:
Trauma
Compression from tumors
MS
B12 deficiency and tables dorsalis
```
49
Most common cause of radiculopathy
Disc derangement
| Pressure from IVF narrowing
50
Compression of a dorsal nerve root
Radiculopathy
51
Characteristics of radiculopathy
- Numbness and tingling
- Loss of vibration and position sense
- Hyporeflexia with NO muscle atrophy (NO input of stretch but muscle shortens/lengthening normal)
- sensory loss dermatomally
- LMNL characteristics of reduced strength, reflexes, sensation
52
What may cause numbness and tingling, loss of vibration or position sense, hyporeflexia, sensory loss in dermatomes, LMNL characteristics of reduced strength, reflexes and sensation?
Compression of dorsal nerve root—Radiculopathy
53
Mononeuropathy characteristics
Unilateral loss in distribution of peripheral nerve
Sensory lost first (vibration often earliest affected)
DTR depressed
54
MC causes of mononeuropathy
Trauma
| Autoimmune
55
Polyneuropathy characteristics
Bilateral loss in glove and stocking distribution
- sensory lost first (vibration) & LONGEST nerves affected first
- DTR depressed
56
MC causes of polyneuropathy
- DM
- malnutrition of alcoholism
- Lyme disease/inflammatory/autoimmune conditions
57
What tissues are devoid of nociceptos
Articulate cartilage
Inner annulus and nucleus of intervertebral disc
Synovial membranes
58
What are mechanical noxious stimuli
Acute trauma
Repetitive microtrauma
Subluxation complex
59
Thermal noxious stimuli
Exposure to excessive heat/cold
60
Chemical noxious stimuli
- histamine
- prostaglandins
- plasma kinins
- potassium
- serotonin
- substance P—released directly from damaged tissue
61
Type A Delta fibers characteristics and what they relay?
Lightly myelinated
| Relay a sharp, stinging sensation
62
Type C pain transmission and characteristics
Unmyelinated
| Aching, burning type of pain
63
Common causes of neuropathic pain
Diabetes
Postherpetic neuralgia
Phantom limb
Trigeminal neuralgia
64
Recurrent meningeal nerve aka?
Sinuvertebral nerve
65
What does the sinuvertebral nerve/recurrent meningeal nerve innervate?
Outer third of annulus fibrosis posteriorly
PLL
Dura
66
What is the significance of the sinuvertebral nerve related to neuropathic pain
Nocioceptive nerve endings within annulus fibrosis of disc. Annular tears can cause low back pain, and in buttocks, SI, and lower region
67
Nerve root irritation cause
No direct compression of NR
| Inflammatory response of disc injury that causes pain
68
Cause of NR compression
Direct compression of NR
69
Presentation of NR irritation
Dermatomal pattern
Hyperesthesia
Increased sympathetics—> vasoconstriction (hypothermia)
Sensory, motor, DTR often normal
70
Presentation of NR compression
Pain, numbness in dermatomal pattern
Hypoesthesia
Decreased sympathetics—> vasodilation (hyperthermia)
-sensory, motor and DTR have decreased findings
71
Particular dermatomal or paraspinal level of ______ often correlates with area of what?
Hyperalgesia
Primary spinal subluxation
72
Cool info: sharpless demonstrated that minuscule amounts of pressure on a NR equivalent to a feather falling on your hand can cause up to a 50% decrease in electrical transmission down the course of the nerve
Wow!
73
If compression at c5 IVF....what disc/NR?
C6 NR
| C5 disc
74
If compression at C5 disc...IVF/NR?
C5 IVF
| C6 NR
75
If T7 IVF compressed what NR and disc involved?
T7 NR
| T7 disc
76
If L5 IVF compressed what disc/NR involved?
L4 disc
| L5 NR
77
If L4 disc herniated what IVF/NR involved?
L5 NR/IVF
78
Motor pathway?
Cortex.....
Brainstem......cerebral peduncle....pyramids (points of crossing)
Spinal cord......lateral corticospinal tract, anterior horn, alpha motor neuron
Peripheral NS.....target muscle
79
From the motor cortex, the motor pathway descends through the ______ _____ and then through the _____ where they ______. From here they enter the spinal cord and ______ in the ____ ______ _____ and synapse in the ____ ____ with __ ______ neurons. From here the neurons target the ________
Cerebral peduncles
Pyramids where they decussate
Descend in the lateral corticospinal tract
Synapse in the anterior horn with alpha motor neurons
Target the muscle
80
Motor pathway lesions would show what kind of findings?
```
Ipsilateral UMN
Contralateral LMN (spinal cord)
```
81
0/5 grade of muscle
Complete paralysis
82
1/5 muscle testing
A twitch of muscle
0-10% of movement
Doctor can feel action but no movement
83
2/5 muscle testing
Active movement available with no gravity
| 11-25% of normal movement
84
3/5 muscle test
Active movement against gravity
| 26-50% of normal movement
85
4/5 muscle testing
Movement against gravity and mild resistance
51-75% normal movement
-resistance of two fingers
86
5/5 muscle testing
76-100% normal movement
87
Increased muscle tone indicates what?
UMNL
88
Decreased muscle tone indicates what?
LMNL
89
Hypertonic
Increased muscle tone
| TWO TYPES
90
What are the two types of hypertonia?
Spasticity
| Rigidity
91
Spasticity
Hypertonia most near middle of ROM
Apparent with fast passive ROM
VELOCITY DEPENDENT (seen with rapid movements)
Lesions of pyramidal tract (corticospinal)
—-seen with stroke, spinal cord compression, motor neuron disease
More tone in initial part of movement aka “clasped knife phenomenon”
92
What type of hypertonia is more apparent with fast passive ROM and is velocity dependent?
Spasticity
93
Lesions of where lead to spasticity?
Pyramidal tract—aka corticospinal tract
94
Lesions in the pyramidal tract—corticospinal tract cause what?
Spasticity
95
What may cause a lesion of the corticospinal tract that may lead to spasticity?
Stroke
Spinal cord compression
Motor neuron disease
96
Clasped knife phenomenon? Associated with?
More tone in initial part of movement
| Spasticity
97
Characteristics of rigidity
```
Increased tone throughout passive ROM
Same resistance in all directions
Independent of speed of movements
Seen in extrapyramidal lesions (Parkinson’s)
2 subtypes: cog wheel, lead pipe
```
98
What type of hypertonia is seen with increased tone through passive ROM and is independent of speed of movement?
Rigidity
99
A lesion where may lead to rigidity?
Extrapyramidal lesions
100
Lesions in extrapyramidal tract may cause what type of hypertonia?
Rigidity
101
What are the two subtypes of rigidity?
Cog wheel and lead pipe rigidity
102
What may cause a lesion in extrapyramidal tract that leads to rigidity?
Parkinson’s
103
Hypotonia? Indicative of?
Decreased muscle tone
| Issues at level of reflex arc aka LMNL
104
What may cause neural shock
Severe upper motor neuron damage in brain or spinal cord
| Cerebral shock and spinal shock
105
What is unique of neural shock in regards to it’s presentation?
Peripheral symptoms first noted even though its an UMNL
106
Deficit in regards to reflexes
Loss of normal neurological function
Reduced muscle tone, stretch, reflexes, strength, volume
LMNL
107
Release in regard to reflexes
Exaggerations or perversions of normal function due to loss of cortical inhibition
**inhibition normally there so that you don’t have crazy reflexes and kick people
Hyperreflexia, hypertonia, and pathologic reflexes
108
Lesions where in reflex deficit?
LMNL
109
Lesions where in release reflex
UMNL
110
Findings in deficit reflexes
Reduced muscle tone, strength, reflexes, strength, volume
111
Findings in release reflexes
Hyper-reflexia, hypertonia, pathologic reflexes
112
0-1 reflex grade indicative of what?
LMNL
113
3-4 grade reflex indicative of what?
UMNL
114
Grading reflexes aka?
Wexler scale
115
Jendrassik Maneuver
Distractions given such as clenching fist, wiggling toes, etc.
Done when reflexes appear to be diminished or absent with no other neurologic findings
116
Clonus
Involuntary rhythmic contractions when sudden passive stretch of muscle occurs
117
Clonus often seen with what other findings
Spasticity and hyperactive DTRs in corticospinal tract disease
118
Pathway of superficial reflexes
Sensory signal reaches spinal cord, ascend, reach brain, motor limb descends cord to reach neurons
119
What can cause a + superficial reflex?
Severe LMNL or destruction of sensory pathways from skin that’s stimulated
Spinal cord damage (UMNL)
120
LMNL cause _____ DTRs, _______ superficial reflexes
| UMNL cause _____ DTRs, and ______ superficial reflexes
Decreased, absent
| Increased, absent
121
What are the 10 superficial reflexes
```
Gag reflex
Corneal blink reflex
Epigastric
Upper abdominal
Middle abdominal
Lower abdominal
Cremasteric reflex
Gluteal reflex
Plantar reflex
Anal
```
122
Innervation of cremasteric reflex
L1-L2
| Ilioinguinal, genitofemoral nerves
123
Female version of cremasteric reflex
Geigel reflex
124
Normal finding in plantar reflex
Plantar flexion of toes and foot
125
+ finding of plantar reflex
Dorsiflexion of great toes and flaring of the other toes
126
Anal reflex innervation
S2-S5
| Hemorrhoidal
127
What controls/inhibits pathologic reflexes
Motor cortex
| Pyramidal tracts
128
Timeline of findings in UMNL?
1. Increased DTR
2. Absent superficial
3. Pathological reflex
129
When are pathological reflexes considered normal?
Infants-6mo
| 2 years for babinski
130
What is one of the most significant indications of disease of corticospinal system at any level from motor cortex through descending pathways?
Babinski sign?
131
What innervations are tested with pupillary light reflex?
Afferent: CN2
| Efferent CN3
132
Accommodation reflex tests what?
CN 3
133
Ciliospinal reflex tests what?
Afferent: cervical pain fibers c8-t2 and CN5
Efferent: cervical sympathetics
134
What is normal finding in ciliospinal reflex?
1-2mm dilation
135
Oculocardiac reflex tests? Normal finding?
Afferent: CN 5
Efferent: CN 10
Decreased heart rate and BP noticed where thumb is pressed on eyeball
136
Carotid sinus reflex tests, normal?
Afferent: CN 9
Efferent: CN 10
Decreased heart rate and fall in BP when press carotid sinus
137
Bulbocavernosus reflex tests? Normal?
S3-s4
Contraction of bulbocavernosis muscle and urethral constriction and anal sphincter contraction when stroke, pinch, or prick the dorsum of the glans of the penis?
138
Reflex dysfunction of the muscle
Stretch reflexes are depressed in parallel to loss of strength
139
Reflex dysfunction of neuromuscular junction
Stretch reflexes are depressed in parallel to loss of strength
140
Reflex dysfunction of peripheral nerve
Stretch reflexes are depressed usually out of proportion to weakness
Bc afferent arc is involved early in neuropathy
141
Reflex dysfunction in nerve root
Stretch reflexes depressed in proportion to contribution that root makes to the reflex
- superficial reflexes are rarely depressed since many overlap
- extensive damage can depress reflex in proportion to amount of sensory loss in dermatomes tested or motor loss in involved muscles
142
Reflex dysfunction and spinal cord and brainstem
Stretch reflexes are hypoactive at the level of lesion and hyperactive below lesion
Superficial reflexes are hypoactive at and below level of lesion and normal above
143
Reflex dysfunction in cerebellum
Lesions don’t have large affect on stretch reflexes
144
Reflex dysfunction and basal ganglia
No consistent DTR or superficial reflex changes
| May see “primitive reflexes” associated with diffuse cerebral dysfunction (Dementia)
145
Reflex dysfunction and cerebral cortex
Unilateral disease affecting motor cortex will give UMN pattern of weakness: hyperactive muscle stretch reflexes and depressed or absent abdominal and cremasteric reflexes on contralateral side
-babinski response possible
-bilateral damage to motor cortex inhibitory control causes emotional expression reflexes to be defective
——-cry or laugh with little cause and don’t understand why they are laughing/crying
————-responses are released in “pseudobulbar” pattern
146
Presentation of transverse cord lesion
Partial/complete interruptions to all motor/sensory paths
Diminished sensation in all dermatomes below lesion
Weakness/reflex loss pattern helpful to determine location of lesion
Causes: trauma, tumor, MS, transverse myelitis
147
What may cause transverse cord lesion
Trauma
Tumor
MS
Transverse myelitis
148
Presentation with hemicord lesion aka?
Brown-square syndrome
Ipsilateral UMN weakness due to lateral corticospinal tract damage
Ipsilateral vibration and joint position (dorsal column)
Contralateral loss of pain and temperature (ant/lat spinothalamic)
Causes: penetrating injuries, MS, lateral compression from tumors
149
What may cause brown-sequard syndrome?
Penetrating injuries
MS
Lateral compression from tumors
150
Presentation of central cord lesion-small
- sensory fibers crossing from spinothalamic tract injuries
- pain and temperature loss
- cape distribution in Cervicals
151
Presentation of central cord lesions-large
Anterior horn cells damaged leading to lower motor findings at level of lesion
Corticospinal tract damaged leaded to UMN signs
Posterior columns: vibration/position affected
Below lesion:
Vibration, position, pain, temp, motor losses with small area of sacral sparing
Causes: syringomyelia, contusion, intrinsic cord tumors
152
What may cause a large central cord lesion
Syringomyelia
Contusions
Intrinsic cord tumors
153
Presentation of posterior cord lesion
Vibration and position sense loss at site and distal
154
Causes of posterior cord lesion
Trauma
Compression from tumor
MS
B12 deficiency and tabes dorsalis
155
Presentation of anterior cord lesion
Pain and temp loss distal to side (anterolateral)
Lower motor weakness at lesion (anterior horn cells)
UMN findings if lesion is large to impact corticospinal tract
Incontinence common as descending tracts controlling sphincter are primarily ventral cord
Cause: trauma, MS, anterior spinal artery infarct
156
What may cause an anterior cord lesion?
Trauma, MS, anterior spinal artery infarct
