What are the functions of the posterior column?
Vibration, conscious proprioception, 2 point and light touch
What are the functions of the lateral spinothalamic tract?
pain and temp (crosses at level)
What are the functions of the vestibular system?
Balance and spatial coordination
What are the functions of the cerebellar system?
Motor control coordinating voluntary movements.
What are the functions of the Motor system - corticospinal tract?
Carries motor and crosses in the brain stem.
What are some characteristics of the confusional states?
Decreased level of consciousness, often reversible example: head injury
What are some characteristics of dementias?
Cognitive function and intellectual decline often irreversible. Example: Hemmorage or stroke.
What would the patient complain of with a brain lesion?
Mental status changes, HA, seizures, ICP visual complaints.
What would the patient complain of with a Pyramidal system lesion?
Uncoordinated voluntary actions
What would the patient complain of with a brainstem lesion?
Cranial nerve deficits
What would the patient complain of with a extrapyramidal system lesion?
Alterations in the involuntary movements (athetosis, resting tumor, tics, dystonia).
What would the patient complain of with a cerebellar lesion?
Uncoordinated motor movements; gait, stance
What would the patient complain of with a spinal cord lesion?
Dissociation of sensory loss, there may be LMN deficits if anterior horn or nerve root is also involved.
What would the patient complain of with a peripheral NS lesion?
Dermatomal distribution complaints, NTW
What neuro exam finding would be present with a brain lesion?
Mental status changes, motor/sensory deficits CONTRALATERAL to side of lesion (neuro signs/sx are dependent on where the lesion is located)
What neuro exam finding would be present with a brainstem lesion?
CN deficits are usually ISPILATERAL, and motor/sensory deficits are CONTRALATERAL to the lesion (Classical cross pattern)
What neuro exam finding would be present with a cerebellar lesion?
Ataxia and intention tremor deficits are IPSILATERAL to the lesion past pointing, dysmentria
What neuro exam finding would be present with an extrapyramidal lesion?
Resting tremors, chorea, athetosis, tics.
What neuro exam finding would be present with a spinal cord lesion?
UMN signs, motor/sensory deficits IPSILATERAL to the lesion, pain/temp CONTRALATERAL to the lesion.
What neuro exam finding would be present with a peripheral NS lesion?
LMN signs, flacid weakness, atrophy, fasculations hyporeflexia in dermatomal or plexus pattern.
What are the 4 types of Aphasia?
- Brocca’s (poor speaking/caveman speech)
- Wernicke’s (poor comprehension)
- Conductive (pt has intact comprehension but can’t explain what they understand)
- Global (poor speaking and comprehension)
Anomia
Inability to use or recognize names
Confabulations
The attempt to fill in memory gaps with false recollections.
Dysarthria
Disturbance of articulation
Dysphonia
Inability/dysfunction of phonation; hoarseness
Dysmetria
Disturbance of the movement towards a target
Dysesthesia
Disturbance of sensation
Paresthesia
Sensation of tingling, pricking of numbness
Ataxia (cerabella)
Staggering, clumsy, drunken; seen in cerebellar disease, alcohol intoxication, and MS
Ataxia (Sensory)
Slapping foot gait, tabetic; commonly seen in posterior column diseases, tabes dorsalis, polyneuropathy
Apraxia
Inability to perform previously learned task.
Agnosia
Inability to recognize common stimuli (objects, colors, sounds, etc.)
Astereognosis
Inability to identify an object by touch.
Agraphesthesia
Inability to identify a number written on the hand
Agraphia
Inability to write
Alexia
Inability to read
Dystonia
Abnormal movements resulting in sustained abnormal postures.
Athetosis
Slow, writhing movements
Chorea
Involuntary and unpredictable rapid irregular muscle jerks
What are the different types of tremors?
- Resting (Basal ganglia)
- Intention (Cerebellar)
- Chorea
- Athetosis
- Distonia
Myoclonus
Sudden rapid twitchlike muscle contractions
Characteristics of UMN lesion
Mild/late atrophy, clonus, hyperreflexia, absent abdominal reflex, spastic muscle tone, EMG/NCV normal.
Characteristics of LMN lesion
Atrophy, fisiculations, hyporeflexia, abdominal reflex is normal, flaccid muscle tone, EMG/NCV positive for fibrillations.
Dominant cerebral hemisphere vs. non-dominant
Language center is usually in dominant hemisphere.
Papilledema
Swelling of optic nerve
Optic atrophy
Atrophy of optic nerve
Paralysis vs. paresis
Paralysis = total loss of voluntary motor control; Paresis = a partial loss of voluntary motor control
Clonus
Series of reflex contractions of a muscle which has been suddenly stretched
Hypotonia vs. Hypertonia
Hypo = reduced resistance to PROM, flaccidity Hyper = rigid usually d/t extrapyramidal lesion
Scotoma
Irregular visual field deficit
Signs of meningeal irritation
Kernigs/brudzinski signs, nuchal rigidity, spinal rigidity.
Hemiplegic gait
Swinging gait; commonly seen in strokes
Scissor gait
Spastic (due to spasticity of adductor mm); seen in cerbral palsy and myelopath
Steppage gait
Equine or foot drop gain; seen in L5 radiculopathy or peroneal nerve disease or weakness of tibialis anterior.
Apraxic Gait
Magnet gait due to diffuse cerebral damage; seen in alzheimers, huntingtons, and hydrocephalus.
Waddling Gait
Seen in weak gluteus muscles and muscular distrophy; trendelenburg may be +
Festinating Gait
Shuffling gait, short steps, hard to start and stop; seen in parkinsons
Bells palsy
Dysfunction of cranial nerve VII
Trigeminal Neuralgia
Disorder of CN V and causes stabbing or electric shock-like pain in the face.
Ocular palsys
CN VI causes double vision
Acoustic Neuroma (Cerebellopontine angle tumor)
Slow growing tumor on CN VII; causes problems with balance and hearing.
Chronic alcoholic encephalopathy
Wernickes encephalopathy and Korsadoffs dementia
Wernickes Encephalopathy
B1/thiamine deficiency seen in chronic alcoholics and severe malnutrition; usually reversible; sx = confusional states, ophtalmoplegia, ataxia; tx = abstinence, IV injections of B1, detox.
Korsakoffs Dementia
A continuation of Wernickes Encephalopathy, seen in chronic alcoholics; IRREVERSIBLE; affects the temporal lobe; causes amnestic dementia (can’t form new memories)
Acute confusional states caused by alcohol withdrawal.
Hallucinations being ~ 48 hours after stopping; may get seizures (poor prognosis); Delirium Tremens begin 3-5 days post and last up to 72 hours (15% risk of mortality)
Meningitis
Viral or Bacterial causes flu-like sx: stiff neck, petechia, body rash, seizures and confusional states. LOC possible. Assume bacterial until proven otherwise.
1st degree concussion
Mild no LOC (dazed or stunned ) PTA <30 mins
2nd degree concussion
LOC < 5 min; PTA 30 minutes to 24 hours
3rd degree concussion
LOC > 5 min; PTA > 24 hours
Second impact syndrome
A person who has sustained 1 minor head injury has a 4 fold increase in risk of heaving a second concussive injury; second impact triggers a rapidly declining sequella w/ 1 seconds to minutes.
Boxers dementia (Pugliestica dementia)
Dementia cause by multiple concussions.
Epidural hematoma/hemorrhages
MC results from a lateral skull fx; lacerates middle meningeal A; Most rapid bleed (minutes to hours); medical emergency.
Subdural hematoma
Following trauma can be acute (minutes to hours), subacute (days-weeks), or chronic (weeks to months); most commonly presents as a slower bleed venous bleeding; usually not associated with skull fractures; elderly are more susceptible.
Intercerebral Hemorrhages
Coup/contracoup injuries; typically located at the frontal/occipital lobes; SX = altered LOC, HA, signs of meningeal irritation, may have focal brain signs.
Subarachnoid Hemorrhages
Most occur spontaneously and are d/t congenitally abnormal blood vessels in circle of willis resulting in a rupture into the subarachnoid space; SX = severe rapid HA, altered LOC, meningeal irritation and nausea and vomiting.
What are some red flags for serious and immediate emergency referral?
“I need my very special head protection” signs of open injury/skull fx, glasgow coma scale
What is the glasgow coma scale?
Scores level of consciousness on a 3 to 15 point scale; can be used as an outcome marker.
What are some signs of dementia?
Loss of memory, disorientation, loss of judgment, loss of abstract thinking, loss of ability to calculate.
What are some causes of dementia?
Alzheimer’s, multi-infarct dementia, trauma, hydrocephalus, metabolic (B12) deficiency, infections, drugs/toxins, brain tumors, parkinsons, hereditary.
Multi-infarct dementia
Vascular dementia from multiple tiny strokes over time; associated with hypertension and diabetes.