intro to neurology Flashcards by Lindsey Dutton

what are important associated symptoms to ask about during HPI

headache, numbness, pins and needles, cold or warmth, weakness, unsteadiness, stiffness or clumsiness,N/V, visual disturbances, altered consciousness

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what are the different portions of a neurological exam

mental status
cranial nerve
motor system
sensory system
coordination and gait
reflex testing

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what is within the mental status exam

general appearance and behavior
speech
mood and affect
thought and perception
cognition: MMSE
Judgement and insight

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what is MMSE

Mini-mental state exam

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what is assessed within the MMSE?

orientation
registration
attention and calculation
recall
language

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what are the cranial nerves

olfactory
optic
oculomotor
Trochlear
trigeminal
Abducens
Facial
Vestibulochochlear
glossopharyngeal
vagus
Accessory
Hypoglossal

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what type of scale is muscle strength graded on for a neurologic exam

0-5 scale

0 is no muscle contraction
5 is muscle can move the joint it crosses through a full ROM against gravity as well as against full resistance

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what is assessed during sensory neurologic exam

touch
pain
deep pain
temperature
joint position sense
vibration sense
two-point discrimination

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what is stereognosis test

object identification with eyes closed

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what is graphesthesia test

ability to feel/identify a number being traced in their palm

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what used to assess coordination in the neurologic exam

rapid alternating movements

(first with hands and then with feet)

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what is diadochokinesia

ability to perform RAM (rapid altenating movements)

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what is dysdiadochokinesis

slow, irregular, clumsy, movements

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how is the gait evaluated

walk across the room, turn and come back
walk heel-to-toe in a straight line (tandem walking)
walk on their toes in a straight line
walk on their heels in a straight line
hope in place on each foot
do shallow knee bend
rise from a sitting position

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what is a hemiplegic gait

abnormal gait: affected leg is held extended and internally rotated, the foot is inverted and plantar flexed and leg moves in circular direction at hip (circumducation)

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what is a diplegic gait

abnormal gait: slow and stiff with legs crossing in front of eachother (scissoring) - often with CP, used to be called spastic gait

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what is a cerebellar ataxic gait

abnormal gait: wide-based and may be associated with staggering/reeling as in drunkness

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what is a sensory ataxic gait

abnormal gait: wide based, the feet are slapped onto the floor, a patient may watch their feet

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what is a neuropathic or steppage gait

abnormal gait: inability to dorsiflex foot, often due to peroneal nerve lesion. results in exaggerated elevation hip/knee to allow foot to clear floor

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what is a dystrophic gait

abnormal gate; pelvic muscle weakness produces lordotic/waddling gait (with trendelenberg tilt)

what is parkinsonian gait

abnormal gate; flexed posure, starts are slow, steps are small and shuffling, there is reduced arm swing, and involuntary acceleration may occur

what is festination gait

another name for parkinsonian gait

what is a choreic gait

abnormal gait: jerky and lurching yet falls are supprizingly rare

what is a apraxic gait

abnormal gait; difficulty initiating walking and may appeared to be glued to the floor. once started, gait is slow and shuffling. however no difficulty performing same leg movements when lying and not bearing weight

what is a antalgic gait

favoring one leg over other to avoid pain (limp)

how are reflexes graded

on a scale 0-4+

what reflexes do we assess?

biceps, brachioradialis, achilles, triceps, patellar and plantar

what is GCS

glasgow coma scale

what is being assessed during CSF labs

appearance total protein glucose cell count (WBC and there should be NO RBCs) opening pressures

what are the indications for lumbar puncture

CNS infection, concern for meningitis suspected on Subarachnoid hemorrhage unexplained seizure/SE intrathecal chemotherapy/contrast thoraco-abdominal aortic aneurysm repair idiopathic intracranial hypertension (pseudotumor cerebri)

when are LPs contraindicated

infection in tissue near puncture site space occupying lesion, especially brain abscess anticoagulation thrombocytopenia with PLT complete spinal block non-communicating hydrocephalus

what labs are used for strokes

CBC, ESR/CRP, serum glucose (HGB A1C), lipids (LDL, HDL, triglycerides)

what are the indications for CT

stroke, tumor, trauma, dementia, SAH

what is CT better at assessing than MRI

acute bleeds

what is MRI indicated for

stroke tumors trauma dementia Multiple Sclerosis Infections Seizures

when is MRI indicated over CT scan

pregnancy and MRI is more sensitive than CT in detecting certain structural lesions such as tumors and vascular abnormalities better contrast between white and grey matter

what is a DW-MRI

diffusion weighted MRI - detect stroke within an hour of onset with high specificity

what do DW-MRI discriminate between

Cytotoxic (strokes) and Vasogeneic dema (cerebral lesions)

what is a PET scan

positron emission tomography may demonstrate function brain abnormalities for structural abnormalities

what are the indication for PET scans

medical refractory epilepsy and evaluations for surgery dementia gradng fliomas can provide early confirmatory evidence in huntingtons disease

what are the different types of angiography used for neurologic cases

formal cerebral angiography Ct angiography MR angiography

what are the indications for angiography

acute stroke to evaluate for LVO intracranial aneurysms/AVMs/Fistulas SAH - evaluating for above etiology venous sinus thrombosis space occupying lesions

when are fibrillation potentials and positive waves found on EMG

typically found in denervated muscle as in myopathic disorders and especially in inflammatory disorders like polymyositis

what do fasiculation potentials seen in EMG mean

they reflect spontaneous activation of individual motor units characteristic of neuropathic disorders especially involving anterior horn cells as in ALS

what are myotonic discharges in EMG

high frequency discharges of potential from muscle fibers that wax and wane in amplitude and frequency as in myotonic dystrophy and myotonia congenita

what do myopathic disorders show on EMG

increase incidence of small, short duration, polyphasic motor units in affected muscles

what do neuropathic disorders show on EMG

number of units activated during a maximal contraction is reduced and units fire faster than normal

What are Evoked potentials

visual, auditory and somatosensory

when are evoked potentials indicated

detection of lesion in MS evaluating efficacy of treatment in MS detection of lesions in other CNS disorders assessment and prognosis after CNS trauma/hypoxia intraoperative monitoring evaluation of visual/auditory acuity