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1

3 elements of consciousness

Arousal
alertness
awareness

2

structures required for level of consciousness

Reticular activating system= reticular formation, nucleus, tegmentum (midbrain), intralaminar nucleus of thalamus and dorsal thalamus

cerebral hemisphere

3

Orientation

to: person, place, time

4

Language

-expression
-comprehension
-repitition
-naming

5

Structures required for language

-expression = Brocas area
-comprehension = Wernicke's area
-repetition= Acute fasciculus
-Naming = verbs/functor: frontal lobe; nouns = temporal-parietal lobe

6

structures for attn and concentration

-cognitive ideas = frontal-subcortical network
-visual-spatial attn = Non-dominant parietal lobe

7

Structures for memory

-encoding and consolidation of memory = hippocampus
-retrieval of memory = frontal-subcortical system

8

structures for semantic knowledge

temporal and parietal lobe

9

CN localization in brain

Midbrain = CN II, III, IV
Pons = CN V, VI, VII, 1/2 of VIII
Medulla = 1/2 of VIII, IX, X, XI, XII

10

CN III paralysis

cannot abduct or look up/down
also have ptosis of eyelid

11

CNIV paralysis

exotropia to R

12

CN VI paralysis

esotropia and no abduction
horizontal homonymous diplopia

13

CN VII paralysis : LMN vs UMN

LMN: ipsilateral facial paralysis with impaired forehead wrinkling
UMN: lower half of face is paralyzed, eye closure and forehead wrinkling preserved

14

Unilateral paralysis of CN IX and X

deviation of uvula to side of lesion

15

CN XIII paralysis

tongue deviation to side of lesion

16

hypotonia

decreased muscle tone
seen in LMN lesions, spinal shock and cerebellar lesions

17

hypertonia

increased, spasticity or rigidity
-seen in pyramidal lesions (spasticity); bilateral frontal lobe lesions (paratonia); extrapyramidal lesions (rigidity)

18

Upper Extremity muscle strength

-shoulder abduction = C5, C6
-Elbow flxn = C5, C6
-elbow extn = C5. C6 (radial nerve)
- finger spreading = C8, TI (ulnar nerve)
-thumb opposition = C8, TI (median nerve)

19

Lower extremity muscle strength

- hip flexion = L1, L2
-knee flexion = L5, S1, S2
- knee extn = L2, L3, L4
-Foot dorsiflexion = L4, L5
- Foot plantar flexion = S1, S2

20

DTR: Upper extremities

Biceps: C5, C6
Triceps: C7
Brachioradials: C6

21

DTR: Lower extremities

Patella: L4
Achilles: S1

22

Babinski reflex

(+) sign = dorsiflexion of big toe
Upper motor neuron lesion

23

Cerebeller sensory signs

dysmetria, dysdiodochokinesis, Romberg (coordination)
Gait and stance