impairment of lang production or comprehensions - broca’s area - wernickes area

lecture 1: neurology Flashcards by sophia carrasco

central nervous system is considered a ____

upper motor neuron disorder

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what are 2 examples of my or neuron disorders in the peripheral nervous system (UMN/LMN)

• Amyotrophic Lateral Sclerosis (Lou Gherig’s disease)*
• Polio/post polio syndrome*

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what are 3 examples of peripheral nerve disorders in the peripheral nervous system

• Radiculopathies
• Plexopathies
• Polyneuropathy

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• Myasthenia gravis
• Lambert Eaton’s myasthenic syndrome
• Botulism

these are all examples of what kind of disorders

neuromuscular junction

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what is capgras delusion

recurrent belief that a person has been replaced by an imposter

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capgras delusion , stiffperson syndrome , and prosopagnosia are examples of what

fascinomas

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capgras delusion is reported with lesions in the ___ hemisphere

right

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what syndrome is diffuse stiffness without weakness or numbness and is an autoimmune disorder

stiffperson syndrome

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define prosopagnosia and what side hemispheric lesion is it

inability to recognize faces of familiar people

right side

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good ___ is essential tp the diagnosis

history

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• Disordered mentation, attention, memory, behavior
• Language and communication disturbances
• Excessive daytime sleepiness, insomnia, fatigue
• Visual disturbances (vision loss, diplopia)
• Weakness, numbness, other sensory alterations, balance
problems
• Sphincter disturbances (urinary or fecal incontinence, inability
to void)
• Erectile or ejaculatory dysfunction
• Sudden (paroxysmal) behavioral changes (seizures, loss of
consciousness)

these are all complaints of what

neurologic

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what are the 8 things that weakness could mean

– Fatigue
– Apathy
– Pain
– Decreased sensation
– Imbalance
– Incoordination
– Drowsiness
– Loss of muscle strength

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what are the 7 things to check for neurologic exam

I. Mental Status & Language
II. Cranial Nerves
III. Motor
IV. Sensation
V. Reflexes
VI. Coordination
VII.Gait

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what are the 4 levels of consciousness

alert

lethargy

stupor

coma

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what level of consciousness are you awake and interactive

alert

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what level of consciousness will the pt appear asleep but may be aroused with stimulation to interact with environment

lethargy

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what level of consciousness will the pt arouse briefly to vigorous stimuli but not to the point of being interactive

stupor

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what level of consciousness is the pt unresponsive to external stimuli

coma

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what is apraxia

inability to carry out a motor act int he absent of weakness or ataxia

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what is dysarthia and what kind of disorder is it and ehat does it affect

slurred speech

motor disorder affecting the muscles of articulation

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what is aphasia

impairment of lang production or comprehensions

broca’s area
wernickes area

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whar are the 6 components of language

spontaneous speech

naming

comprehension

repetition

reading

writing

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what is the path of language in the brain

heschl’s gyrus , primary auditory cortex
wernickes area , superior temporal gyrus
arcuate fasciculus
broca’s area , left inferior frontal

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what links written words with language

angular gyrus

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what is **anosmia** mean

loss of smell

what is **dysguesia**

altered taste

what are common path for cranial number 1 (olfactory nerve) sumptomatic and asymptomatic

symp: post viral , head trauma asymptomatic: alzheimer’s , parkinson’s

what CN deals with – Visual acuity – Visual fields – Ophthalmoscopy – Pupillary reactivity (afferent limb) – Color perception

cn II: optic

what mm goes with CN IV: trochlear N

superior oblique mm

what mm does the motion for CN VI: abducens N

lateral rectus MM

what exam do you do for CN III, IV and VI

extraocular movements , ptosis

what mm do the motion for CN III: oculomotor

superior rectus inferior rectus medial rectus inferior oblique

when you are doing the swinging flashlight test what is the direct response and consensual response

the direct response is shine light into pupil and look for constriction consensual response is look for opposite pupil constriction

if you do the swinging flash light test and there is no direct response what is the problem

problem with ipsilateral optic never

if you do the swinging flashlight test and there is no consensual response what can be the 3 problems

problem with opposite optic nerve , ipsilaterla parasympathetic of CN 3 or pupillary constrictor mm

what CN is – Muscles of mastication (chewing) – sensation of the face, conjunctiva, sinuses

CN V: trigeminal nerver

what is the exam for CN V: trigeminal

corneal reflex strength of jaw facial sensation

what 2 CN does the corneal reflex test and what are u doing and looking for

CN V and VII touch cornea gently with cotton swab and look for eye lid blinking

what CN is this – Muscles of facial expression, stapedius – Lacrimal glands (tearing) – Taste of anterior 2/3 of tongue

CN VII: facial

what is the exam for CN VII: facial

show teeth , wrinkle forehead, close eyes tight

if there is a central lesion for CN VII what does that mean

lower half of face weak on the contralateral side (stroke) ## Footnote if there is a right sided lesion then the left half od the lower face will be weak bc it crosses

if there is a peripheral lesion for CN VII: facial what does tha mean

entire half of face weak on the ipsilateral side bell’s palsy

what is the exam for CN VIII: vestibulochoclear nerve

hearing to finger rubs or tuning fork eye movements , nusyagmus head thrust dix hall pike

what cn is this – Sensation/taste from posterior 1/3 tongue, back of the throat – Motor nerve elevates pharynx, contributes to gag – Parasympathetics to parotid

CN XI: glossopharyneal nerve

what CN is this – Motor nerve innervating muscles of pharynx, larynx, tongue, smooth muscles – Major autonomic nerve - parasympathetic efferent

CN X: vagus nerve

what is the exams for CN XI and X

palatial elevation gag reflex taste swallowing assessment of speech

what 2 mm does the CN XI: accessory n inn

SCM and traps

what CN INN the tongue MM

CN XII: hypoglossal n

what are the 3 different tones

flaccidity rigidity spasticity

what is flaccidity define as

little resistance to passive movement

what tone is steady muscular tension that is equal in degree in opposing mm groups

rigidity

what tone is sustained increase in tension of a mm when it is passively lengthened

spasticity

which tone is speed dependent

spasticity

what brain strucutre has to do with rigidity

atrophy, pseudohypertrophy these are consider what in the motor exam

bulk

what 2 things do you check in the motor exam

bulk and tone

what are the 5 upper motor neuron signs

- stiffness , spasticity - weakness in pyramidal pattern ( flexor strong in UE and extensors stronger in LE ) - hyperreflexia -pathological reflexes - babinskis

what are the 4 lower motor neuron sign

-•Weakness, muscle atrophy, fasciculations, cramps. •NO SENSORY INVOLVEMENT •NO PAIN •Hypoactive reflexes

what grade of power is partial arc of movement with gravity eliminated

what grade of power is full arc against gravity and some added resistance

what number is it if the reflex is normla

what do you rate a clonus reflex

what is a Series of rhythmic involuntary muscle contractions induced by sudden passive stretching of a muscle

clonus (UMN lesion)

is hoffmann sign UMN or LMN and what finger do you do it on

UMN and middle

what is the babinski sign

extensor plantar response

when is the babinski sing abnormal

when the toes goes up (except in babies)

what tract is pain and temperature

lateral spinpthalamic tract

what tract is light touch

ventral spiniothalamic tract

what tract is vibration and proprioception

DCML

what part of the neurologic exam do you – Screen for distal/proximal gradient, asymmetry, dermatomes

V. sensation

what is one of the more earliest signs of dorsal column disease

romberg sign

when sit he romberg sign positive

when pt is able to stand with his feet together while his eyes are open but sways or falls when they are closed

when is the romberg sign included during the neurologic exam

sensory or coordination exam

when during the neurologic exam do you test the function of the cerebellum, basal ganglia, and related connections.

VI. coordination exam

disorders of the coordination exam manifest as what 5 things

imbalance incoordination ataxia dusdiadochokinesia abnormal movements

what 2 coordination test assess for dysmetria and intention tremor

finger nose finger test and heel to shin test

what does rapid alternation movements test for

dysdiadochokinesia

define station

attitude or manner of standing , including posture

what does fiat assess

width of the base , arm swing , pelvis rotation , height of step and symmetry

MRI, CT, myelography, angiography, perfusion, DAT are all examples of what

neuro imaging

electroencephalography (EEG), electromyography (EMG), nerve conduction studies, evoked potentials these are examples of what

neurophysiology

– Inflammatory and infectious conditions, including meningitis, encephalitis, multiple sclerosis – Subarachnoid hemorrhage – Pseudotumor cerebri (idiopathic intracranial hypertension): high opening pressure – Cancer involving meninges what is a diagnosis of these things

lumbar puncture

lumbar puncture inject what medications

chemotherapy , anesthesia

what levels of the spinal cord does the lumbar puncture go in at and into what space

L4/L5 epidural

what is normla measure pressure for lumbar puncture ____ mm H2O

80-200

what are some complications for lumbar puncture

post LP HA bleeding infection back pain

what are 5 advantages of computed tomography

– Emergency diagnosis of acute conditions (stroke, trauma). Blood easily seen. – Quick and readily available – Only option for those with contraindications to MRI – Visualization of bone (skull) – High resolution of vascular structures

what are disadvantages of computed tomography

radiation exposure and poor visualization of BS

what is hyper dense on a CT

calcium and bone

what is hypodense (dark) on CT

CSF, fat

is white matter or grey matter darker on CT

white

is blood hyper dense or hypodense on CT

hyper dense

on a CT , stroke , edema , fluid and air are ____

hypodense

what are the 3 advantages of MRI

no radiation exposure much higher resolution unmarred by bony artifact

what are 3 disadvantages of MRI

some contraindications (pacemaker) can’t assess bone long acquisition time

what is the test of choice for imaging most central nervous system disease/lesions

MRI

what choice of imaging would you do for these … infarcts, hemorrhages, vascular malformations, aneurysms, tumors, degenerative disorders, contusions, demyelination (MS), epilepsy, infections

MIR

can an MRI be done with or without contrast material (gadolinium)

yes

MRI: delusion weighted imaging is ___ in acute stroke

bright

what is an injection of 5-25 mL of radiopaque dye into **subarachnoid space** via lumbar puncture.

myelography

myelography is combined with what to allow for visualization of subarachnoid space

CT scanning

what are the 4 things that myelography evaluates for

spinal stenosis , cord arteriovenous malformation , tumor and abscess

what do you usually do instead of a myelography

MIR

what is injection of dye into cranial arteries (via catheterization from femoral artery)

conventional angiography

what can you visualize with a conventional angiography

occlusion , dissections , primary angiitis , aneurysms , vascular malformations

conventional angiography is. an intra arterial injection of ___

thrombolytic

what is interventional for conventional angiography

clot removal , stenting , angioplasty , coils and glue

what measure brain electrical activity thru scale electrodes

EEG

what does an EEG evaluate for

seizures , brain death , encephalopathy , dementia , coma

what is a Recording of electrical activity in central sensory pathways produced by visual (VEP), auditory (BAEP), or sensory (SSEP) stimulation

evoked potential

what does VEP evoked potentials mean

alternation checkerboard pattern

what is BAEP (auditory) evoked potientials mean

auditory clicks thru earphones

what does SSEP ( sensory) evoked potential mean

electrical stimuli applied to peripheral nerves

what do you use for Diseases of muscle, nerve, neuromuscular junction

EMG (electromyography) and NCV ( nerve conduction velocities)

what is an Insertion of a small needle into individual muscles and recording of motor unit potentials at rest and with activity

electropgyogrpahy

what is an Electrical stimulation over nerves with recording of sensory and motor nerve potentials and velocities

nerve conduction velocities

what will an axonal neuropathic show for an eMG and NCV

decreased amplitudes on NCV , abnormal spontaneous activity on EMG

what will a demyelinating neuropathies show on a EMG and NCV

slowed condution

what will a myopathies show on an EMG and NCV

normal NCV , small duration , low amplitude potentials

what does myasthenia gravis show on an EMG and NCV

abnormalities on repetitive nerve stimulation

what does this describe – Increased tone – Hyperreflexia – No atrophy

UMN

what does this describe – Decreased/normal tone – Hyporeflexia – Atrophy

LMN