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Flashcards in Nervous System Deck (129):
1

Four Brain Regions

Cerebrum: frontal, parietal, temporal, occipital
Diencephalon-Thalmus, Hypothalmus and basal ganglia
Brainstem- Midbrain, Pons, Medulla
Cerebellum

2

Brain Tissue

Gray- formed by collection of erve cell bodies
White- myelin coated axons
Internal capsule- where all myeinated fibers from cerebral cortex converge and descend into brainstem

3

Diencephalon

Thalmus(sensory impulses relay to cerebral cortex)
Hypothalmus( homeostasis- reg HR,BP, Temp also endocrine, emo behavior. Hormones excreted from hypothalmus directly affect pituitary)
basal ganglia(affect movement)

4

Thalmus vs Internal Capsule

Thalmus bus stop for all sensroy impulses going into brain, Internal capsule bus stop for all sensory impules going out of brain

5

Consciousness

interaction between cerebral hemispheres, diencephalon, upper brainstem, RAS

6

Cerebellum

base of brain, coordinates movement, maintains upright position

7

Spinal Cord

C1-8
T1-12
L1-5
S1-5
C

8

Cauda Equina

Spinal cords ends at L1-2, then the lumbar and sacral roots fan out like horse tail

9

Lumbar puncture

done L3-4 or L4-5

10

CN 1-12

On old olympus towering tops a finn and german viewed some hopps

11

CN can be motor, sensory or both

Some say marry money but my brother says big breasts matter more

12

Nerve Roots

Ant root- motor/efferent
Post root- sensory/afferent

13

Upper motor neurons

cell bodies originate in brain and spinal cord. UA to leave CNS, must synapse with lower motor neurons, which carry message to muscle/rest of body

14

Lower motor neurons

cell bodies located in brain stem, but axons can leave CNS to synapse with muscles- These are cranial/spinal nerve

15

Motor: Corticospinal (pyramidal) tract

mediate voluntary movement by stim muscle action and inhibiting others. Carry impulses that inhibit muscle tone. Originates in motor cortex of brain. Motor fiber travels down lower medulla, cross to opposite side of medulla, cont down, syn with ant horn/immediate neurons.

16

Corticobulbar

tracts synapsing in brainstem with motor nuclei of CN

17

Motor: Basal Ganglia System

complex system includes motor pathway between cerebral cortex, basal ganglia, brainstem, spinal cord. Maintains muscle tone and control body movements

18

Motor: Cerebellar System

receives sensory/motor input and coordinates motor activity, maintains equilibrium, helps control posture.

19

Movement

Voluntary- Cortex
Automatic- basal ganglia
reflex sensory- sensory receptors.

20

Higher motor pathways

affect motor mvmt only through lower system- translates into sction in ant horn. Lesion in any areas- will affect mvmt or reflex activity

21

Upper vs Lower motor neuron damage

Upper- inc muscle tone/DTR
Lower- dec muscle tone/DTR

22

Damage to Basal Ganglia

inc muscle tone, diturbs posture/gait, bradykinesia, invol mvmt

23

Damage to Cerebellum

dec muscle tone, imp coordination/gait & equilibrium
Nystagmus, dysarthria, hypotonia and ataxia

24

Sensory Pathways

reflex activities, conscious sensation, body position, reg ANS(HR,BP,RR), relays impulses from skin/mucous membranes/ tendons/ viscera, reg sensation of pain/temp/position/touch.

25

Sensory: Spinothalmic Tract 1

from neuron to post horn, synapse with secondary neurons- cross to opposite side and travel up to thalmus (Pain, temp, crude touch-light touch not localized)

26

Sensory: Spinothalmic Tract 2

sensations of vibration/position/fine touch(with localization)- pass directly into post horn- travel up to medulla with secondary sensory neurons, cross to opposite side at medullary level and cont to thalmus.

27

Thalmic Level

Quality of sensation perceived, fine distinction not made

28

Sensory Cortex

Full perception, localization, high order discrimination made

29

Sensory Cortex Lesions

may not impair perception of pain/touch/ position but will impair finer discrimination.
Cannot appreciate size/shape/texture of object by feel.

30

Proprioception

sense of mvmt, body position independant of vision. Gained from input of sensory nerve terminals in muscles/tendons/joints/vestibuar apparatus
Loss of position sense- tabes dorsalis, MS, B12 def from post colum disease, PN form DM

31

Dermatome

band of skin innervated by sensory root of a single spinal nerve
Sensory level may be several segments below injury- reason unknown

32

DTR

tap on tendon, activates special sensory fibers, trigger sensory impulse to spinal cord via peripheral nerve synapses directly with ant horn innervating same muscle, crosses NM junction, muscle contracts, completes reflex arc

33

HH c/o

HA, dizzy, vertigo, weakness, numbness, abn/loss of sensation, LOC, syncope/near-syncope, Sz, tremors/invol mvmt

34

HA

Ask: severity, location, duration assoc Sx like visual, wkns, loss of sens. Affected by sneezing, coughing or suddent mvmt of head- which can inc ICP
SAH- worst HA of life
Meningitis- severe HA
Mass lesions/absess- dull HA in same location

35

Dizzy

what experienced, light headed/faint, room spining/rotating
Light-headedness in plapitations, near syncope from VV stim, low BP, febile, or others.
Vertigo- inner ear, brainstem tumor.
Elderly- meds may contribute
Assoc Sx- diplopia, dysarthria, ataxia- may be present in vertebrobasilar TIA or CVA

36

Weakness

Assoc with, gen/location, paralysis, onset, progression, mvmt affected?
TIA/CVA- wkns/paralysis
Focal wkns- ischemia, vasc, mass lesion CNS, PNS, MS DO, muscle diseases
Bilat prox wkns- myopathy

37

Myasthenia Gravis

wkns made worse by repeated effort and imp with rest

38

Loss of Sensation

numb, diff moving a limb, alter sens, tingling/pins-needles

39

Parasthesia

Limb goes to sleep= compresion of nerve, tingly. prickly, feeling of warmth, coolness or pressure.
If in hands and around mouth- hyperventilation

40

Dysesthesia

distorted sensation in repsonse to stim, may last longer than stimulus

41

Pain

May arise from neurologic causes but often reported with Sx of other body systems
Burning pain- painful sensory neuropathy

42

LOC/ fainting

Complete black out or hear voices.
Symptoms of feeling faint- light headed, weak, wo actual LOC- near/presyncopal
Anyone witness- Sz mvmt, onset/offset sudden/slow

43

Syncope

sudden temp LOC and postural tone- dec blood flow to brain
Cardiac- arrythmias cause- more common in older pt, sudden onset/offset. AS, HOCM, MI, Massive PE
Other causes of syncope: Hypocapnea d/t hyperventilation, hypoglycemia, hysterical fainting.
Unlike Sz- no incontinence, tonic-clonic mvmt, postictal state but may have bitten tongue or bruised limbs.

44

Vasovagal

young people with stress- warning symptoms- flushed, warmth, N- slow onset, slow offset

45

Seizures

Paroxysmal DO sudden excessive electrical DC in cerebral cortex or underlying structure. May or may not LOC. Any abn feelings, thought process, sensation, smells, abn mvmt.

46

Tremors

unable to controll trembling/shaking/body mvmt.

47

RLS

develops at rest, accompanied by urge to move, relief with walking. Usually occurs at night. CNS iron/dopamine def, or dysmetabolism. Chronic ext tissue pathology/inflammation
Tx: daily exercise, adequate sleep, Dopaminergic meds (Requip,Mirapex), Correction of Fe def.

48

Health Promotion

Stroke/TIA prevention
Reduced periphearl neuropathy
Three D's

49

Stroke stats

Ischemia 80-85%
Hemmorhage 15-20%
ICH 10-15%
SAH 5%

50

TIA

sudden focal neuro deficit lasts less than 24 hours. Precursor to stroke, 3 months after TIA, 15% progrss to CVA esp if RF present.

51

Stroke warning signs

sudden numbness, wkns, confusion, aphasia/dysathria, understanding, walking, dizzy, loss of balance/coordination, trouble seeing in 1 or 2 eyes, severe HA

52

S/S of stroke depend on area affected

Most common MCA- visual field cuts, contralat hemoparesis, sens deficits
Left hemi-aphasia
Right hemi- neglect/inattention to opposite side of body

53

Stroke RF Primary prevention

modifiable RF- HTN, smoking, HPL, DM, obesity, lack of exercise, heavy ETOH. Careful mngmt afib, asymp carotid disease. For ICH/SAH- BP MNGMT. RF for SAH- smoking, HTN, ETOH abuse, family HX first degree relative

54

Stroke RF Secondary Prevention

If TIA, focus on cause: atherosclerotic lg vessel disease, carotid emboli, small vessel lacunar disease, idiopathic.
Younger pt- consider Takayasu arteritis, art dissection, fibromuscular dysplasia, cocaine, drug use. May need ASA/coumadin for prevention.

55

Peripheral Nueropathy

Polyneuropathy
Autonomic Dysfunction
Mononeuritis Multiplex
Diabetic Amyotrophy

56

Dementia

Alzheimers
Vascular
Lewy Body- Parkinsons
Frontotemporal

57

Depression neurotransmitters

Serotonin- if depleted: irratabilty, hostility, SI
Norepi depletion: dullness, lethargy

58

CN 1: Olfactory

Test for common odors one side at a time with eyes closed.
Loss of smell with: sinus conditions, head trauma, smoking, aging, cocaine, Parkinsons

59

CN 2: Optic

Inspect optic fundi, check disc. Test visual fields by confrontation bilaterally
Visual field deficits. Can occur with glaucoma, retinal hemm, optic neuritis. Bitemp hemianopsias-defect at optic chiasm- usually pituitary tumor.
Homonymous hemianopsias or quad in postchiasmal lesions- usually parietal lobe assoc w/CVA

60

CN 2&3: Optic and Oculomotor

Inspect size/shape pupil, can be 0.4mm between pupils.
CN 3 palsy- larger pupil abn constriction- parasympathetic denervation, ptosis, opthalmoplegia. In Horner's Syndrome- pupils constrict to loght but d/t sym degen the affected pupil remains small(miosis) d/t abn pupillary dilator muscle

61

CN 3,4,6: Oculomotor, Trochlear, Abducens

EOM's, ?diplopia, convergence, ?nystagmus, Look at distant object- check for inc/dec nystagmus, ?ptosis
Dysconjugate gaze?
Diplopia? Monocular with glasses/contacts/cataracts/astigmatism/ptosis. Binocular with CN 3/4/6 neuropathy (40%), muscle disease from MG/trauma/throid opthalmopathy, internuclear opthalmoplegia.

62

Nystagmus

cerebellar disease esp with gait ataxia & dysarthria & vestibular DO.

63

Ptosis

CN 3 palsy, Horner's syndrome(ptosis, meiosis, anhidrosis), MG

64

CN 5: Trigeminal

M: Temporal & Masseter muscle
S: Pain at forehead, cheek & jaw, sharp vs dull. If abn- test for temp too. Also check for light touch.
Masseter- diff chewing
Pterygoid- diffmoving in opposite direction
Unilateral wkns- CN 5- pontine lesion
Bil wknsin cerebral hemispheris disease because of bil cortical innervation.
Corneal refelx: look away and touch cornea with something soft- should blink

65

Stroke pattern

facial/body sensory loss on same side but contralateral cortical or thalmic lesion.
Ipslateral face but contralateral body sensory loss in brainstem lesions

66

Trigeminal Neuralgia

isolated facial sensory loss in peripheral nerve DO

67

Absent corneal reflex

CN 5 or 7 lesion. Abs blinking and sensorineural hearing loss= acoustic neuroma

68

CN 7: Facial

raise eyebrows, frown, close eyes tightly, show upper and lower teeth, smile, puff out cheeks.
flattening of asolabial fold/drooping of lower eyelid- facial weakness
In unilateral paralysis, mouth droops on the paralyzed side when pt smiles or grimaces.

69

Bell's Palsy

Injury to CN 7, affects upper and lower face, a central lesion affects lower face. Other symptoms Bell's Palsy- loss taste, hyperacusis, inc or dec tearing

70

CN 8: Acoustic

Whispered voice; conductive vs sensorineural
AC/BC- Weber test
Rinne test
Hearing loss from: excess cerumen, otosclerosis, OM- hearing loss, presbyacusis- aging- usually SN loss

71

CN 9&10: Glossopharyneal & Vagus

Diff swallowing
mvmt soft palate and uvula when saying "AHHHH"
Gag refex
Hoarse = vocal cord paralysis
Nasal= palate paralysis
Check for unilateral palate mvmt= lesion CN 9 or CN10

72

CN 11: Spinal Accessory

shoulder shrug, turn head into hand on face
trapezius wkns with atrophy and fasiculations in PN DO. If paralysis- shoulder droops down and lat.

73

CN 12: Hypoglossal

tongue protruded, move side to side
Unilateral cortical lesion- tongue deviates away from side of lesion, toward side of wkns
Dysrthria and amyotrophic lat scleoris, polio

74

Hypertrophy or Pseudohypertrophy

check muscl bulk/atrophy/hypertrophy. Flattening in prominences between metacarpals suggests atrophy but in median and ulnar nerve damage.

75

Muscular Atrophy

PN DO- spinal cord, RA, protein calorie malnutrition

76

Dec Muscle Tone

PN DO, cerebellar disease or acute stages of spinal cord injury

77

Hypotonia

flaccidity, PN DO.

78

Paresis

wekness. Hemiparesis is one sided

79

Paralysis

plegia or absense of strength. Para- legs, Quad- all ext.

80

Weak grip

cervical radiculopathy, deQuervains tenosynovitis, carpal tunnel syndome, arthrits, epicondylitis

81

Wkns extention at elbow

radial nerve damage

82

Weak finger abduction

ulnar nerve DO

83

Weak opposition of thumb

median nerve DO- carpal tunnel

84

Myopathy

Proximal symmetric muscle weakness- muscle DO

85

Polyneuropathy

Distal symmetric muscle weakness- PN DO

86

Coordination= Cerebellum

RAS
Pt to Pt mvmt
Gait
Stand specified way

Coordination worsens with eyes closed

87

Dydiadochokinesis

cerebellar dysfunction. Cannot perform RAS- irregular and clumsy
Upper motor neuron wkns and basal ganglia disease may impair RAS but not same way

88

Dysmetria

While doing RAS, patient overshoots but corrects self and reaches goal.

89

Intention tremor

at the end of movement

90

Past pointing

Repetitve consistent deviation to one side, while eyes closed suggests cerebellar or vestibular disease

91

Ataxia

gait instability
causes: cerebellar disease, ETOH, loss of position sense.

92

Gait

across room, heel to toe, on heels, on toes, hop in one leg in place, shallow knee bend, rise from sitting
UA heels and toes- distal muscular weakness
UA heel walk- corticospinal tract damage
UA hop- wkns, lack of position snese, cerebellar dysfunction
UA shallow knee bend- prox muscle wkns
UA rising from sit- prox muscle wkns

93

Stance

Rhomberg
Pronator drift

94

Rhomberg

Position sense test- feet together, stand with eyes closed 30-60 seconds, min sway normal. Positive test= cerebellar ataxia

95

Pronator drift

Stand 20-30 sec arms forward palms up, eyes closed. Should be able to hold, tap down on arms, should be able to hold. Sens and Spec for corticospinal tract lesion
Downward drift with flex fingers and elbow may occur
Sideward/upward- loss position sense

96

Anestesia

abs of touch sensation

97

Hypesthesia

dec sensitivity

98

Hyperestesia

ins sensitivity

99

Vibration

1st sense lost in PN neuropathy. Common causes: DM, ETOH, Post colum disease- tertiary syphyllis or vit B def
Can use to test cord lesion on trunk

100

Astereoognosis

UA to recognize objects in hand with eyes closed

101

Discriminative Sensations

Stereognosis
Graphestesia
2 Pt discrim
Pt localization
Extinction
Alterations indicate lesion in sensory cortex

102

Hyperreflexia

CNS lesion along desc corticospinal tract
Look for assoc upper neuron- wkns, spasticity, + Babinski

103

Hyporeflexia

Diseases of spinal nerve root, Spinal nerve, plexuses, PN. Look for assoc lower motor unit disease- wkns, atrophy, fasciculations
Use reinforcement if dim or absent- isometric contraction of other muscle for 10sec before testing to inc reflex activity

104

Positive Babinski/Plantar Reflex

DF big toe, CNS lesion. Also from drug, ETOH, postictal after Sz

105

Meningeal Signs: Brudzinski

hands behind head while supine, flex neck forward, Normal neck supple. Stiff/Resistance in 90% with meningitis, 20-85% for SAH, also present in arthritis and neck injury

106

Meningeal Sign: Kernig

supine, flex leg at hip and knee, then straighten knee- may cause some discomfort but not pain. Pain is positive finding- If bilateral = meningeal irritation

107

Lumbosacral RadiculopathY

straight leg raise, DF foot, pain= + finding
Compression spinal nerve root as it exits vertebral foramen, assoc with wkns, dermatomal sensory loss, usually herniated disc, Most common herniated disc- L5-S1, spinal angles sharply. Ipsilateral calf wasting, wk ankle DF.

108

Sciatica

S1 distribution- low back pain with nerve pain that radiates down leg

109

Asterixis

ID metabolic encephalopathy when mental function impaired. Stop sign with hands, watch 1-2 minutes
Sudden breif nonrythmic flexion of hands/fingers: liver disease, uremia, hpercapnia

110

Winging of Scapula

Shoulder muscles weak or atrophic, push hands against wall- scapula lie close to thorax.
In winging, medial border of scapula juts backwards- wkns serratus muscle- MD or injury to long thoracic nerve
If thin, may appear winged

111

Stupous/Comatose Patient

ABC's, LOC, Neuro exam

112

2 Don't with coma pt

don't dialate pupils- single most important clue about cause(structural vs metabolic)
Don't flx neck if trauma

113

5 clinical signs strongly predict death

abs corneal reflex
abs pupillary response
abs WD to pain
no motor response
at 72 hrs, no motor response

114

Doll's eyes

In comatose pt with no neck injury turn head side to side. Eyes should move toward opposite side. If eyes don't move=midbrain or pons lesion

115

Oculovestibular Reflex with Caloric Stimulation

If oculocephalic reflex abs, assess brainstem fxn, not performed on an awake pt.Ice cold water into ear canal. If brainstem intact eyes will move toward cold water. No response= brainstem injury

116

CSF/Blood in nose/ears

suggests skull fracture or OM- possible brain absess

117

ACA

contralat leg wkns

118

MCA

largest vasc bed for stroke.
contralat facial, arm>leg wkns, sensory loss, field cut, aphasia(L MCA), or neglect,apraxia(R MCA)

119

Subcortical

contralat motor or sensory deficit w/o cortical signs

120

PCA

contralat field cut
cortical bindness, but pupil response present.

121

Brainstem/Vertebral or Basilar Artery branches

dysphagia, dysarthria, tongue/palate dev, ataxia, crossed sensory/motor deficits(ips face with contra s/m deficits)

122

Basilar Artery

Oculomotor deficits, ataxia, crossed s/m deficits
Complete occlusion= lock in syndrome

123

Tremors

Resting/Static
Postural/Action
Intention

124

Types of seizures

Partial: Simple partial, Complex partial
Gen: Grand Mal, Absence, Atonic or drop attack, Myoclonic
Pseudoseizures

125

Wernicke's Aphasia

fluent receptive aphasia
Post superios temporal lobe

126

Broca's Aphasia

non fluent expressive aphasia
Post inferior frontal lobe

127

Muscle Tone Disorders

spasticity
rigidity
flaccidity
paratonia

128

Speech Disorders

Aphonia
dysphonia
dysarthria
aphasia: exp/rec

129

Facial Dyskinesias

Tic
Chorea
Athetosis
Dystonia
Spatic Torticollis