Neuro Flashcards
1
Q
What does SWIFT stand for?
A
- Symmetry
- Wasting
- Involuntary movements
- Fasciculation
- Tremor
2
Q
What is Battle’s sign?
A
- mastoid ecchymosis
- an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma
(A) Basilar skull fracture in the temporal bone can cause cerebrospinal fluid (CSF) to leak from the nose or ear
(B) Periorbital ecchymosis, called raccoon’s eyes.
(C) Battle’s sign over the mastoid process.
3
Q
What are the main subheadings in a motor exam?
A
- bulk: atrophy, asymmetry
- tone: hypotonia, hypertonia, cogwheeling
- power
- 0 no muscle contraction detected
- 1 flicker or trace contraction
- 2 active movement with gravity eliminated
- 3 active movement against gravity
- 4 active movement against gravity and some resistance
- 5 active movement against full resistance without evident fatigue (normal)
- reflexes
- 4+ very brisk, hyperactive, with clonus
- 3+ brisker than average, may be normal or abnormal
- 2+average/normal
- 1+ somewhat diminished, low normal
- 0 no response
- coordination
- rapid alternating movements
- finger nose test
- rebound
- sensory function
- pain
- vibration
- light touch
- temperature
4
Q
List 3 meningeal signs
A
- Neck stiffness
- With the patient lying flat on the bed, the examiner gently flexes the neck passively. The chin is brought to the chest. If there is resistance to neck flexion this may indicate meningeal irritation.
- Brudzinski’s sign
- With the patient supine and examiner lifts the head off the bed and into chin-to-chest position. If there is flexion of the hips and knees (and pain) during the manoeuvre this indicates meningeal irritation.
- Kernig’s sign
- With the patient supine the examiner passively flexes patient’s knee and hip to 90 degrees. Then examiner tries to passively straighten the leg while keeping the hip flexed. If there is pain or increased resistance bilaterally this suggests meningeal irritation.
5
Q
Comment on what kind of changes you would expect in LMN vs UMN lesion vs extrapyramydal
A
LMN
- muscle tone = flaccid
- involuntary movements = fasciculations
- reflexes = decreased
- plantar reflexes = down going
- patterns of muscle weakness = proximal, distal, or focal
UMN
- muscle tone = spastic
- involuntary movements = none
- reflexes = increaed
- plantar reflex = upgoing
- Pyramidal pattern
- look for hemiparetic gait (flexed arm, extended legs)
- Upper extremities: extensors weaker than flexors
- Lower extremities: flexors weaker than extensors
EXTRAPYRAMIDAL
- muscle tone = rigid
- involuntary movements = none
- reflexes = normal
- plantar reflex = down going
- pattern of muscle weakness
6
Q
Tests for UMN lesion?
A
- Babinski Reflex: ‘Up-going‘ big toe ± fanning of toes indicates an UMN lesion
- Hoffmann’s Reflex: Flexion of IP joint of the thumb when tapping/flicking/flexing the nail of the index or ring finger may indicate an UMN lesion if asymmetrical
- Pronator Drift: Unable to maintain full arm extension and supination; side of forearm pronation reflects contralateral pyramidal tract lesion; closing eyes accentuates effect
7
Q
What is the pramidal pattern of muscle weakness?
A
- UMN
- Weaker arm extensors: shoulder abduction, elbow extension, wrist extension, finger extension, finger abduction
- Weaker leg flexors: hip flexion, knee flexion, ankle dorsiflexion
8
Q
What are the deep tendon reflexes - root and muscle tendon?
- biceps
- brachioradialis
- triceps
- finger flexores
- hip adductors
- knee extensors
- plantar flexion
A
Root / Muscle Tendon
C5/6 = Biceps
C6 = Brachioradialis
C7 = Triceps
C8 = Finger flexors
L2/3 = Hip adductors
L3/4 = Knee extensors
S1/2 = Plantar flexion
9
Q
A
primary sensation
- spinothalamic tract: crude touch, pain, temperature
- dorsal column-medial lemniscus pathway: fine touch, vibration, proprioception
cortical sensation
- graphesthesia, stereognosis, extinction, 2-point discrimination
