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Neuro- Abnormals Flashcards

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1
Q

disorders of consciousness can either effect _____ or _____

A

the level of consciousness (LOC) or the content of consciousness

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2
Q

what is LOC vs content of consciousness?

A

LOC: injury in ascending reticular activating system or both cerebral hemispheres (changes influence the state of consciousness- e.g. hallucination)
Content: Level of Consciousness may be normal but content is abnormal (e.g. dementia)

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3
Q

Difference in time-of-onset for LOC vs Content of Consciousness change

A

Determining time of onset helps diagnose:
acute confused state- impaired LOC
Dementia- not impaired LOC, slowly progressive

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4
Q

What are we trying to determine in a mental status evaluation? 4 possibilities?

A
  1. dementia
  2. acute confused state cause by a number of things
  3. focal lesion
  4. psychiatric disorder (may be caused by lesion, genetic, illness, etc)
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5
Q

5 parts of testing cognition and what disease states or these results indicative of?

A 
Orientation- acute or dementia
Attention- dementia, delirium
Remote memory- dementia, 
Recent memory- dementia, delirium
New learning ability- amnesia
*(delirium and amnesia are both acute states, dementia is chronic) - essentially trying to determine acute vs chronic
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6
Q

what is aphonia?

A

loss of voice from the LARYNX (from disease or nerve damage)

-this is a step up from dysphonia- less severe impairment from, say, laryngitis

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7
Q

what is dysphasia?

A

impairment of speech resulting from a brain lesion or neurodevelopmental disorder

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8
Q

what is dysphonia?

A

(Cranial Nerve X) – difficulty in speaking; hoarseness

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9
Q

what is dysarthria?

A

Impairment or clumsiness in the uttering of words due to disease that affect the oral, lingual, or pharyngeal MUSCLES

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10
Q

what is aphasia?

A

absence or impairment of the ability to communicate by speech, writing, or signs because of BRAIN DYSFUNCTION

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11
Q

what is wernicke’s aphasia?

A 
sensory speech area issue: 
Fluent, rapid, voluble, effortless
Malformed words
Nonsensical sentences
Incomprehensible
-Location: Posterior superior temporal lobe
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12
Q

what is broca’s aphasia?

A

Motor speech area issue:
Non-fluent, slow, few words, laborious
Meaningful words with impaired inflection/articulation
May drop small words
Comprehend words/reading fair to good
Impaired: repetition, naming, writing
-Location: Posterior inferior frontal lobe

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13
Q

what is bell’s palsy?

A 
CN VII Peripheral lesion
Paralyzes entire side of face on side of lesion
Eye will not close
Flattening of nasolabial fold
Inability to raise eyebrows
Lower face paralysis
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14
Q

lower portion of the face controlled by what? upper portion of face controlled by what?

A

Lower portion of face controlled by contralateral upper motor neurons of the cortex (Stroke may affect these)

Upper face controlled by both sides of cortex, so motor neurons on opposite side of cortex allow fair movement of the upper face

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15
Q

CN 7 central lesion could cause…

A

Eye closes but may be weak
Nasolabial fold is flat
Raises eyebrows
Lower face paralyzed

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16
Q

what is jerk nystagmus?

A

has a fast and a slow phase and is defined by the direction of its fast component.

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17
Q

issues in what three areas can cause nystagmus?

A

peripheral or central nerves

cerebellar

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18
Q

what is the dix-hallpike test?

A

test when pt has vertigo w/change in position:
The head, turned to the right is rapidly lowered 30 degrees below horizontal while gaze is maintained to the right.
The eyes are observed for nystagmus patient notes the following about their vertigo:
Onset
Severity
Cessation

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19
Q

peripheral lesion vs central lesion… how will these present different in a dix hallpike test for nystagmus and vertigo?

A

peripheral lesion will show more severe signs- distress from vertigo, vomitting
includes latency, fatiguability (response remits as position is maintained) and habituation

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20
Q

what are resting tremors?

A

(Static)
Prominent at rest
May decrease/disappear with movement
Example: Parkinson Tremor

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21
Q

what are postural tremors?

A 
(Action)
Occur when affected part is maintaining a posture
Examples: 
Hyperthyroidism: Fine and rapid
Anxiety/Fatigue
Benign Essential (Familial) Tremor
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22
Q

what are intention tremors?

A

Absent at rest, Occur with activity
*Worsen as they get near target (aka- trying to pick up a pen, it will get worse as the hand nears the pen)
Example:
Multiple Sclerosis (Disorder of Cerebellar Pathway)

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23
Q

what are tics?

A

Brief, coordinated, repetitive movements at irregular intervals
Examples:
Tourette’s syndrome

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24
Q

what is athetosis?

A

Slow and twisting movements with a large amplitude
-face and extremities, spastic
Example:
Cerebral palsy

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25
what is dystonia?
Similar to athetosis: Involve larger body portions (trunk), maintained longer -->stuck in a twisted posture
26
what is chorea?
Rapid, brief, jerky, irregular, unpredictable, non-repetative (unlike tics) Rest or interrupt normal coordinated movement Seldom repeat Face, head, lower arms, hands example: huntingtons
27
what is hemiballismus?
flaccid affected limbs with violent swinging or writhing motions of the contralateral arm and leg Often due to structural abnormality (thalamus/subthalamic nucleus lesion)
28
what causes muscle atrophy?
a decrease in neuron stimulation- can be resultant of nerve damage, immobility (a cast) - damage can be anywhere from anterior horn to muscle (aka LMN disease)
29
what is flaccidity? what causes it?
LOWER MOTOR NEURON lesion from anterior horn cell to peripheral nerve includes... Hypotonia – lack of tone; loose floppy limb, Hyperextensible or flailing, Weakness Example: Guillian-Barre or Initial phase of spinal cord injury (spinal shock) or stroke
30
what is spasticity? what causes it?
Lesion of UPPER MOTOR NEURON or corticospinal tract system Muscle tone increased (Hypertonic) -rate dependent: increased tone with rapid motion, increased tone at extremes of arc
31
what is "clasp-knife" resistance?
refers to spasticity...Initial hypertonia may disappear suddenly as limb relaxes
32
what is rigidity? what causes it?
Lesion of the BASAL GANGLIA system Resistance is increased regardless of arc or rate of movement “Lead-pipe rigidity” Example: Parkinsonism
33
what is "cogwheel rigidity"?
superimposed ratchet-like jerkiness on flexion and extension of the wrist or forearm
34
what type of movements is the cerebellum responsible for?
Cerebellum is for coordinating and fine-tuning movements already set in motion and for correcting speed, accuracy of direction and intensity of force to meet intended purpose.
35
what appendages do the cerebellar hemispheres control?
Cerebellar hemispheres control ipsilateral (same side) appendages.
36
what are the 3 tests for motor coordination?
1. Gait and posture: look for Ataxic gait 2. Finger to nose, heel to shin: Looking for inability to complete the action– dysmetria 3. RAM- rapid alternating movements: look at Smoothness and ability to perform- dysdiadochokinesia
37
what abnormals are we noting with the 3 motor coordination tests?
1. Slumped posture, trunk leaning to right 2. Steppage gait (like you are going up stairs), cerebellar ataxia, scissors gait, Parkinsonian gait, sensory ataxia (can’t feel your feet so you walk funny) 3. RAM uncoordinated, slow, F-N with dysmetria
38
what is spastic hemiparesis?
type of gait/posture abnormality UMN (corticospinal tract) lesion (stroke) -paralysis of one side- poor flexor muscle control on that sides arm and leg, holding arm close, foot turned in and dragging
39
what is steppage gait?
Foot drop Usually due to peripheral motor unit disease Drag feet or lift high then slap down (as if walking up stairs)
40
what is parkinsonism gait?
``` Basal ganglia defect Stooped with flexion of head, arms, hips, knees Slow start Short shuffling steps Festination (involuntary hastening) Diminished arm swings Stiff turn around Poor posture control ```
41
what is cerebellar ataxia?
Staggered, unsteady, wide based Exaggerated turn difficulty Cannot stand with feet together with eyes open or closed
42
what is sensory ataxia?
Loss of position sense in legs Polyneuropathy or posterior column damage Throw feet forward and out and bring down on heel then toe (double tap) Watch ground when walking proprioception of feet gone: if Eyes closed, Cannot stand with feet together (positive romberg)
43
4 parts of sensory system analysis
1. Check the Spinothalamic Tract: Pain temperature, Light touch 2. Check the Dorsal Columns : Proprioception with position sense of digits (Vibration- tuning fork) 4. Romberg: Proprioception of feet 4. Sensory interpretation- now that we know all the columns work lets see what the brain can do with the incoming information - Graphesthesia - Sterognosis
44
why do we check all reflexes? what does this help determine?
helps place a lesion in the system
45
what should all DTRs be ?
2+ and symmetric
46
increased reflexes come from what? decreased reflexes come from what?
Increased reflexes can be from UMN lesions | Decreased reflexes can be from LMN
47
UMN lesion: what is it and what does it feature?
Disruption of pyramidal (corticospinal) pathway from motor cortex to anterior horn cell Features: Muscle Weakness Increased DTRs Depressed abdominal response Spasticity – increased tone (rate dependent and at extremes of arc)
48
LMN lesion: what is it and what does it feature?
Disruption of the pathway between motor nucleus and neuromuscular junction Example: Guillain-Barre Features: Weakness in muscles supplied by affected motor neuron Diminished DTR Fasciculation Wasting Flaccidity – loss of tone May be an acute stroke or spinal shock finding
49
Lesions at _______ seldom have sensory deficits, but lesions of the _____ or ______ usually have sensory deficits
anterior horn cell; nerve root or peripheral nerve
50
3 types of LMN lesions
Nerve Root Disorders: Degenerative spine disease Single Peripheral Nerve: Compression, Angulations, Stretch Myasthenia Gravis
51
what is myasthenia gravis?
Activity at neuromuscular junction interrupted by antibody deposit on postsynaptic acetylcholine receptor site Weakness of any skeletal muscle – fatigable Late and inconsistent – wasting Preserved reflexes
52
lesion of cerebral cortex, how does it effect motor, sensory and DTRs?
Motor: Chronic contralateral corticospinal-type weakness Flexion of Arm Plantar Flexion Hip is in external rotation Sensory: Contralateral sensory loss in limbs and trunk (same side as motor deficits) DTRs: Increased
53
lesion of brainstem, how does it effect motor, sensory and DTRs ?
Motor: Contralateral weakness and spasticity CN deficits (diplopia secondary to weak EOM, dysarthria) Sensory: Variable, no “typical” findings DTRs: Increased
54
lesion of spinal cord, how does it effect motor, sensory and DTRs?
Motor: Weakness and spasticity often affecting both sides (if bilateral cord damage) Paraplegia, Quadriplegia Sensory: Dermatomal sensory deficit on bilateral trunk at level of lesion Sensory loss due to tract damage below level of lesion DTRs: Increased
55
Lesion of the Subcortical Gray Matter (Basal Ganglia) | effect on motor, sensory and DTRs?
Motor: Slow (bradykinesia), rigid, tremor Sensory: Not affected DTRs: Normal or decreased
56
cerebellar lesion, effect on motor, sensory and DTRs?
Motor: Hypotonic, ataxic, other (Nystagmus, dysmetria, dysdiadochokinesis) Sensory: Not affected DTRs: Normal or diminished
57
lesion of anterior horn cell, effect on motor, sensory and DTRs?
Motor:Weakness, atrophy in segmental or focal pattern Fasciculations Sensory: Intact DTRs:Diminished
58
spinal root and nerve lesions, effect on motor, sensory and DTRs?
Motor: Weakness, atrophy in root-innervated pattern Sometimes fasciculations Sensory: Corresponding dermatomal sensory deficits DTRs: Diminished
59
peripheral nerve mononeuropathy, effect on motor, sensory and DTRs?
``` Motor: Weakness, atrophy in peripheral nerve distribution Sometimes fasciculations Sensory: Sensory loss in nerve pattern DTRs: Diminished Example: Trauma ```
60
peripheral nerve polyneuropathy: effect on motor, sensory and DTRs?
Motor: Weakness, atrophy more distal than proximal Sometimes fasciculations Sensory: Deficits, commonly stocking-glove distribution DTRs: Diminished
61
NMJ lesion: effect on motor, sensory and DTRs?
``` Motor: Fatigability more than weakness Sensory: Intact DTRs: Normal Example: Myasthenia Gravis ```
62
muscle lesion: effect on motor, sensory and DTRs?
Motor: Weakness more proximal than distal. Rare fasciculations Sensory: Intact DTRs: Normal or diminished Example: Muscular dystrophy (genetic myopathy with progressive muscle weakness/wasting; several subdivisions)

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