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Neuro Misc. Flashcards

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1
Q

Describe protective vs diminished monofilament testing

A

5.07 and 10 g of force for protective

The 5.07 Semmes-Weinstein monofilament is calibrated so that it takes 10 grams. of force to bend it when touched on the skin of the foot. Inability to detect this. degree of force indicates that the client has a loss of protective sensation.

5.07 OR UNDER FOR PROTECTIVE SENSATION

ANYTHING ABOVE MEANS LOSS OFF EITHER, POSITIVE TEST

4.18 OR UNDER for light touch…polyneuropathy

4.18 and 1 g of force for diminished b/c seeing if its there
A positive test for the 1g monofilament (4.17) occurs when the patient cannot feel the monofilament when applied to specific areas of the skin.

This indicates diminished light touch sensation and suggests early sensory loss or mild neuropathy.

Testing DCML b/c light touch.

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2
Q

What tract does crude touch fall under

A

Spinothalamic

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3
Q

Describe keyy diff in ACA vs MCA vs PCA lesion

A

ACA - Impacts LE more
MCA -Impacts UE and face more
PCA - Vision, cerebellar

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4
Q

What is prosopagnosia

A

Inability to recognize names, faces due to occipital lesion (PCA)

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5
Q

Main traits of frontal lobe

A

Motor, brocas area (non fluent aphasia), executive, judgement

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6
Q

Main traits for the parietal lobe

A

Interpretation, sensory + perception, memory

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7
Q

Temporal lobe

A

Memory, Wernickis area (fluent aphasia), auditory, all comprehension (related to Wernickes)

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8
Q

Occipital

A

Vision

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9
Q

Hippocampus

A

Memory

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10
Q

Basal Ganglia

A

Voluntary movement, muscle tone, posture, control

Parkinsons, Huntingtons, Tourettes, OCD, ADD, Dyskinetic CP

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11
Q

Amygdala

A

Emotion

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12
Q

Thalamus

A

Relay or processing center
(thalamic pain syndrome) spontaneous pain cont side

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13
Q

hypothalamus

A

Receives from autonomic ns, regulates hormones

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14
Q

Epithalamus

A

Pineal gland, melatonin, circadian rhythm

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15
Q

Cerebellum

A

Controls muscle tone, coordination, balance

CAUSES IPSILATERAL IMPAIRMENT

ataxia, nytsagmus, tremor, hypermetria, poor balance, dysmetria (under/over shoot)

Dysdiadochokinesia (rapid alternating movements)

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16
Q

Pons

A

Respiratory rate norm is 12-20 CN 5-8 come out of pons
30-60 for 0 to 1 yo
20-40 for 2 to 5 yo
20-30 for 3 to 11

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17
Q

Medulla oblongata

A

Regulation of respiration and HR, reflex centers e.g vomiting, cough, sneeze

Relay somatic sensory info

Causes contralateral effects. All tracts cross in the medulla accept ALS (spinothalamic tracts)

CN 8-12 come from here

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18
Q

ACA

A

Cont LE involvement…bowel and bladder, frontal lobe so personality changes, aphasia

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19
Q

MCA

A

Most common. Cont UE and face, Wernickes aphasa, If dominant side, then all aphasias

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20
Q

Global aphasia

A

is issue both understanding and producing speech

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21
Q

PCA

A

Thalamic pain syndrome* and cortical blindness
Cont pain and temp loss
Ataxia
Homonymous hemianopsia e.g Left 50 percent of both eyes is out
Prosopagnosia - difficulty recognizing faces
Visual agnosia - issues processing visual input

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22
Q

Vertebral basilar artery

A

Brainstem and cerebellum involvement
Locked in syndrome, vegetative state, vertigo, nystagmus, loss of consciousness

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23
Q

Signs of meningitis

A

Fever, headache, neck stiffness

Light sensitivity

Brudzinkis sign - neck flexion causes hip and knee flex
Kernigs sign - pain with hip flex and knee ext

Lumbar puncture, refer out

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24
Q

DCML

A

vibration, proprioception, two-point discrimination
graphesthesia - the ability to identify letter numbers etc.

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25
spinothalamic
Ant - crude touch and pressure Lat- pain and temp (ALS) - crosses at spinal cord
26
Corticospinal tract related to
Positive babinski (toes spread and extend with swipe under foot), absent superficial abdominal and cremasteric, loss of voluntary movement
27
Rubrospinal tract
Muscle tone control
28
Reticulospinal tract
Voluntary and reflex activity
29
Tectospinal tract
Cont postural tone related to auditory and visual stimuli
30
A fibers
fasted and myelinated for motor and sensory
31
Superficial abdominal reflex
L8-T1 stroke quadrant near umbilicus and should move in that direction
32
Corneal blink superficial reflex
involved trigeminal (sensory) to facial (motor) closes eye stroke eye
33
Cremasteric superficial reflex
L1-L2 scratch medial thigh, scrotum should elevate on that side
34
Gag reflex
CN IX and X touch back of throat and gag should occur
35
Plantar reflex
L5-S1 Stroke lat aspect of sole of foot Normal response is flexio of toes Babinski would be ext and spreading toes (abd)
36
Superficial reflex test grading and indications
Absent or present Consider peripheral neuropathy if pathology
37
Deep tendon reflex
0 (nothing), 1+, 2+ (normal), 3+ (brisk), 4+ (very brisk) Biceps is more C5 Brachioradialis more C6 Could overlap though Consider peripheral neuropathy if pathology
38
Dominant hemisphere is
opposite of the dominant hand. If im R hand dominant its because I'm L brain dominant.
39
L hemispehere (assuming dominant)
Brocas, Wernicke, global aphasia, positive thoughts, logical, judgment
40
R hemisphere (assuming nondominant)
Creativity Negative thoughts Spatial Kinesthesia
41
Why is preservation of pinprick relevant post stroke
proximity corticospinal tracts and spinothalamic tract so if its preserved then better prognosis for moto recovery
42
Asia A
Complete. No sensory or motor below the leesion
43
Asia B
Sensory below the lesion (at least in sacral segments)
44
Asia C
Motor preserved in less than half of levels below lesion have more than 3/5
45
Asia D
Motor preserved in more than half of levels below lesion have more than 3/5
46
Asia E
Normal both sensory and motor
47
Spinal shock
Sympathetic loss, everything decreased (reflex, sensation, power, bowl and bladder flacid) Edema buildup 3-6 days
48
Autonomic dysreflexia vs orthostatic hypotension
AD: if face is red, raise the head. Sit up to get blood flow to body OH: If face is pale, raise the tail (Trendelnberg) to get blood flow to head
49
Autonomic dysreflexia
Lesion is at or above T6 Raise in BP flushed face Sit pt up, check for stimulus, activate EMS in that order
50
Conus Medullaris
L1 typically, termination of spinal cord Injury above will act as UMN (spastic, hyperreflexxixc bladder and bowel) - suprapubic tapping for intervention to cause reflex - Digital stimulation Injury below will act as LMN (flaccid, areflexic) - catheter or valsalva to force out - Manual evacuation Catherization for both initially
51
How may breathing chnage visually with SCI
Normal is elevation and expansion at chest wall and epigastric region without abdominal rising Paradoxical: Upper ribcage moves inwards and abdominals move out *IN cervical or upper thoracic due to loss of external intercostals Decreased functional cough due to internal intercostals
52
Pressure relief every 15 min
Lean forwards more than 45 degrees Tilt in space more than 65
53
Intrinsic plus position for tenodesis grip
Wrist 20 ext MCP 90 ( so that they stay tight so there is no give when stretched during active wrist extension) IP sligjt flexion
54
Hamstrings and QL
Dont overstretch HS 100 to 110 stretch in supine
55
Upright positioning
Gradually increase angle May use abdominal binder or compressions If symptoms of OH Bring down to supine or trendelenberg (COMPLETELY GO DOWN) and let symptoms subside before proceeding
56
Connus medullaris
L1 Above is UMN spastic Below is LMN Areflexic flacid
57
Internal capsule lesion causes
Contralateral hemiparesis in body and contralateral facial weakness (ON BOTTOM HALF OF FACE CONT)
58
Most common UE spasticity early stroke
Adductors, pronation, wrist, finger flexion
59
Dyspraxia
Impairment of skilled learned movement
60
vertebrobasilar insufficiency
Signs are visual field cuts, visual dysfunction, drop attacks, unsteadiness/incoordination
61
Location of cranial nerves in relation to infarct locations
CN 1, 2 anterior brain (vision, smell) CN 3, 4 midbrain (eye movment) CN 5,6,7,8 Pons CN 9, 10, 11, 12 Medulla
62
Cerebrum
Cont sx in body and face
63
Brain stem
Face and body opposite side sx
64
Anosognosia
Denial, neglect, lack of awareness of paralaysis
65
Somatoagnosia
Perceptual disorder relayed to body scheme (aware of body and relationship of parts of body)
66
Prosopagnosia
Perceptual disorder inability to recognize faces
67
Visual agnosia
Inability to recognize objects in general
68
Monofilament
5.07 monofilament or less is normal sensation Anything above , means loss of protective sensation
69
ALS
ALS pain crude touch temperature
70
DCML
fine touch proprioception Two point discrimination
71
Key for bowel/bladder spasticity or flaccid quesitons
If the specific organ system (bowel/bladder/sexual dysfunction) is referenced → Use S2-S4 Reflex Arc...S2 is cutoff If the question is more general motor control or spasticity/flaccidity → Use UMN vs. LMN ....L1 is cutoff
72
Cauda equina
Areflexic bowel dysfunciton
73
Myelomeningocele
Flaccid bowel
74
Parietal info
Impairments such as neglect, somatosensory loss, and impaired spatial relationship are common with resections in the parietal lobe
75
Basal ganglia info
Individuals who have basal ganglia dysfunction have difficulty initiating movements, and this can be addressed through the augmentation of sensory cues
76
Tongue towards
affected side
77
Crude touch vs fine touch
DCML is fine touch
78
Wallenberg syndrome is also called lateral medullary and posterior inferior cerebellar artery syndrome.
Signs (horners syndrome = decreased pupil size, drooping eyelid, decreased sweating) due to sympathetic loss double vision, slurred speech dizziness
79
Medial medullary syndrome distinguishing factor
Ipsilateral tongue atrophy and deviation BUT LE and UE is affected on contralateral side

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