- Decorticate - Indicates damage to cerebral cortex or areas above brainstem - Corticospinal tract damage - Rigid flexion - Upper arms held tightly to sides of body - Elbows, wrists, fingers flexed - Feet plantar flexed - Legs extended and internally rotated - Tremors or intense stiffness

Neurological Flashcards by Faye R

Neurological Evaluation: Inspection

Respirations: bc it’s driven by brain
- Observe rate, rhythm, pattern
- You’ll see changes in ^ if brain affected even if lungs are fine
Pupils: presence/absence of PEERLA gives insight to CN II, III, IV, VI
- Observe size, quality, rxn to light
Ocular movement
- Observe position of eyes/eyelids at rest
- Check for horizontal deviation of eye
Posture and Muscle Tone
- Observe gait, ambulation, etc.

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LOC Grading (LOC, Technique, Pt Response)

Alert: Speak in norm voice tone
- Spontaneously opens eyes
- Looks at you
- Responds appropriately
Lethargic: Speak in loud voice
- Opens eyes but appears drowsy
- Looks at you
- Responds
- Returns to sleep
Obtundation: Gently wake as if waking someone who’s asleep
- Opens eyes
- Looks at you
- Responds slowly
- Somewhat confused
- Decreased alertness and interest in environment
- Goes back to sleep after conversing
Stupor: Apply painful stimuli (sternal rub, tendon pinch, etc.)
- Arouses during painful stimuli
- Verbal response slow or absent
- Returns to unresponsive state when stimuli ceases
Comatose: Apply repeated painful stimuli
- Remains unarousable
- Eyes closed

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Assessing Brain Damage w/ Glasgow Coma Scale (What, Highest/Lowest Scores, Used for, Based on)

What: initial GCS used as baseline to compare w/ future follow-up GCS score
Highest: 15 & Lowest: 3
Used for traumatic situations where there’s some type of brain insult
Based on…
- Eye-opening response
- Verbal response
- Motor response (to verbal command and/or painful stimulus)

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Abnormal Flexion ⇒

Decorticate
Indicates damage to cerebral cortex or areas above brainstem
Corticospinal tract damage
Rigid flexion
Upper arms held tightly to sides of body
Elbows, wrists, fingers flexed
Feet plantar flexed
Legs extended and internally rotated
Tremors or intense stiffness

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Abnormal Extension ⇒

Decerebrate
Indicates damage to midbrain or upper pons within brainstem
Brainstem damage
Rigid extension
Arms fully extended
Forearms pronated
Wrists and fingers flexed
Jaws clenched
Neck extended
Back may be arched
Feet plantar flexed
Occurs spontaneously, intermittently, or in response to stimuli

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Overview of Assessing Coordination (Testing Systems of…)

Motor: muscle strength
Cerebellar: rhythmic movement and steady posture
- Rapid alternating movements
- Point-to-Point movements
- Gait and other related body movements
- Posture
Vestibular: balance and coordination of eye, head, body movement
Sensory: positional senses

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Cerebellar Function Testing Techniques (Cerebellum Definition, Techniques + Steps)

Cerebellum: processes input from other areas of brain, spinal cord, sensory receptors to provide precise timing for coordinated, smooth movements of skeletal muscular system
- Stroke affecting cerebellum ⇒ may cause dizziness, nausea, balance and coordination problems
Rapidly Alternating Movements
- Steps: Hands on lap, face down first + Flip hands up and down as fast as possible
Fine Motor Coordination: Upper Extremities
- Finger to nose + Touch that finger from nose to nurse’s finger by fully extending arm & Touch thumb to rest of fingers as fast as possible
Fine Motor Coordination: Lower Extremities
- Steps: Put heel to shin + Slide heel from shin and down to leg
Romberg Test
- Steps: Standing eyes closed + Feet together + Stay in that steady position for 30 secs + Nurse needs hands around pt in case they fall

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Overview of Assessing Sensory System Functioning (assessing & testing for)

Pain & Temp controlled by → Spinothalamic Tracts
- Spinothalamic Tracts: sensory pathway originating in spinal cord that transmits info to thalamus abt pain, temp, itch, and crude touch
Position & Vibration controlled by → Posterior Columns/Dorsal Column
- Posterior Columns/Dorsal Column: area of white matter in dorsomedial side of spinal cord, part of dorsal funiculus, made up of fasciculus gracilis and fasciculus cuneatus + part of ascending posterior column-medial lemniscus pathway important for well-localized fine touch and conscious proprioception
Light Touch controlled by → Spinothalamic & Posterior Columns
Comparing…
- Symmetrical areas
- Distal and proximal ends of body parts
When testing vibration and position sensation → test fingers and toes first
- Distal → proximal bc if they have distal intact then they’ll have proximal intact

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Peripheral Nerve Sensory Testing Lower Extremities (Sensation Type + Description)

tactile: light touch using cotton
pain: using stick to press and slide down
vibratory: instrument on malleoli and hit it to feel vibration
positional: rubbing toes and asking if it’s going up or down

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Cortical Sensory Function in Upper Extremities (Technique + Description)

Stereognosis:
- Eyes closed
- Give pt common object (coin)
- They feel it and tell you what it is
Two Point Discrimination:
- Eyes closed
- Poke their palms w/ one point first then two points at same time
- Ask if they’re being poked w/ one or two points
Graphesthesia:
- Eyes closed
- Using end of Q-tip, write letter or number
- Ask them what you wrote

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Reflexes Testing (DTR Definition, Hyperactive & Diminished Reflexes Suggests ___, Notes)

Deep Tendon Reflexes (DTR): means of assessing spinal nerves so make sure you have pt’s baseline on hand
Hyperactive reflexes → suggests CNS disease
Diminished reflexes → suggests ↓ sensation due to damaged spinal segments
Note that diseases of muscles may also diminish DTRs

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DTR Reflex Testing Grading Scale

0: no response
1: somewhat diminished (low norm)
2: av, norm
3: brisker than av, may indicate disease
4: very brisk, hyperactive

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Superficial Reflexes (Present or Absent) (Reflex + Spinal Level)

Upper Abdominal → T7, T8, T9
- Abdominal reflexes can be lost w/ age and/or abdominal surgeries
Lower Abdominal → T10, T11
- Abdominal reflexes can be lost w/ age and/or abdominal surgeries
Cremasteric → T12, L1, L2
- What: stroking inner thigh of male pt proximal to distal to elicit cremasteric reflex
  - Testicle and scrotum should rise on stroke side
    - Absent w/ upper and lower motor disorders, testicular torsion, L1 and L2 spinal injury
  - Helps in recognizing testicular emergencies!!!
Plantar → L4, L5, S1, S3

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Deep Reflexes (Present or Absent) (Reflex + Spinal Level)

Biceps → C5, C6
Brachioradial → C5, C6
Triceps → C6, C7, C8
Patellar → L2, L3, L4
- If someone has herniation or herniated disc from back injury (common place to have injury is in lumbar region so herniations in lumbar regions L2, L3, L4) ⇒ means they have absent patellar reflex
Achilles → S1, S2

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Dizziness & Vertigo (Causes)

Palpitations → may cause lightheadedness
Vasovagal stimulation, low BP, febrile (fever-like Sxs) illnesses, excessive HTN med dosage → may cause near-syncope
Inner ear conditions or Brainstem conditions like tumors → may cause vertigo (environment around is spinning) accompanied by other neurological S&S

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Vertigo: Peripheral

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Far less concerning/dangerous
Usually concerns inner ear
Treatable
Onset: Sudden
Causes less severe
Duration: intermittent w/ severe Sxs
Affected by head position and movement
Motor function, coordination, gait intact
NV more frequent
Benign Positional Vertigo (BPV)
- Onset: sudden, often when rolling onto affected side or tilting head up
- Duration: few seconds – <1 min
- Hearing: unaffected (tinnitus absent)
- Additional features: sometimes nausea, vomiting, nystagmus
Meniere’s Disease
- Onset: sudden
- Duration: several hrs – ≥1 day
- Hearing: sensorineural hearing loss– recurs, eventually progresses
- Tinnitus: present, fluctuating
- Additional features: pressure or fullness in affected ear, NV, nystagmus

Vertigo: Central

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Dangerous/Quality of life affected
Usually concerns brainstem deficits
Onset: sudden
Causes: more severe
Duration: variable but rarely continuous
Hearing: unaffected (tinnitus absent)
Additional features: usually w/ other brainstem deficits– dysarthria, ataxia, crossed motor and sensory deficits

Weakness or Paralysis (Causes)

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Transient Ischemic Attack: temporary and all Sxs resolve in 24 hrs
Cerebrovascular Accident: stroke that needs CT scan before any Tx
- Ischemic: due to emboli that prevented blood flow to brain
  - Treated w/ meds to dissolve clots
- Hemorrhagic: massive bleed in brain → blood has nowhere to go → buildup of pressure → causes damage fast
  - If ischemic-clot-dissolving meds used as Tx ⇒ kills pt
CNS lesions: causes focal weakness (specific body part weakened/affected depends on where in brain lesion is)
Myopathy: when muscle fibers don’t function normally → causes bilateral proximal muscle weakness like muscular dystrophy
Polyneuropathy: causes bilateral distal muscle weakness
Myasthenia Gravis: autoimmune disorder
- ↑ muscle weakness w/ repeated effort
- ↓ muscle weakness w/ rest

Myasthenia Gravis (what, associated with, S&S, incidence)

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What: when IS mistakes healthy tissue → produces antibodies that block muscle cells from receiving neurotransmitters from nerve cells
Associated w/: tumors of thymus (organ of IS)
S&S: Weakness of voluntary (skeletal) muscles ⇒ ↑ muscle weakness w/ repeated effort
Incidence: affect ppl of any age but common in young women and older men

Infections: Meningitis (what, causes, S&S, seen more in)

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What: inflammation of meninges (membrane around brain/spinal cord)
Causes: bacteria, virus, fungi, parasite, other toxin
S&S:
- Nuchal rigidity/stiff neck
  - If pt unable to touch chin to chest or if painful → think meningitis
- Severe headache
- Fever
- Malaise
- ↓ LOC
- Stupor
- Coma
- NV
Seen more in pts who have severe deficits in IS

Infections: Encephalitis (what, causes, S&S)

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What: inflammation of brain itself
Causes: bacteria, virus, fungi, parasite, mosquito bite, etc.
S&S:
- Photophobia
- Lethargy
- Muscle weakness
- Fever
- Irritability
- Nuchal rigidity/stiff neck
- Other neurological Sxs

CVA & TIA Same S&S

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Sudden onset of 1 or more of following:
- Unilateral numbness/weakness of face, arm, or leg
- Confusion
- Difficulty speaking or understanding
- Changes in vision, unilateral or bilateral
- Loss of balance, difficulty w/ ambulation
- Severe headache w/ unknown etiology

CVA (what + other notes)

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What: hemorrhagic (massive brain bleed where blood has nowhere to go ⇒ pressure causes damage) OR ischemic (emboli prevents blood flow to brain)
Ischemic med Tx will kill hemorrhagic pt bc it’s clot dissolving and hemorrhagic is alrdy excessively bleeding !!! ⇒ CT scan first before any Tx !!!
Needs Tx within 3 hrs of S&S onset

TIA (what + other notes)

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What: narrowing of blood vessels in brain ⇒ decrease in blood flow and oxygen supply
S&S fully resolves within 24 hrs

CVA & TIA Same Risk Factors

- Age: - Older > - Women taking birth control pills or pregnant > bc of clotting side effects - A-fib - ↑ lipids - Hx of HTN, DM, CAD, surgery

CVA & TIA Same Detection

- BE FAST - Balance changes - Eyesight changes - Facial drooping - Arm weakness - Slurred speech - Time to call 911

Parkinson’s Disease (what, S&S, risk factors)

- What: slow, progressive disease where there’s damage to dopamine-producing nerve cells in striatum nigra ⇒ results in poor communication between parts of brain that coordinate and control movement and balance - S&S: - Insidious/Slow onset - Bradykinesia: slowing or freezing of movement - Tremor of hands, arms, legs, jaw, face - Pill rolling: pill between forefinger and thumb and they keep rolling it - Muscle rigidity - Shuffled walk bc of affected coordination ⇒ ambulation affected - Impaired posture - Changes in speech - Falls - Anxiety - Dementia in late stage - Risk Factors: - Age - FHx of Parkinson’s (large role) - Pesticide exposure - Head trauma that can later result in Parkinson’s

Multiple Sclerosis (MS) (what, S&S, diagnosed with)

- What: autoimmune disorder that causes progressive demyelination of nerve fibers Myelination of nerve fibers ⇒ better and fast signal transmission than unmyelinated Demyelination affects brain and spinal cord - S&S: commonly remitting/relapsing - Paresthesia - Diplopia and/or Nystagmus - Depression - Impaired gait - Difficulties w/ bowel/bladder - Sexual dysfunction - Fatigue - Diagnosed w/ brain scan

Speech Disorders (aphonia, dysphonia, dysarthria, aphasia)

- Aphonia: loss of voice w/ disease that affects larynx or its nerve supply - Dysphonia: less severe impairment in volume, quality, or pitch of voice - Causes: laryngitis, laryngeal tumors, unilateral CN X paralysis - Dysarthria: defect in muscular control of speech apparatus ⇒ slurred/nasal speech - Causes: motor lesions of CNS or PNS, Parkinson’s, Cerebellar disease - Aphasia: disorder in producing or understanding language - Cause: lesions in dominant cerebral hemisphere - Types: - Wernicke’s: fluent & repetitive where rapid speech, inflection and articulation good but sentences makes no sense - Broca’s: nonfluent & expressive where speech is slow and laborious, inflection and articulation impaired but sentences make sense

COVID-19 S&S

- Anosmia: loss of smell - Ageusia: loss of taste - Peripheral nerve damage - Disorientation & Confusion - Psychosis - Post-traumatic stress - Memory loss - Altered mental status - Encephalitis - Hemorrhage - Dizziness - Agitation - Headache - Weakness - Stroke

Traumatic Brain Injury (S&S: changes in...)

- Physical - Behavioral - Cognitive - Interpersonal - Environmental

Red flags

- “Worst headache of my life” - Pt 50+ w/ no Hx of headaches recently complaining of headache → think secondary type of headache

Age-Related Considerations: Infants & Children

- Normal - Significant brain growth in 1st yr of life + continues to ~12-15yrs - Reflexes primitive in newborn (grasping, startle, stepping) - Motor maturation is cephalocaudal in nature (head to toe development) - Abnormal - TBIs - Cerebral palsy: permanent disorder of movement and posture development bc it’s a group of disorders that can involve brain and nervous system function - Affects: cognitive learning/thinking, vision, hearing, movement - Types: spastic, dyskinetic, ataxic, hypotonic, mixed, etc. - Myelomeningocele (Spina Bifida): congenital defect of one or more vertebrae (commonly lumbar or sacral) that permits meningeal sac filled w/ a portion of spinal cord to protrude - Affects (depends on severity): walking, bladder control - Shaken Baby Syndrome: shaking kid and brain excessively - Abuse bc brain is bouncing from one side of skull to other - S&S: if they have these and no Hx of other disease → think abuse - Subdural hematoma - Retinal hemorrhage - Brain swelling

Age-Related Considerations: Pregnant Women

- Normal (relieves after delivery) - Increase sleep in 1st trimester w/o feeling rested - Decrease sleep in 3rd trimester: has associated somatic Sxs like leg cramps - Carpal tunnel syndrome due to fluid retention

Age-Related Considerations: Older Adults

- Normal - ↓ # of cerebral neurons: not associated w/ deterioration in mental function - ↓ velocity of nerve impulse ⇒ may slow response time

Stroke Primary & Secondary Prevention

- Primary: Target modifiable risk factors of cardiovasc diseases - HTN - Smoking - Dyslipidemia - DM - Weight management - Diet & Nutrition - Physical activity - EtOH - Secondary Prevention: For pts who alrdy had TIA or CVA → identify underlying cause and reduce cardiovasc risk factors + interventions of antiplatelet agents, anticoagulants, carotid revascularization

How to Document General OBJECTIVE Findings

- AO x3 = alert and oriented to person, place, time - AO x 4 = alert and oriented to person, place, time, event - No apparent distress - Conversation clear and appropriate - CN II-XII grossly intact - Balanced gait - Upright posture - Negative Romberg test - Muscle Strength 5+ BUE & BLE - Peripheral sensations intact BIL - DTRs 2+ BUE & BLE

Neurological Flashcards

(37 cards)