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Flashcards in Neurological exam - SA Deck (57):
1

Can you have the same disease of a different localisation?

Yes

2

Does lesion size = CS severity?

No

3

Does CS severity = prognosis?

No

4

Does location (anatomy) = function?

Yes

5

What is using the loss of function to work out the location?

Neurolocalisation

6

How is the spinal cord divided?

- C1-C5
- C6-T2
- T3 - L3
- L4 - Cd

7

Where might a neurological lesion be located?

- BRAIN (forebrain, brainstem, cerebellum)
- SC
- Neuromuscular

8

2 aims of neuro exam

- neurologically normal or abnormal?
- localisation of lesion

9

Tools for neuro exam

- room
- chair
- yoga mat
- reflex hammer
- haemostats
- Q tips (corneal reflex)
- cotton balls
- penlight
- lens

10

State the 8 parts of the neuro exam

1. mentation
2. posture
3. gait
4. postural reactions
5. spinal reflexes
6. cranial nerves
7. palpation
8. nociception

11

Define mentation

- LEVEL of consciousness: alert, obtunded, stupor / semicoma, coma
- QUALITY of consciousness: appropriate, inappropriate (compulsion, dementia/ delerium)

12

What is assessed with posture?

- head
- limbs
- body

13

Outline head posture

- Tilt (roll) suggests vestibular disease
- Turn (yaw) suggests forebrain disease

14

Outline limb posture

- wide based stance - proprioceptive loss
- narrow based stance - weakness?
- decreased weight bearing - evidence of pain?

15

What are the 3 different body postures?

- decerebrate
- decerebellate
- Schiff-Scherrington

16

Control of gait = ?

requires integration of proprioceptive and motor systems

17

What is determined in gait analysis?

- normal or abnormal
- which limbs?
- paresis, ataxia, lame, combination?

18

Define paresis

- decreased voluntary movement
- can be UMN or LMN
- differentiation cannot be based on severity alone
- also assess postural reactions, spinal reflexes, mm tone

19

Features - UMN paresis

- MUSCLE TONE is normal to increased in limbs caudal to the lesions
- SPINAL REFLEXES are normal to increased in limbs caudal to the lesion
- STRIDE: length is normal to increased, spastic
+/- ATAXIA (sensory) - swaying/ floating gait, knuckling

20

Features - LMN paresis

- MUSCLE TONE is decreased in limbs with a reflex arc containing a lesion
- SPINAL REFLEXES are decreased to absent in limbs with a reflex containing the lesion
- STRIDE: length is normal to decreased, stiff, 'bunny hopping', +/- collapse
+/- ATAXIA (sensory) knuckling

21

3 types of ataxia

1. sensory (proprioceptive)
2. cerebellar
3. vestibular

22

Describe sensory ataxia

= loss of sense of limb/ body position
- wide based stance
- increased stride length
- swaying/ floating gait
- knuckling

23

Describe cerebellar ataxia

= disorder of rate and range of movement
- hypermetria
- intention tremor
- postural tremor
- jerky movements
- (high step thoracic gait)

24

Describe vestibular ataxia

- UNILATERAL: falling/ leaning/ circling to one side, head tilt
- BILATERAL: wide excursions of the head, +/- head tilt, crouched posture
- strabismus nystagmus commonly

25

Outline the purpose of assessing postural reactions

= requires integration of proprioceptive and motor systems
- similar pathways to gait
- pathways are long ('sensitive/ non-specific', interpret with gait, spinal reflexes, mm tone)

26

List some possible postural reactions to teat

- paw positioning
- hopping
- wheelbarrowing
- hemiwalking (tactile, visual)
- extensor postural thrust
* always look for symmetry*

27

What does the biceps tendon reflex test?

Tendon reflex - musculocutaneous nn - C6-8

28

What does the triceps tendon reflex test?

Tendon reflex - radial nn - C7-T2

29

What does the patellar tendon reflex test?

Tendon reflex - Femoral nn - L4-6

30

What does the gastrocnemius tendon reflex test?

Tendon reflex - sciatic nn - L6-S2

31

Name 2 flexor (withdrawal) spinal reflexes

- thoracic limb
- pelvic limb

32

What does the thoracic limb withdrawal reflex test?

multiple nn - C6-T2

33

What does the pelvic limb withdrawal reflex test?

Sciatic nn - L6 - S2

34

What does the perineal spinal reflex test?

Pudendal nn (S1-3) - there should be a bilateral response to a unilateral stimulus

35

How do you do the cutaneous truni mm spinal reflex test?

pinch skin in lumbar region with haemostats (not cats!)

36

Interpretation - decreased/ absent spinal reflex

- lesion within reflex arc
- physical limitation of movement (joint fibrosis, mm contracture)
- excitement/ fear
- 'spinal shock'

37

Interpretation - exaggerated spinal reflex

- lesion to UMN pathways cranial to the spinal cord segment tested (since UMN attenuates tone in reflex arc)
- excitement/ fear (increased SNS tone)
- 'psuedohyperreflexia' due to loss of antagonism form mm on other side of limb

38

List the cranial nn

1 olfactory
2 optic
3 occulomotor
4 trochlear
5 trigeminal
6 abducent
7 facial
8 vestibulocochlear
9 glossopharyngeal
10 vagus
11 accessory
12 hypoglossal

39

Which CN is tested in a vision test?

CN2 --> forebrain

40

Which CN is tested in a menace response?

CN2 --> forebrain --> cerebellum --> brainstem --> CN 7

41

Which CN is tested in a PLR?

CN 2 --> brainstem --> CN 3
(both direct and indirect)

42

Features of Horner's syndrome

= sympathetic denervation of the orbit
- miosis
- ptosis
- enopthalmos

43

Which CNs give motor to the extraocular mm? 3

3 occulomotor
4 trochlear
6 abducent

44

What controls strabismus (eye position)?

CN 8 --> central vestibular/ brainstem --> CN 3, 4, 6 (i.e. same as nystagmus)

45

What controls nystagmus (eye movement)?

CN 8 --> central vestibular / brainstem --> CN 3, 4, 6 (i.e. same as strabismus)

46

What causes palpebral reflex?

CN 5 --> brainstem --> CN 7

47

What causes corneal relfex?

CN 5 --> brainstem --> CN 6 (globe reaction, any blinking is controlled by CN 7)

48

Function - trigeminal - CN 5

- motor to mm of mastication so signs of dysfunction include atrophy and inability to close jaw

49

Function - facial - CN 7

- motor to mm of facial expression
- signs of dysfunction: facial paresis/ paralysis, facial asymmetry
- palpebral reflex: 5 > brainstem > 7
- menace response: 2 > forebrain > cerebellum > brainstem > 7
- autonomic innervation of lacrimal glands (test with STT-1)

50

Function - vestibulocochlear nn (CN 8)

COCHLEAR: auditory
VESTIBULAR: signs of dysfunction: ataxia (vestibular), head tilt, strabismus, nystagmus (abnormal)


PHYSIOLOGIC NYSTAGMUS: 8 > brainstem > 3, 4 and 6

51

Describe the types of nystagmus

- PHYSIOLOGIC: normal, decreased/ absent
- SPONTANEOUS / PATHOLOGIC
- DIRECTION: horizontal, rotary, vertical, fast-phase
- CONJUGATE/ DYSCONJUGATE
- POSITIONAL: inducible

52

Function - vagus nn - CN10

- sensory and motor to pharynx
- gag reflex: CN9 and 10 --> brainstem --> CN 9 adn 10

53

Function - hypoglossal nn - CN 12

- motor to tongue
- signs of dysfunction: paresis/ paralysis of tongue, atrophy/ asymmetry of tongue, seen as deviation of tongue

54

What are the types of palpation?

- LIGHT: swelling, atrophy
- DEEP: pain
- LOCATION: head, spine, limbs
- determine if focal or diffuse

55

Define nociception

= conscious perception of pain
- receptors --> brain
- SUPERFICIAL: skin
- DEEP: bone (periosteum)
- test cutaneous autonomous zones as necessary

56

T/F: limb withdrawal does not equal pain perception

Ture

57

Name 3 different types of lesion to then use to work out ddx

- focal
- multifocal
- diffuse