Neurological Examination Flashcards
(50 cards)
1
Q
Components of neuro exam
A
- patient history
- cranial nerve function
- motor function (e.g. reflexes)
- somatosensory function
- coordination
- mental status
2
Q
Patient history
A
- age
- education (higher is predictor of reducing cognitive decline later in life)
- handedness: brain is somewhat lateralized (i.e. language is L Hem dominant, left half of brain controls r side of body. for left handed people, 75% are L hem dominant for language, the remaining 25% can be variety of things (bilateral dominance, R hem dominant). R handers = very common L hem
- past medical history
- family medical history
- use of medication/ rec. drugs
- disease profile (sudden/gradual, change over time, triggers/relievers of symptoms, severity)
3
Q
Cranial nerve I
A
Olfactory, Sensory
- smell
- ppl w/ problem often don’t notice
- common to damage, only takes 1 hit to head
- ethmoid ridge (cribiform plate, hole in bone) axons go through
- hit to head = shear axon
4
Q
Cranial nerve II
A
Optic, sensory
- vision
- common problem: neoplasm/growth on or beside optic nerve that puts pressure on it and causes vision issues
5
Q
Cranial nerve III
A
Oculomotor, motor
- most eye movement, eyelid movement
6
Q
Cranial nerve IV
A
Trochlear, motor
- eye movement
- smallest cranial nerve
7
Q
Cranial nerve V
A
- trigmenial, both
- facial somatosensation, movement of biting/chewing/swallowing/jaw muscles
- 3 branches, receive info from different parts of face
8
Q
Cranial nerve VI
A
- abducens, motor
- eye movement
9
Q
Cranial nerve VII
A
- facial, both
- taste from anterior tongue, a little facial sensation, all muscles of facial expression
10
Q
Cranial nerve VIII
A
- vestibulocochlear, sensory
- sound, sense of balance
11
Q
Cranial nerve IX
A
- glossopharyngeal, both
- taste and sensation from posterior tongue muscles of pharynx (speech, swallowing)
12
Q
Cranial nerve X
A
- vagus, both
- outer ear canal sensation, motor control of heart, lungs, viscera, larynx (speech), more
13
Q
Cranial nerve XI
A
- accessory, motor
- movement of muscles of head rotation and shoulder shrug
14
Q
Cranial nerve XII
A
- hypoglossal, motor
- movement of tongue muscles (speech, swallowing)
15
Q
how to assess damage to CNI
A
- block one nostril, have patient smell something with eyes closed
16
Q
anosmia
A
loss of smell
- often shows up bc of loss of flavour when eating
17
Q
how to assess CNII
A
- standard visual acuity test for each eye (Snellen chart)
- visual field confrontation
fundoscopy: dim lights so pupils get big (better view of retina), have them look at something far away. assess reflexes. asses fundus (shape of disk) - intracranial pressure and papillledema (swollen optic nerve)
18
Q
Muscles that control movement of eye
A
6
- 4 controlled by oculomotor
- 1 controlled by trochlear
- 1 controlled by abducens
19
Q
how to assess CN VI
A
(abducens)
- follow an object/light without moving their head
- check for gaze restrictions
20
Q
Ptosis
A
one eyelid is droopy, somewhat covers pupil
- indicates issue with oculomotor nerve
21
Q
Gaze Palsy
A
trouble moving eyes in certain way
- could be issue with CN III, IV, VI
22
Q
Nstagmus
A
eyes dart involuntary
- could be issue with CN III, IV, VI
23
Q
how to asses CN V
A
(trigeminal)
- somatosensory: use cotton and pinprint
- motor function: client does a motor function, feel for muscle definition (when muscle don’t receive steady info from nerves they atrophy)
- test reflex (cornea, jaw)
24
Q
how to asses CN VII
A
(facial) - look for assymetries - look for muscle tone (resistance to force) common issue: Bell's Palsy - loss of muscle tone - paralysis 1/2 face - unilateral - viral - spontaneously resolves
25
How to assess CN VIII
(vestibulocochlear)
- close one ear, whisper in other ear, ask patient to recite what was said)
- check for balance issues
26
how to assess CNX
can't test a lot of it
| - can test tongue, larynx/pharynx
27
how to assess CN XI
- head resistance
| - shrug shoulder resistance
28
how to assess CN XII
- stick out tongue, lateral movement
| - assess strength of tongue against cheek
29
key features to examine in motor function test
- gross appearance of muscle
| - muscle tone, strength (resistance)
30
upper vs motor lesions
upper: often have more spasticity, overreact to reflexes
lower: weaker reflex
both: difficulty controlling muscle
31
testing somatosensory function
- pain
- light tough and proprioception
- testing for astereognosis (inability to identify object from touch)
- testing for agraphesthesia (inability to tell what was written on skin (letter/number))
32
proprioception
the sense though which we perceive the position and movement of our body, including our sense of equilibrium and balance,
33
Assessing coordination
- quick, alternating movements,
- point- to - point movement
- heel- to- shin test (patient lying down, instruct him to place their right heel on their left shin just below the knee and then slide it down their shin to the top of their foot. Have them repeat this motion as quickly as possible without making mistakes)
- standing/sitting
- gait
- romberg test
34
romberg test
patient stand still with their heels together. Ask the patient to remain still and close their eyes. If the patient loses their balance, the test is positive. Hands out in front of them
To achieve balance, a person requires 2 out of the following 3 inputs to the cortex: 1. visual confirmation of position, 2. non-visual confirmation of position (including proprioceptive and vestibular input), and 3. a normally functioning cerebellum. Therefore, if a patient loses their balance after standing still with their eyes closed, and is able to maintain balance with their eyes open, then there is likely to be lesion in the cerebellum. This is a positive Romberg.
35
Mental Status Exam (MSE)
- attention/orientation (observe alertness. spell/count backwards. regions involved = focal cortical/subcortical, or diffuse (toxin)
- language (fluency, naming, repetition, prosody (rhythm), comprehension, reading, writing, praxis (ability to follow verbal command))
- memory (digit span, pointing span, object learning, past events, factual knowledge. regions = medial temporal structures)
- visuospatial function (line cancellation, copy geometric designs, judgement of line orientation, object/face/colour recognition)
- executive functions (judgement, verbal fluency, luria 3-step, drawing loops, oral trail making test) damage = PFC
36
contralateral neglect
failure to attend to L side of world
| - occurs from damage to R parietal lobe (stroke)
37
agnosia
- failure to self-reflect disorder
| - semi-common in contralateral neglect
38
apraxia
inability to follow verbal command to do a motor function
39
aphasia
problem with language production/comprehension
focal or diffuse damage to L hem language network
40
alexia
problem reading
focal or diffuse damage to L hem language network
41
agraphia
problem writing
focal or diffuse damage to L hem language network
42
digit span
MSE memory test
| - series of # to repeat, normal operating range = 7 +/- 2
43
Prosopagnosia
failure to recognize faces
problem with: R hem attention network
44
constructional apraxia
difficulty putting pieces of object together
problem with: R hem attention network
45
dressing apraxia
difficulty getting dressed
problem with: R hem attention network
46
luria 3-step
fist edge palm]
test of perseverative behaviour
47
oral trail making test
recite 1-26, then a-z, then 1a, 2b .....
- test of perseverative behaviour
48
perseverative behaviour
Perseveration is repetitive and continuous behaviour, speech or thought which is often due to frontal lobe injury to the brain.
49
verbal fluency
how many words can you think of that start with f? name 15 cities
50
drawing loops, alternating patterns
test of perseverative behaviour
| MSE executive function
