Osteopathic considerations in the neuro patient

Question 1

Components of the Nervous System

Answer 1

• CNS: Brain and Spinal cord
• PNS: Motor and sensory
• ANS: Sympathetic and Parasympathetic
• Enteric: Small and Large intestine

Question 2

The Prosencephalon becomes?

Answer 2

1. Telencephalon –> cerebral hemispheres, Hippocampal formation , BG
2. Diencephalon –> Thalamus/Hypothalamus/Subthalamus

Question 3

The Mesencephalon becomes?

Answer 3

Midbrain

Question 4

The Rhombencephalon becomes?

Answer 4

1. Metencephalon –> Cerebellum, pons

2. Myelencephalon –> Medulla

Question 5

Lateral Ventricle

Answer 5

• Bilateral

- connect to 3rd by Foramen of Monro

Question 6

Third Ventricle

Answer 6

• Intrathalamic adhesion

- Connect to 4th by Aqueduct of Sylvius

Question 7

Fourth Ventricle

Answer 7

• Midline Foramen of Magendie - Bilateral Foramen of Luschka

Question 8

Components of a Neuro Exam? 7

Answer 8

• Mental Status
• Cranial Nerves
• Motor
• Sensory Reflexes
• Cerebellar Function
• Special Tests

Question 9

Mental Status Exam Psych aspects? 11

Answer 9

• Appearance,
• Behavior,
• Attitude,
• Mood,
• Affect,
• Speech,
• Thought/thought process
• Content,
• Perception,
• Judgment,
• Insight

Question 10

Mental status Exam Neurological aspects? 6

Answer 10

• Attention & Concentration
• Language
• Memory (Short & Long Term)
• Calculation
• Abstraction
• Praxis

Question 11

Mini Mental State Examination

Answer 11

• screens for dementia

-

Question 12

Anatomy:

Olfactory Nerve?

Answer 12

Cribiform plate (ethmoid bone)

Question 13

Anatomy:

Optic Nerve?

Answer 13

Optic Canal (sphenoid)

Question 14

Anatomy:

What passes through the superior orbital fissure? What bone is it found in?

Answer 14

• CN III, IV, VI, and Ophthalmic division of V

- sphenoid

Question 15

What passes through the foramen rotundum?

Answer 15

Maxillary division of CN V

Question 16

What passes through foramen ovale?

Answer 16

Mandibular Division of CN V

Question 17

What passes through the internal auditory meatus? What bone is this found in?

Answer 17

• CN VII, VIII

- Temporal

Question 18

What passes through the Jugular Foramen?

Answer 18

CN IX, X, XI

Question 19

What passes through the Hypoglossal Canal? Course of canal and what does this nerve meet up wit?

Answer 19

• CN XII
• in the occipital bone: the canal goes around the foramen magnum, through the occipital condyles allowing CN XII to meet up with C1 nerve

Question 20

Motor Components of the nervous system

Answer 20

• Anterior to Central Sulcus, Precentral Gyrus (Motor Cortex)
• Anterior spinal cord (Corticospinal Tract)

Question 21

General Assessment of Motor Component

Answer 21

• Assess muscle tone
• Assess strength (5/5)
• Observe for Fasciculations, Dystonias, Chorea, Ballismus

Question 22

Where does the corticospinal tract originate and decussate?

Answer 22

Origin: Motor cortex

Dec: Medulla

Question 23

What are the 3 components of the sensory portion and what to they include?

Answer 23

1. Exteroceptive: External environment
2. Interoceptive: Blood Pressure, Chemical gradients
3. Proprioceptive: Orientation, position in space of the body

Question 24

Primary Modalities of the Sensory System? What information do they carry? Where do they decussate?
Where do they converge?

Answer 24

1. Posterior Columns: Light Touch, Proprioception and Vibration; Dec: medulla
2. Spinothalamic Tracts (Ant & Lat): Pain (Itch/Tickle) and Temperature: Dec: the spinal cord level
3. Both converge on Ventral Posterior Thalamus

Question 25

What are the Secondary/Cortical Modalities of the Sensory System? What do they require?

Answer 25

- 2 Point Discrimination - Stereognosis - Graphesthesia - Tactile Localization - Requires Parietal Cortex

Question 26

Reflexes of the Nervous System

Answer 26

- UE - LE - Primitive: rooting, glabellar, grasp

Question 27

Testing Cerebellar Function?

Answer 27

- gait - Rapidly alternating movements - finger to nose - heel to shin

Question 28

What is Disdiadokokinesis?

Answer 28

Inability to perform rapid alternating movements

Question 29

What is dysmetria?

Answer 29

inability to perform coordinated movements (failed finger to nose or heel to shin)

Question 30

Special tests? what do the test for?

Answer 30

1. Babinski (plantar) - upper motor neuron impairment 2. Hoffman's Test (UE equivalent for Babinski) - tapping the nail on the third or forth finger. A positive Hoffman's is the involuntary flexing of the end of the thumb and index finger 3. Hoover's (Malingering)

Question 31

Concept of Somatic Dysfunction in Neurology

Answer 31

1. Based on Segmental Facilitation 2. - Motor neuron pools in spinal cord segments related to areas of somatic dysfunction were maintained in a state of facilitation. - Chronically hyperresponsive to impulses from any source in the body (proprioceptive/nociceptive) - Maintain hypertonic muscles innervated by these segments 3. Spinal cord is an organizer and active participant in the disease process

Question 32

Axoplasmic Flow: Direction? Impaired by?

Answer 32

- Bidirectional: Anterograde/Retrograde - Impaired by: 1. Primary Disease of the Neuron 2. Mechanical deformation of nerve (entrapment, stretch)

Question 33

How does Somatic Dysfunction in Neurology effect the Patients response to OMT?

Answer 33

Neuroendocrine mechanisms Affect/Emotions MSK

Question 34

Sustained Patterns of excitability results in? | Increased Afferent result in?

Answer 34

1. Learned Behavior | 2. Somatic/Sympathetic Efferent of Facilitated segment