SA Neuro Exam Flashcards
(44 cards)
Does the size of the lesion correlate well with severity of dz in neuro?
no, speed of onset more telling of severity
- eg. slow growing tumour, brain can compensate for a long time
When localizing the lesion, what different options do we have?
> Brain - Forebrain - Brainstem - Cerebellum > Spinal cord - C1-C5 - C6-T2 - T3-L3 - L4-Cd > Neuromuscular
What are the 2 main aims of the neuro exam?
- Is the patient neurologically normal or abnormal?
2. Localisation
What should be done before the neuro exam? Which parts hould be left until the end?
- full PE and musculoskeletal exam
- leave noxious parts to the end
What are the 8 parts of the neuro exam?
- Mentation
- Posture
- Gait
- Postural Reactions
- Spinal Reflexes
- Cranial Nerves
- Palpation
- Nociception
How is mentation described?
> Level - alert - obtunded - stupor - coma (unresponsive to pain) > quality - appropriate - innapropriate (compulsion, dementia/delerium)
What can be looked at to judge posture?
- Hed position
- tilt (vestibular disease)
- turn (forebrain disease) - Limb position
- wide base (proprioceptive loss)
- narrow base (weakness)
- v weight bearing (pain) - Body
- Decerebrate (both pairs of limbs spastic extension, neck dorsally stretched out, not fully concious)
- Decerebellate (forelimbs extended, hid limbs flexed, neck slightly up, concious)
- Shiff-Sherrington (spinal cord lesion, concious, forelimbs normal but stiff, voluntary control still present and withdrawal, hindlimbs paralysed and no withdrawal reflex)
What can be assessed when looking at gait?
> Normal or abnormal? > Limbs affected? - paresis - ataxia - lameness - combination
What is paresis? What are the 2 forms? What should also be assesed when looking at potential paresis?
> decreased voluntary movement
- UMN or LMN (NOT based on severity)
- Also assess postural reactions, spinal reflexes and muscle tone
How can UMN paresis be identified?
- UMN = ^ muscle tone and spinal reflexes caudal to the lesion
- stride length normal/increased
- spasticity
How can LMN paresis be identified?
- LMN = v muscle tone and decrease/loss of spinal reflexes in limbs with a reflex arc containing the lesion
- stride length normal/decreased, stiff, bunny hopping, +- collapse
+- ataxia (sensory) knuckling and slappy gait
Signs of sesnroy/proprioceptive/spinal ataxia
- wide based stance
- ^ stride length
- swaying/floating gait
- knuckling
Signs of cerebellar ataxia
- disorder of rate and range of movement
- hypermetria
- intention tremor
- postural tremor
Signs of vestibular taxia
> unilateral - falling/leaning/circling - head tilt > bilateral - wide excursions of the head \+- tilt - crouched posture > strabismus and nystagmus
What do postural reactions require to be intact?
- proprioceptive AND motor systems
- similar pathways to gait
- senstivie but non-specific
- interpret with gait, spinal reflexes and muscle tone
How do sensory tracts relate to the brain?
- ipsilateral sensory tract to midbrain, then crosses to forebrain of contralateral side
- eg. absent paw positioning reflex on L = R forebrain lesion
Give examples of postural reactions
- hopping
- wheelbarrow
- hemiwalking
- placing (tactile/visual)
- extensor postural thrust
What nerve does biceps tendon spinal reflex test?
Musculocutaneous n. C6-8
What nerve does triceps tendon spinal reflex test?
Radial n. C7-T2
What nerve does patellar tendon spinal reflex test?
Femoral n. L4-6
What nerve does gastroc tendon spinal reflex test?
Sciatic n. L6-S2
What nerve does thoracic limb withdrawal reflex test?
Multiple nn C6-T2
What nerve does pelvic limb withdrawal reflex test?
Sciatic n. L6-S2
What nerve does perineal reflex test? What should happen with this test?
Pudendal n. S1-3
- bilateral response to a unilateral stimulus
