Strokes

Question 1

What does “conjugate gaze” refer to in neurologic assessment?

Answer 1

Conjugate gaze refers to the coordinated movement of both eyes in the same direction, which is a normal finding in a neurological exam.

Question 2

Explain “disconjugate gaze” and when it might be observed.

Answer 2

Disconjugate gaze occurs when the eyes do not move in tandem in the same direction. It can be observed in cases of nerve damage or lesions in the brainstem that affect eye movement.

Question 3

What is the significance of pupil position in a neurological assessment?

Answer 3

Pupil position is significant as asymmetrical or abnormally positioned pupils can indicate increased intracranial pressure, nerve damage, or other serious neurological conditions.

Question 4

How can an abnormal conjugate gaze present during a neurological exam?

Answer 4

An abnormal conjugate gaze can present as an inability to move both eyes in one or more directions, indicating possible damage to the brainstem or cranial nerves involved in eye movement.

Question 5

What are potential causes of a disconjugate gaze?

Answer 5

Potential causes of disconjugate gaze include cranial nerve palsies, stroke, trauma, or congenital abnormalities affecting the muscles or nerves controlling eye movement.

Question 8

What does “conjugate gaze” refer to in neurologic assessment?

Answer 8

Conjugate gaze refers to the coordinated movement of both eyes in the same direction, which is a normal finding in a neurological exam.

Question 9

Explain “disconjugate gaze” and when it might be observed.

Answer 9

Disconjugate gaze occurs when the eyes do not move in tandem in the same direction. It can be observed in cases of nerve damage or lesions in the brainstem that affect eye movement.

Question 10

What is the significance of pupil position in a neurological assessment?

Answer 10

Pupil position is significant as asymmetrical or abnormally positioned pupils can indicate increased intracranial pressure, nerve damage, or other serious neurological conditions.

Question 11

How can an abnormal conjugate gaze present during a neurological exam?

Answer 11

An abnormal conjugate gaze can present as an inability to move both eyes in one or more directions, indicating possible damage to the brainstem or cranial nerves involved in eye movement.

Question 12

What are potential causes of a disconjugate gaze?

Answer 12

Potential causes of disconjugate gaze include cranial nerve palsies, stroke, trauma, or congenital abnormalities affecting the muscles or nerves controlling eye movement.

Question 13

What indicates a negative “doll’s eyes” reflex and what does it suggest about brainstem function?

Answer 13

A negative “doll’s eyes” reflex, where the eyes remain midline as the head is turned, suggests possible damage to the brainstem or impairment due to medication or other factors.

Question 14

Which cranial nerves are involved in the “doll’s eyes” reflex and what damage to them implies?

Answer 14

The cranial nerves involved are CN III (oculomotor), CN VI (abducens), and CN VIII (vestibulocochlear). Damage to these nerves can impair the reflex, indicating potential brainstem dysfunction.

Question 15

What is dysarthria and what are its common causes?

Answer 15

Dysarthria is a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system. Common causes include stroke, brain injury, tumors, and diseases that cause degenerative changes in the central nervous system.

Question 16

What is aphasia and how does it differ from dysarthria?

Answer 16

Aphasia is a disorder that affects the ability to communicate, usually due to damage to the language parts of the brain. Unlike dysarthria, which is a motor issue of articulation, aphasia involves problems with language processing and production.

Question 17

Name the types of aphasia and a defining characteristic of each.

Answer 17

Broca’s aphasia (non-fluent and struggles with speech production), Wernicke’s aphasia (fluent but nonsensical speech and poor comprehension), and global aphasia (severe impairment in all forms of language communication).

Question 18

Describe Broca’s aphasia and its primary symptoms.

Answer 18

Broca’s aphasia, often termed non-fluent aphasia, is characterized by slow, halting speech and struggle to form words. Patients often understand spoken language well but have difficulty with speech production and grammar.

Question 19

What are the key features of Wernicke’s aphasia?

Answer 19

Wernicke’s aphasia is known as fluent aphasia. Patients can produce many words and they often speak in long sentences, but the sentences can lack meaning, include unnecessary words, and have poor comprehension.

Question 20

How does global aphasia present differently from other types of aphasia?

Answer 20

Global aphasia is the most severe form, where individuals lose almost all language function, both in comprehension and production. Patients with global aphasia can produce few recognizable words and understand little or no spoken language.

Question 21

What assessments are used to diagnose dysarthria?

Answer 21

Assessments for dysarthria typically involve evaluating the clarity of speech sounds and the ability to move the mouth, tongue, and palate. Common tools include the Frenchay Dysarthria Assessment and the Dysarthria Examination Battery.

Question 22

How is aphasia typically treated?

Answer 22

Aphasia treatment usually involves speech and language therapy aimed at improving language skills and communication abilities. Techniques can include exercises in naming, repetition, and utilizing compensatory strategies for effective communication.

Question 23

What neurological tests are conducted to diagnose aphasia?

Answer 23

Neurological tests for aphasia may include brain imaging like MRI or CT scans to identify areas of brain damage, along with comprehensive language tests administered by a speech-language pathologist.

Question 24

What is Broca’s Aphasia?

Answer 24

Broca’s Aphasia is a type of non-fluent aphasia characterized by speech that is halting and effortful. Patients often have good comprehension but struggle with speech production and grammar.

Question 25

How does Broca's Aphasia affect communication?

Answer 25

Individuals with Broca's Aphasia may produce short sentences with simplified grammatical structures. They often omit small words like 'is' and 'the' but generally understand spoken language well.

Question 26

What is Wernicke's Aphasia?

Answer 26

Wernicke's Aphasia is a type of fluent aphasia where individuals can speak in long sentences with normal grammar, but the sentences may lack meaning or include unnecessary or invented words.

Question 27

How does Wernicke's Aphasia affect understanding and communication?

Answer 27

Patients with Wernicke's Aphasia typically have poor comprehension and are often unaware of their mistakes. Their speech is fluent but may be nonsensical or irrelevant to the conversation.

Question 28

What is Global Aphasia?

Answer 28

Global Aphasia is the most severe form of aphasia where individuals lose almost all language function, both in comprehension and production, typically resulting from extensive damage to the language areas of the brain.

Question 29

What are the communication capabilities of someone with Global Aphasia?

Answer 29

Individuals with Global Aphasia can produce few recognizable words and may understand little or no spoken language, significantly impairing their ability to communicate.

Question 30

What is Anomic Aphasia?

Answer 30

Anomic Aphasia is a type of aphasia where individuals have persistent difficulties in retrieving the names of everyday objects, despite having fluent speech and good comprehension.

Question 31

How does Anomic Aphasia affect daily communication?

Answer 31

People with Anomic Aphasia can speak fluently and understand speech, but often have word-finding interruptions and may use vague phrases like 'that thing' when they cannot recall the correct word.

Question 32

What is decorticate posturing?

Answer 32

Decorticate posturing is a type of abnormal body posture that involves rigidity, clenched fists, and arms held tight to the body with elbows bent. It typically indicates damage to the nerve pathway between the brain and spinal cord.

Question 33

What does decorticate posturing suggest about brain function?

Answer 33

It suggests damage to the cerebral hemispheres, particularly the cortical regions.

Question 34

What is decerebrate posturing?

Answer 34

Decerebrate posturing is an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. It usually signifies brain stem damage.

Question 35

What does decerebrate posturing indicate about the level of brain injury?

Answer 35

It indicates damage at the level of the brainstem or lesions affecting the upper brain stem.

Question 36

What is the Medical Research Council (MRC) scale for muscle strength?

Answer 36

The MRC scale is a grading system used to assess muscle strength on a scale from 0 to 5. 0 indicates no muscle contraction, and 5 indicates normal muscle strength.

Question 37

Describe grade 1 on the MRC muscle strength scale.

Answer 37

Grade 1 indicates a flicker or trace of contraction in the muscle.

Question 38

What does grade 3 signify on the MRC scale?

Answer 38

Grade 3 indicates that the muscle can contract against gravity but not against resistance.

Question 39

Explain what grade 5 on the MRC scale represents.

Answer 39

Grade 5 represents normal muscle strength, where the muscle contracts normally against full resistance.

Question 40

What does the presence of the pupillary light reflex indicate in an unconscious patient?

Answer 40

The presence of the pupillary light reflex in an unconscious patient indicates intact function of the midbrain and the third cranial nerve (oculomotor nerve), suggesting some level of brainstem function.

Question 41

What is the significance of the oculocephalic reflex in unconscious patients?

Answer 41

The oculocephalic reflex, or 'doll's eyes,' is significant in unconscious patients as its presence indicates intact brainstem function. When the head is turned, the eyes should move conjugately to the opposite direction, showing proper vestibulo-ocular reflex function.

Question 42

What does it suggest if the eyes stay midline when the head is turned in an unconscious patient?

Answer 42

If the eyes stay midline when the head is turned in an unconscious patient, it suggests an absence of the oculocephalic reflex, indicating potential damage or dysfunction in the brainstem, particularly affecting the cranial nerves and vestibular nuclei involved in eye movement.

Question 43

How does an absent oculocephalic reflex affect clinical management?

Answer 43

An absent oculocephalic reflex in an unconscious patient can be a sign of severe brainstem damage. This finding requires urgent medical evaluation to determine the underlying cause and to initiate appropriate treatments, such as managing intracranial pressure or addressing specific brain injuries.

Question 44

What is the Spetzler-Martin Grading Scale?

Answer 44

The Spetzler-Martin Grading Scale is a grading system used to predict the risk of permanent neurological deficits following surgery for arteriovenous malformations (AVMs) in the brain. It assesses AVMs based on three criteria: size, whether they are located in eloquent brain areas, and their pattern of venous drainage.

Question 45

How does the Spetzler-Martin Grading Scale predict risk in AVM surgery?

Answer 45

The Spetzler-Martin Grading Scale scores AVMs from 1 to 5, combining size (small, medium, large), location (eloquent or non-eloquent brain areas), and venous drainage (superficial or deep). A higher score indicates a higher risk of neurological deficits post-surgery, aiding clinicians in deciding the best treatment approach.

Question 46

What does 'Level of Consciousness' assess in a mental status exam?

Answer 46

Level of Consciousness in a mental status exam assesses a patient's alertness and responsiveness. It evaluates how awake and aware the patient is, ranging from fully alert to various levels of impaired consciousness such as lethargy or coma.

Question 47

What are the components of 'Orientation' in a mental status exam?

Answer 47

Orientation in a mental status exam involves assessing a patient's awareness to three spheres: person (self-awareness), place (environment), and time (temporal awareness).

Question 48

How is 'Person' orientation assessed in a mental status exam?

Answer 48

Person orientation is assessed by asking the patient to state personal details such as their name, age, or occupation.

Question 49

How is 'Place' orientation assessed in a mental status exam?

Answer 49

Place orientation is assessed by asking the patient to describe where they are, such as the type of building, the city, or the type of setting they believe they are in.

Question 50

How is 'Time' orientation assessed in a mental status exam?

Answer 50

Time orientation is assessed by asking the patient to state the current date, day of the week, month, or year.