Week 11- Neuro Flashcards by Nicole Herberger

4 regions of brain:

Cerebrum, diencephalon, brainstem, cerebellum

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Aggregation of neuronal cell bodies:

Gray matter

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Neuronal axons that are coated with myelin:

White matter

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These allow nerve impulses to travel more quickly:

Myelin sheaths

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Sections of spine:

Cervical c1-c8
Thoracic t1-t12
Sacral s1-s5
Coccygeal

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The brain and the spinal cord:

CNS

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Cranial nerves and the peripheral nerves:

PNS

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The corticospinal tract, the basal ganglia system, the cerebellar system:

Motor pathways

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Reflexes, conscious sensation, body position, regulate autonomic functions:

Sensory pathways

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Muscle stretch reflexes (deep tendon reflexes):

Reflexes

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Common or concerning neuro symptoms:

HA, dizziness

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Primary HA:

Migraine, cluster, and trigemjnal autonomic cpehalgias

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Red flags for HAs:

Sudden/thunderclap
New onset after 50
Fever/stiff neck
Worst HA of my life- subarachnoid hemorrhage
Dull HA increased by coughing
Recurring in the same position- Tumor/abscess
Migraine (pound)

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Pins and needles:

Paresthesias

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Distorted sensations:

Dysesthesias

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A rhythmic oscillatory movement of a body part resulting from contraction of opposing muscle groups:

Tremors

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An infarction of CNS tissue

Cerebrovascular ischemia

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Transient episode of neuro dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction:

TIA

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ABDC2 for stroke:

Age greater/equal to 60
BP greater than/equal to 140/90
Clinical features of focal weakness, impaired speech without focal weakness
Duration 10-59 minutes of greater/equal to 60 minutes
Diabetes

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This causes visual field cuts and contra lateral hemiparesis and sensory deficits:

Occlusion of the middle cerebral artery

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This causes aphasia:

Occlusion of the left middle cerebral artery

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This cause neglect or inattention to the opposite side of the body:

Occlusion of the right middle cerebral artery

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Warning signs of stroke:

Face drooping
Arm weakness
Speech difficulty
Time to call

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Modifiable risk factors for stroke:

HTN 
Smoking 
Dyslipidemia
Diabetes 
Weight, diet, nutrition 
Physical activity
Alcohol use

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Disease specific risk factors for stroke:

Afib CAD OSA

Most common, slowly progressive, often asymptomatic, risk factor for ulcerations, arthropathy, and amputation:

Distal symmetric polyneuropathy

Unilateral thigh pain and proximal lower extremity weakness:

Autonomic dysfunction, mononeuropathies, and polyradiculopathies

Diabetic foot exam should include:

Pin prick sensation Ankle reflexes Vibration perception Plantar light touch sensation (semmes-weinstein monofilament)

This often causes burning electrical pain in the lower extremities, often at night:

Distal symmetric polyneuropathy

Reactivation of latent varicella within the sensory ganglia that causes painful, unilateral vesicular rashes in dermatomal distribution:

Herpes zoster

Multifactoral syndrome, acute confusional state marked by sudden onset, fluctuating course, inattention and at time, changing level of consciousness:

Delirium

Declines in memory and cognitive ability that interfere with ADLs

Dementia

This is more common in individuals with medical conditions:

Depression

Components of a neuro exam:

``` Mental status Cranial nerves Motor system Sensory system Deep tendon, abdominal and plantar reflexes ```

CN1 (olfactory) function is ___ and to test ___.

Sense of smell | Present with a non-irritating odor

Loss of smell may come with:

Head trauma, smoking, aging, cocaine use, Parkinson’s

CN II is the:

Optic nerve

CN II (optic) function is ___ and is tested by ____.

Vision | Visual acuity, visual fields by confrontation, pupillary light reaction, near response

CN III is the :

Oculomotor nerve

CN III (oculomotor) function is___ and is tested by ____.

Pupillary constriction, opening the eye (lid elevation) and most EOMs Pupillary light reaction, near response (constriction and accommodation), EOMs, convergence

Abnormal pupillary constriction

Anisocoria- CN III palsy

Ptosis plus opthomoplegia:

``` Intracranial aneurysm (awake) Transtentorial herniation (comatose) ```

If anisocoria worsens in the darkness, the small pupil has abnormal dilation and can be related to:

Horner syndrome or simple anisocoria

CN IV is called:

Trochlear

CN IV (trochlear) function:

Downward, internal rotation of the eye

CN IV (trochlear) test:

EOMs, convergence

Binocular diplopia in CN IV neuropathy caused by:

MG, trauma, thyroid opthalmopathy

CN V is called:

Trigeminal

CN V ( trigeminal) function:

Motor-temporal and masseter muscles (jaw clenching, lateral pterygoids) Sensory- facial (ophthalmic, maxillary, mandibular

CN V (trigeminal) test:

Motor- clench teeth,open jaw, move side to side Sensory- pain on forehead, cheeks, and chin Corneal reflex- touch cornea with cotton

Unilateral jaw weakness caused:

Pontine lesions

Bilateral jaw weakness caused by:

Bilateral hermispheric diagnosis

Ipsilateral facial and body sensory loss from contra lateral cortical or thatlmic lesions caused by:

Stroke

Blinking absent on both sides with:

CN V lesions

CN VI is called:

Abducens

Abducens function:

Lateral deviation of the eye

CN VI (abducens) test:

Six cardinal fields of gaze, convergence

Nystagmus May be associated with:

Cerebellar diagnosis

CN VII is called:

Facial

CN VII (facial) function:

Motor- facial movements (expression, closing the eye, closing the mouth) Sensory- taste for salty, sweet, sour, and bitter; sensation from the ear

Blinking absent one the side of weakness in:

Lesions of CN VII

CN VII (facial) test:

Raise eyebrows, frown, close both eyes tightly, try to open them, show both upper and lower teeth, smile, puff out both cheeks

Flattening of the nasolabial fold and drooping of the lower eyelid suggest:

Facial weakness

CN VIII is called:

Acoustic

CN VIII (acoustic) function:

Hearing (cochlear division) and balance (vestibular division)

CN VIII (acoustic) test:

Whispered voice test, Rinne, Weber

Vertigo with hearing loss and nystagmus:

Meniere disease

CN IX is called:

Glossopharyngeal

CN IX (glossopharyngeal) function:

Motor- pharynx | Sensory- posterior portions of the eardrum, the pharynx, and the posterior tongue

CN IX (glossopharyngeal) test:

Difficulty swallowing, movement of the soft palate and the pharynx (symmetric), uvula midline

Hoarseness caused by:

Vocal cord paralysis

Dysphagia caused by

pharyngeal or palatal weakness

CN X is called:

Vague

CN X (vagus) function:

Motor- palate, pharynx, and larynx | Sensory- pharynx and larynx

CN X (vagus) test:

Difficulty swallowing, movement of the soft palate and the pharynx (symmetric), uvula midline

CN XI is called:

Spinal accessory

CN XI (spinal accessory) function:

Motor- SCM and upper portion of the trapezius | I’m

CN XI (spinal accessory) test:

Look for atrophy or fasciculations, shrug against resistance, turn head to each side against hand, observe for contraction of the opposite SCM and note the force of the movement against your hand

CN XII is called:

Hypoglossal

CN XII (hypoglossal) function:

Motor- tongue

CN XII (hypoglossal) test:

Tongue protrude midline, move tongue side to side and note symmetry

Proprioception is:

Body position

Ability to identify an object by feeling it:

Stereogenosis

Number identification when a number is drawn on patients palm:

Graphesthesia

Two-point discrimination is:

Two ends of opened paper clip, or two pins, touch a finger pad simultaneously; find the minimal distance at which a person can discriminate the two points: normal is <5mm on the finer pad

+4 grade for reflexes is:

Very brisk, hyperactive with clonus

If reflexes are hyperactive, follow up with:

Ankle clonus test

Ankle clonus test:

Support the knee partially flexed Dorsiflex and plantarflex the foot while encouraging patient to relax Look for rhythmic oscillations-CNS disease

Oculocephalic reflex is the:

Doll’s eye movements- hold eyes open, turn head quickly from side to side- eyes should move to opposite side that head is turned

Ice water into the ear canal; intact brainstem, eyes will deviate toward ear being tested:

Oculovestibular relfex