Blumenfeld Neurologic Exam

Front 1

MS exam memory: what is being tested

Back 1

immed recall deficit = impaired attn. delayed recall deficit= impaired MTL or dienceph or frontal/subcort dysfx

Front 2

Gerstmann's syndrome

Back 2

impaired calc, L/R confusion, finger agnosia, agraphia. lesion in dominant PL
addition, sub, identify l/r body parts, name and identify each digit, write name and a sentence

Front 3

apraxia definition

Back 3

inability to follow a motor command not due to a primary motor or language deficit. caused by higher order planning and conceptualization of mtor task (pretend to comb your hair, strike a match and blow it out)

Front 4

ideomotor apraxia

Back 4

perform awkard movements that minimally resemble task, despite otherwise normal motor exam. damage to dom PL or premotor cortex (wave goodbye, use a screwdriver). can be only face/mouth

Front 5

test of somatosensory neglect

Back 5

extinction on double simultaneous stimulation

Front 6

test of CNII

Back 6

opthalmoscope to look at vessels, retina, optic nerve, papilledema. visual acuity with eye chart and color vision test, visual fields and blink-to-threat in comatose pts

Front 7

test of CNI

Back 7

smell samples of soap, coffee, etc.

Front 8

test of pupillary response (which CNs?)

Back 8

CNII and III. direct response - shine light in eye. consensual response- constriction of opposite pupil

Front 9

afferent pupillary defect

Back 9

decreased direct response caused by decreased visual fx in 1 eye (CNII) but spared pupillary constriction (CNIII) when elicited thru consensual response. use swinging flashlight test, affected eye will dilate rather than constrict

Front 10

pupil accommodation

Back 10

moving object close and far away from eye. pupils constrict when object moved towards it.

Front 11

CN for extraoccular movements (eye movements)

Back 11

CN III, IV, VI (oculomotor, trochlear, abducens)

Front 12

saccades test

Back 12

rapidly refixating on different objects, such as fingers from each hand held apart

Front 13

optokinetic nystagmus (OKN)

Back 13

moving a strip with parallel stripes in front of pt. look for rhythmic nystagum with slow mnmts towards stripes and rapid movements back to midline

Front 14

vestibulo-ocular reflex

Back 14

oculocephalic reflex, a form of the vestibulo-ocular reflex, is tested by holding the eyes open and rotating the head from side to side or up and down. The reflex is present if the eyes move in the opposite direction of the head movements, and it is therefore sometimes called doll's eyes. the absence of doll's eyes suggests brainstem dysfunction in the comatose patient but can be normal in the awake patient

Front 15

test for CN V

Back 15

Trigeminal nerve- tactile extinction, corneal reflex, jaw jerk reflex

Front 16

test for CN VII

Back 16

facial nerve- look for asymmetry in face, expressions, blinking.facial weakness can be from contralateral motor cortex lesions, LMN in CN VII, neuromusc junction, or face muscles

Front 17

test of CN VIII

Back 17

vestibulocochlear- hearing w/ tuning fork, extinction, vertigo, limitations w/ horizontal or vertical gaze, oculocephalic maneuver

Front 18

CN for articulation (many)

Back 18

CN V, VII, IX, X, XII. can cause dysarthria, quiet, breathy, nasal, low, high pitched or other abnormalities. speech prod defs can also be cerebellar, motor cortex, BG or descending BS pathways.

Front 19

test of CN XI

Back 19

trapezius, sternocleidomastoid muscles - shrug shoulders, turn head fex head forward from supine

Front 20

test of CN XII

Back 20

tongue movements

Front 21

signs of upper motor neuron disease (project via corticospinal tract )

Back 21

weakness, hyperreflexia (increased reflexes) and increased tone. acute UMN lesions often have flaccid paralysis with decreased tone and decreased reflexes

Front 22

signs of lower MN lesions

Back 22

weakness, atrophy, fasciculations (spontaneous quivering movements), hyporeflexia

Front 23

muscle strength tests

Back 23

5/5 scale 0- no contraction, 1/5 - muscle flicker, no movement, 2/5-movement possible, not against gravity, 3/5- mvmt against gravity but not against examiner 4/5- mvmt possible against some resistance 5/5 normal movement

Front 24

deep tendon reflexes

Back 24

use hammer on limb that is relaxed and symmetrical. clonus- in brisk relfexes it is a repetitive vibratory contraction in response to muscle and tendon stretch. rated from 0-5, 1-3 is normal

Front 25

plantar response

Back 25

scraping sole of foot from heel to small toe to big toe. normal response is downward contraction of toes. abnormal response- babinski sign is upgoing big toe and fanning of other toes."silent" toes are abnormal. UMN lesion anywhere in corticospinal tract

Front 26

spinal cord damage reflexes

Back 26

abdomina, cutaneous reflex, cremasteric reflex, bulbocavernous reflex (rectal sphincter), anal wink

Front 27

frontal release signs

Back 27

snout, grasp, root suck . glabellar response- continuous blinking to forehead tapping

Front 28

ataxia

Back 28

medium to large amplitude involuntary movements w/ an irregular oscillatory quality superimposed and interfering w/ normal smooth trajectory of mvmt

Front 29

ataxia (cont)

Back 29

overshoot- past-pointing target. dysdiadochokinesia- abnormal alternating mvmts.

Front 30

truncal ataxia

Back 30

affects proximal musculature, esp involved in gait stability, caused by midline damage to cerebellar vermis and assoc pathways. tandem gait abnormal

Front 31

appendicular ataxia

Back 31

affects mvmt of extremeties and caused by lesions of cerebellar hemispheres and assoc pathways (finger to nose test) or rapid alternating mvmts (HEEL-SHIN TEST, FINGER-TO-NOSE, precision finger tap)

Front 32

romberg test

Back 32

close eyes w/ feet together and maintain balance. midline cerebellar lesions, severe proprioceptive or vestibular lesions

Front 33

gait

Back 33

stance- how far apart are feet, posture, stability, circumduction (abnormal arced trajectory in medial to lateral direction), knee bend, arm swing, leg stiffness, initiation and stopping gait, turning

Front 34

gait apraxia

Back 34

perplexing, controversial abnormality when person can carry out normal gait movements when lying down but can't walk standing (NPH, frontal d/o)

Front 35

caloric stimulation

Back 35

infuse ice water into ear canal, if vestibulo-ocular reflex intact u will see nystagmus w/ fast phase opposite side of water infusion

Front 36

posturing reflexes

Back 36

indicates damage to descending UMN pathways (decorticate and decerebrate)

Front 37

decorticate position

Back 37

brainstem transected above the level of the red nuclei. flexor posturing (hands flexed inward towards cortex w/ fists clenched, toes pointed away)

Front 38

decerebrate position

Back 38

indicates lesion below red nucleus (lower on brainstem). arms extended down pointing away from cortex. worse prognosis than decorticate.

Front 39

triple flexion

Back 39

flexion at knee, thigh and dorsiflexion of ankle, does not require brainstem functioning

Front 40

brain death tests

Back 40

irreversible lack of brain function. caloric test, apnea test (lack of spontaneous respirations w/o ventilator. angiogram and eeg can confirm

Front 41

malingering tests coma

Back 41

hand drop over face, saccadic eye movement (cd indicate locked in)