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358 Cards in this Set
- Front
- Back
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What is the function of the central nervous system?
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coordination and control of the body
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What is the function of the peripheral nervous system?
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carries information to and from the central nervous system
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What is the function of the autonomic nervous system?
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coordinates and regulatesthe internal organs of the body like the cardiac and smooth muscle
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What is the function of the sympathetic division?
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prods the body into action during times of physiologic and psychologic stress
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What is the function of the parasympathetic division?
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conserve body resources and maintain day to day body functions such as digestion and elimination
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What does the interrelationship of the nervous system permit the body to do?
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-receive sensory stimuli from the environment
-identify and integrate the adaptive processes needed to maintain current body functions -orchestrate body function changes required for adaptation and survival - integrate the rapid responsiveness of the CNS with the more gradual responsiveness of the endocrine system - control cognitive and voluntary behavioral processes - control subconsciousness and involuntary body functions |
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how many layers of meninges surround the brain and spinal cord?
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3
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where does the brain receive its blood supply from?
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2 internal carotids
2 vertebral arteries |
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how does the blood drain from the brain?
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travels through venous plexuses and dural sinuses that empty into thee internal jugular veins
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What is the function of the cerebral cortex?
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general movement, visceral function, perception, behavior, and the integration of these functions
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What is the function of commissural fibers
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interconnect the counterpart areas in each hemisphere permitting the coordination of activities between the hemispheres
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What is the function of the frontal lobe?
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voluntary skeletal movement and fine repetitive motor movements as well as control of eye movement
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What is the function of the parietal lobe?
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processing sensory data as it is received with the interpretation of tactile sensations, as well as visual, gustatory, olfactory, and auditory sensations
recognition of body parts and awareness of body position (proprioception) |
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What is the function of the occipital lobe?
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primary vision center and provides interpretation of visual data
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What is the function of the temporal lobe?
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perception and interpretation of sounds and determination of their source
integration of taste, smell, and balance |
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Where is the reception of speech and interpretation of speech located?
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Wernicke area
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What is the function of the basal ganglia
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processing station between the cerebral motor cortex and upper brainstem
refine motor movement |
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What does the cerebellum work with to carry out its function?
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aids the motor cortex of the cerebrum in the integration of voluntary movements
processes sensory information from the eyes, ears, touch receptors, and musculoskeletal works with the vestibular system to use the sensory data for reflexive control of muscle tone, balance and posture to produce steady and precise movements |
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What is the function of the thalamus
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integrating center for perception of various sensations such as pain and temperature
relays sensory aspects of motor information between the basal ganglia and cerebellum |
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What is the function of the pons?
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transmits information between the brainstem and cerebellum relaying motor information from the cerebral cortex to the contralateral cerebellar hemisphere
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Where does the descending corticospinal tract decussate (cross to the contralateral side)?
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medulla oblongata
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What cranial nerves are sensory?
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olfactory
optic acoustic |
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What cranial nerves are motor?
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oculomotor
trochlear abducens spinal accessory hypoglossal |
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What cranial nerves are both motor and sensory?
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trigeminal
facial glossopharyngeal vagus |
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What nerves are associated with the medulla oblongata and what is its function?
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CN IX TO XII
-respiratory, circulatory, and vasomotor activities, houses respiratory center - reflexes of swallowing, coughing, vomiting, sneezing, and hiccuping - relay center for major ascending and descending spinal tracts that decussate at the pyramid |
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What nerves are associated with the pons and what is its function?
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CN V TO VIII
-reflexes of pupillary action and eye movement - regulates respiration; houses a portion of the respiratory system - controls voluntary muscle action with corticospinal tract pathway |
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What nerves are associated with the midbrain and what is its function?
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CN III AND IV
- reflex center for eye and head movement - auditory relay pathway -corticospinal tract pathway |
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What nerves are associated with the diencephalon and what is its function?
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CN I AND II ALSO RELATED TO THALAMUS
- relays impulses between cerebrum, cerebellum, pons and medulla - conveys all sensory impulses - integrates impulses between motor cortex and cerebrum - controls state of consciousness, conscious perceptions of sensations and abstract feeling |
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What is the function of the epithalamus?
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houses the pineal body
sexual development and behavior |
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What is the function of the hypothalamus?
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major processing center of internal stimuli for autonomic nervous system
-maintains temperature control, water metabolisms, body fluid osmolarity, feeding behavior and neuroendocrine activity |
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What is the function of the pituitary gland?
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hormonal control of growth, lactations, vasoconstriction, and metabolism
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Where does the spinal cord begin and end?
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at the forament magnum and terminates at L1 or L2
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What is found in the gray matter of the spinal cord?
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sensory pathways and autonomic nervous system
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What is found in the white matter of the spinal tract?
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ascending and descending spinal tracts
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What is the functions of the ascending tracts?
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carry sensation
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What is the function of the posterior dorsal column tract?
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carries the fibers and sesnsations of fine touch, two point discrimination and proprioception
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What is the function of the spinothalamic tract?
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carry the fibers for sensation of light and crude touch, pressure, temperature and pain
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What is the function of the descending spinal tract?
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convey impylses to various muscle groups by inhibiting or exciting spinal activity
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What is the function of the corticospinal tract?
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permits skilled, delicate and purposeful movement
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What is the function of the vestibuulospinal tract?
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cause the extensor muscles of the body to suddenly contract when an individual starts to fall
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What is the function of the corticobulbar tract
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innervates the motor function of the cranial nerves
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Where are upper motor neurons
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nerve cell bodies for motor pathways that originate and terminate within the CNS
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What is the role of upper motor neurons
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influence, direct, and modfiy spinal reflex arcs and circuits
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Where are the lower motor neurons?
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originate in the anterior horn of the spinal cord and extend into the peripheral nervous system?
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What is the function of lower motor neurons
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transmit neural signals directly to the muscles that permit movement
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injury to upper or lower motor neurons results in permanent paralysis?
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lower motor neurons
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what word describes the specific body distribution of a spinal nerve?
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dermatome
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what is located in the anterior root of the spinal cord?
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motor or efferent fibers of the anterior root carry impulses from the spinal cord to the muscles and glands of the body
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What is located in the posterior root of the spinal cord?
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sensory or afferent fibers carry impulses from sensory receptors of the body to the spinal cord, and then on to the brain for interpretation by the cerebral sensory cortex
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How does the reflex arc work?
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spinal afferent neuron initiates reflex when receives an impulse stimulus
response is transmitted via the efferent neuron in the anterior horn stimulation a brisk contraction its dependent on intact afferent neurons, functional synapses of the spinal cord, intact efferent neuron, functional neuromuscular junctions and competent muscle fibers |
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When occurs to the nervous system during the first year of life?
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majority of brain growth and also have myelinations of the nervous system
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What inhibits the primitive brain reflexes?
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advanced cortical functions and voluntary control begin to take over
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In what direction does motor maturation develop?
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cephalocaudal direction
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What changes occur in pregnancy to the nervous system?
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hypothalamic pituitary neurohormonal changes. tend to increases sleep time even though they dont feel rested
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What are risk factors for stroke?
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hypertension
obesity sedentary lifestyle smoking tobacco products stress increased levels of serum cholesterol, lipoproteins and triglycerides use of oral contraceptives sickle cell anemia family history of diabetes mellitus, cardiovascular disease, hypertension and increased serum cholesterol levels congenital cerebrovascular anomalies |
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What are risk factors for falls in older adults
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one or more fall in the past year
past history of stroke neurologic condition like Parkinson disease, dementia or peripheral neuropathy disorder of gait or balance lower extremity weakness or sensory loss impaired vision use of an assistive device |
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What is the procedure for the neurologic exam?
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cranial nerves
proprioception and cerebellar function sensory function deep tendon reflexes |
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How do you test the olfactory nose
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test ability to identify familiar orders one naris at a time with the eyes closed
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How do you test the optic nerve?
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vision with eye charts
perform opthalmic exam of fundi |
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How do you test the Occulomotor, trochlear, and abducens nerve?
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inspect eyelids for dropping
inspect pupils size for equality and their direct and consensual response to light and accomodation test extrocular eye movement |
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How do you test the trigeminal nerve?
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inspect face for muscle atrophy and tremor
palpate jaw muscle for tone and strength when patient clenches their teeth test superficial pain and touch sensation of each branch test corneal reflex |
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How do you test the facial nerve?
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inspect symmetry of facial feature with various expression (smile, frown, puffed cheeks, wrinkled forehead)
test ability to identify sweet and salty tastes on each side of the tongue |
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How do you test the acoustic (vestibulocochlear) nerve?
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sense of hearing with whisper screening test or audiometry
compare bone and air conduction of sound |
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How do you test the glossopharyngeal and vagus nerve?
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test ability to identify sour and bitter tastes
test gag reflex and ability to swallow inspect palate and uvular for symmetry with speech sounds and gag reflex observe for swallowing difficulty evaluate quality of guttural speech sounds |
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How do you test the spinal accessory nerve?
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test trapezius muscle strength
test SCM muscle strength |
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How do you test the hypoglossal nerve?
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inspect tongue in mouth and while protruded for symmetry, tremors and atrophy
inspect tongue movement toward nose and chin test tongue strength with index finger when tongue is pressed against the cheek evaluate quality of lingual speech sounds |
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Which nerve is one of the first to lose function with increased intracranial pressure?
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CN VI abducens
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how do you differentiate between an upper and lower motor neuron lesions of the face?
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when the upper motor neurons are affect voluntary movement are paralyzed but emotional movements are spared (still able to move forehead) in lower motor neuron disorder all facial movements on the affected side are paralyzed
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How do you test vestibular function?
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Romberg test
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What involuntary movements should you search for while doing a neurologic exam
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tremors, tics of fasciculations
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How do you test rapid rhythmic alternating movements?
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seated patient taps with both hands, alternately turning up and down the palms of the hands
patient touch the thumb to each finger of the same hand |
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How do you test accuracy of movements?
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finger to finger test, finger to nose test, heel to shin test with the eyes open
movement should by rapid, smooth, and accurate needs to be done bilaterally |
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tremor seen with arms held extended, disappears when limb is at rest, small amplitude
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enhanced physiolgic tremor
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What causes an enhanced physiologic tremor?
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drug or alcohol withdrawal
hyperthyroidism, hyperglycemia drug toxicity |
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what tremor is bilateral symmetric and primarily seen in hands or outstretched arms
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essential tremor
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What are potential causes of essential tremor?
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no consistent cerebral pathology but may have an autosomal dominant inheritance pattern
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What will worsen an essential tremor
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stress or fatigue
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What will improve an essential tremor?
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alcohol
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What type of tumor is seen during intentional movements?
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intention tremor
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What are potential cause of intention tremor?
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cerebellar disorder like MS or alcohol abuse
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What type of tremor is seen with a limb at rest with slow supination and pronation movements
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resting tremor
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What causes a resting tremor
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Parkinson disease
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How do you initially evaluate balance?
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Romberg test
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What does a positive romberg sign indicate?
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cerebellar ataxia
vestibular dysfunction sensory loss |
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What should be continuously noted observing the patients gait?
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continuously sequence stance and swing step after step
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gait pattern where the affected leg is stiff and extended with plantar flexion of the foot, the foot is typically dragged or circumduction and the affect arm is flexed and adducted and does not swing
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spastic hemiparesis
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gait pattern where the patient uses short steps, dragging the ball of the foot across the floor
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spastic diplegia (scissoring)
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What causes spastic diplegia?
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injury to the pyramidal system
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What gait is associated with the hip and knee are excessively elevate d high to lift the plantar flexed foot off the ground, the foot is brought down to the floor with a slap and the patient is unable to walk on heels
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steppage gait
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What gait is associated with legs kept far apart and weight shifted from side to side in waddling motion
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dystrophic gait
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What causes dystrophic gait?
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weak hip abductor muscles
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What gat is associated with the legs position far apart and the heel stamps on the ground with each step?
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tabetic gait
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What gait is associated with the feet wide based, staggering and lurching from side to side and often accompanied by swaying of the trunks
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cerebellar gait
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What gait is associate with wide base, feet are thrown forward and outward bringing them down first on heels then on toes and the patient watches the ground to guid his steps
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sensory ataxia
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What gait is associated with short shuffling steps and with hesitation on starting and difficulty stoppin
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Parkinsonian gait
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What gait is associated witth jerky, dancing movments appear nondirectional
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dystonia
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What gait is assocaited with uncontrolled falling
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ataxiaa
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What gait is associated with the patient limiting the time of weight bearing on the affected leg to limit pain
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antalgic limp
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What are expected findings to find testing sensory stimulus bilaterally
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minimal difference side to side
cprrect interpretation of sensation discrimination of the side of body tested location of sensation and whehter proximal or distal to previous stimuli |
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What is used to test primary sensory functions?
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supperficial touch
supperficial pain with light and sharp touch temperature differnce deep pressure vibrations and position of joints |
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What may loss of sensory modalities indicated?
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perippheral neuropathy
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What does symmetic sensory loss indicate
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polyneuropathy
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What does cortical or discriminatory sensory functions test?
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cognitive ability to interpret sensation
suspect lesions in posterior column of spinal cord |
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How do you test stereognosis?
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hand patient familiar object and have them identify the object baed on touch and manipulation
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How do you test extinction phenomenon
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simultaneously touch two areas on each side of body with sharp edge and have patient tell you haw many stimuli there are and where they are
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How do you test graphesthesia?
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with blunt pen or applicator draw letter number or shape on patients hand and have them identify it
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What is the pattern of sensory loss with a single peripheral nerve
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area of sensory loss is less than the anatomic distribution of the nerve, loss of sensation is greatest in the central portion
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What is the pattern of sensory loss with multiple peripheral nerves
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sensory loss is most severe over legs and feet or over hands usually involves all modalities of sensation
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What is the pattern of sensory loss with multiple spinal nerve roots
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incomplete loss of sensation in any area of the skin usually occurs when once nerve root is affected
if two or more nerve roots affected zone of sensory loss is surrounded by partial loss and possible loss of deep tendon reflex |
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What is the pattern of sensory loss with complete transverse lesion of the spinal cord?
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all forms of sensation of lost below the level of the lesion; pain, temperature and touch sensations are lost one to two dermatomes below the lesion
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What is the pattern sensory loss of a partial spinal sensory syndrome?
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pain and temperature sensation are lost one to two dermatomes below the lesion on the opposite side of the body from the lesion; proprioceptive loss and motor paralysis occur on the lesion side of the body
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What tract provides superficial pain and temperature
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lateral spinothalmic
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What tract provides superficial touch and deep pressure
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anterior spinothalmic
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What tract provides vibration, deep pressure, position sense, stereognosis, point location and two point discrimination
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posterior column
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What tract provides proprioception
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anterior and dorsal spinocerebellar
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What tract provides rapid rhythmic alternating movement, voluntary movement, deep tendon reflex and plantar reflex
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lateral and anterior corticospinal
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What tract provides posture and romberg, gait and instinctual motor reactions
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medial and lateral reticulospinal
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What is the reflex of the upper abdomen
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T8, T9, T10
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What is the reflex for the lower abdomen
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T10, T11, T12
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What is the reflex for the cremasteric
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T12, L1,, L2
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What is the reflex for the plantar
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L5, S1, S2
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What is the biceps reflex
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C5 and C6
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What is the brachioradialis reflex
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C5 and C6
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What is the triceps reflex
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C6, C7, C8
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What is the patellar reflex
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L2, L3, L4
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What is the achilles reflex?
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S1 and S2
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What reaction occurs with abdominal reflex
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slight contraction of the umbilicus toward each area of stimulation should occur bilaterally
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What reactions occurs with the cremasteric reflex?
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testicle and scrotum should rise on the stroked side
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What reaction occurs with the plantar reflex ?
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Babinski sign
dorsiflexion of great tow with or without fanning of other toes indicates upper motor neuron lesion normally have plantar flexion of toes reflex present in children under the age of two |
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How should the limb be positioned to test deep tendon reflexes?
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with slight tension on tendon to be tapped
locate correct point on tendon for stimulation |
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What is the grading scale for deep tendon reflexes?
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0= no response
1= sluggish or diminished 2= active or expected response 3= more brisk than expected, slightly hyperactive 4= brisk, hyperactive, with intermittent or transient clonus |
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What is the expected findings for upper motor neuron lesions?
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increased muscle tone and spasticity
little or no muscle atrophy but decreased strength sensation loss may affect entire limb hyperactive deep tendon reflexes positive babinski sign no fasciculation paralysis of voluntary movements damage above brainstem affects contralateral side and below brainstem affects ipsilateral side |
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What is the expected findings for lower motor neuron lesions?
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decreased muscle tone and flaccidity
loss of muscle strength and atrophy sensory loss following distribution of dermatome weak or absent reflexes fasciculation paralysis of muscle damage affects ipsilateral side |
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how do you position the patient for biceps reflex?
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flex patients arm to 45 degrees
causes visible or palpable flexion of elbow |
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How do you position the patient for brachioradialias reflex?
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flex to 45 degrees and pronate the hand
pronation of forearm and flexion of elbow should occur |
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How do you position the patient for the triceps reflex
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flex patients arm to 90 degrees supporting arm in antecubital fossa
see visible extension of the elbow |
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How do you position the patient for the patellar reflex?
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flex patients knee to 90 degrees
contraction of quads leads to extension of lower leg |
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How do you position the patient for the achilles reflex
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flex knee to 90 and keep ankle in neutral position
contraction cause plantar flexion of foot |
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How do you test for clonus?
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test when reflexes are hyperactive
have knee partially flexed and briskly dorsiflex the foot with your other hand maintaining the foot in flexion should see no rhythmic oscillating movements |
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What do you use to test for protective sensation in patients with DBM and peripheral neuropathy?
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5.07 monofilament or Waardenberg wheel
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Where do you roll the Waardenberg wheel?
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Random pattern in several sites on the plantar surface of the foot and on one site on the dorsal surface
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How long should the monofilament be applied to each site?
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1.5 seconds, do not repeat sites
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How do you know adequate pressure has been applied?
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Filament bends
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Loss of sensation to the touch of monofilament/ Waardenberg is an indication of what?
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Peripheral neuropathy, and hte loss of protective pain sensation that alerts patients to skin breakdown/injury
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Nuchal rigidity is a sign of?
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Meningitis and intracranial hemorrhage.
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How do you test for nuchal rigidity?
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Slid hand under head and raise it, flexing the neck. Try to make the patients chin touch sternum.
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How do you make the determination of true stiffness more accurate?
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Placing hand under shoulders when the patient is lying down and raising the shoulders slightly to help relax the neck.
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What else can cause ppain in the neck and resistance to neck motion?
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Painful swollen LNs & superficial trauma.
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What vaccines reduce the risk of developing meningitis in children?
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H. Influenzae type B & pneumococcal vaccine (PCV7)
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What is the Brudzinski sign?
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Involuntary flexion of hips & knees when flexing the neck indicates meningeal irritation
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What is the adult pneumococcal vaccine?
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PPV
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What is the Kernig sign?
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Flexing the leg at the knee and hip when the patient is supine....attempting to straighten the leg. Pain in the low back & resistence to straight leg = positive
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What are the symptoms of meningitis?
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Fever, heachacke, stiff neck, photophobia, nausea, vomiting
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How sensitive/specific are Brudzinski/Kernig signs?
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5% Sensitive; 95% specific
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What is the positive/negative predictive value of Brudzinski/Kerning signs?
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27/72%
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How sensitive/specific is nuchal rigidity?
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Sensitive 30%; Specific 68%
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What is the positive/negative predictive value of nuchal rigidity?
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26/73%
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What should you observe for in an infant?
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Odd facies that may be suggestive of congenital conditions that include neuro problems : low set ears, port wine stains
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What spontaneous activity should be observed in an infant?
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Symmetry, smoothness of mocement. Coordinated sucking/swallowing.
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Hands hare held in fists for how long?
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First 3 months
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When do hands open for longer periods?
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After 3 months
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When does purposeful movment occur?
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At 2 months = reaching and grasping for objects
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When does taking objects with one hand occur?
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6 months
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WHen does transferring of objects from one hand to another occur?
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7 months
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When does purposefully releasing objects occur?
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10 mo
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What reduces risk of SIDS?
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Change in sleep position form prone to the back. Encourage supervised tummy time to stimulate gross motor development.
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Procedure for CN II, III, IV, VI evalutation in newborns/infants?
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Optical blink reflex; Gases intensely at close object or face; Focuses on and tracks an object with both eyes; Doll's eye manuver
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Procedure for CN V evaluation in newborns/infants?
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Rooting reflex & sucking reflex
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Procedure for CN VII evaluation in newborns/infants?
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Observe infant's facial expression when crying (wrinkle forehead & symmetry of smile)
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Procedure for CN VIII evaluation in newborns/infants?
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Acoustic blink reflex; Movement of eyes in direction of sound; Freezes eyes with high-pitched sound; Doll's eye maneuver
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What is the acoustic blink reflex?
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Loudly clapping hands 30cm from babys head causes them to blink in response to the sound. No response after 2-3 days of age => hearing problems, but if you repeatedly test infant they will become habituated
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What is the doll's eye reflex?
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Infant held in armpit area in upright position with head facing you => rotate infant in one direction then the other => infants eyes should turn in the direction of rotation and then in the opposite direction when rotation stops. No reflex => vestibular problem/ eye muscle paralysis
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Procedure for CN IX and X evaluation in newborns/infants?
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Swallowing and gag reflex
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Procedure for CN XII evaluation in newborns/infants?
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Coordinated sucking/swallowing; pinch infant's nose to see mouth open and tip of tongue rise in midline position
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What is the optical blink reflex?
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Optical blink reflex: shine a light in open eyes => observe the quick closure of hte eyes and dorsal flexion of the infants head => no response indicates poor light perception
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What is the rooting reflex?
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Rooting reflex: touch corner of mouth => infant opens mouth and turns head in direction of stimulation => if infant has recently been fed response will be weak/absent
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What is the sucking reflex?
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Finger in infants mouth => tongue should push up against your finger with good strength; note pattern, strength, pressure of sucking
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Seeing a baby withdraw all limbs from a painful stimulus provides measure of?
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Sensory integrity
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What reflex is present at birth?
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Patellar
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What reflexes appear at 6mo of age?
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Achilles and brachioradialis
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What should be used to test reflexes on an infant?
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Finger
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How many beats are ankle clonus normal?
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1 or 2
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How many an beats of ankle clonus merit further evaluation?
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10 or more
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What is a positive Babinski sign?
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Fanning of toes and dorsiflextion of great toe
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How long is Babnski found in kids?
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Until 16-24 mo of age
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When evaluating posture and movement, what should you be observing for?
|
Symmetry & smoothness; rhythmic twitching; sustained asymmetric posturing; paroxysmal episodes of these signs => epilepsy; muscle strength and tone
|
|
|
Delay in sitting or walking is a sign of?
|
Cerebellar disorder
|
|
|
What is the Denver II?
|
Tool to determine whether a child is developing as expected: fine/gross motor skills, language, personal-cocial skills
|
|
|
What is the Ages and Stages tool?
|
A standardized parent questionnaire to assess development.
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|
What do the first stages of walking look like?
|
Wide-based gait
|
|
|
What does an older child walk like?
|
Feet are closer together, has better balance, and recovers more easily when unbalanced
|
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|
What are the coordination skills that develop in a young child?
|
Heel-to-toe walking, hopping and jumping
|
|
|
What can three pennies be used for in an evaluation?
|
Gain the child's cooperation and evaluate vision, extraocular movements, and hearing by dropping the coinds on the floor. Asking the child to pick up the pennies tests their vision and balance. Sticking a moist coin to the childs nose and asking them to walk allows for obstervation of gait/posturing.
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|
What penny trick tests Romberg?
|
Asking the child to balance a penny on the nose and dorsum of each extended hand.
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|
How do you evaluate light touch on a child?
|
Child closes eyes and points to where you touch/tickle. Have child differentiate between hard/soft textures. Using tuning fork evaluate vibration. No pain testing.
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|
What is the palmar grasp and when is it present?
|
Birth: Head midline, touch palm of hand from ULNAR side => strong grasp, sucking facilitates grasp. Strongest at 1-2 mo of age, gone by 3mo
|
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|
What is the plantar grasp and when is it present?
|
Birth: Touching the plantar surface of hte infants feet at base of toes causes them to curl downwards. Strongest up to 8mo
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|
What is the moro reflex and when is it present?
|
Birth: Semisitting position => head and trunk drop back to 30 degree angle => symmetric abduction/extension of arms => fingers fan out and thumb/index form a C => arms adduct in an embracing motion and then relax in flextion. Reflex strong at 3-4mo, gone by 6mo
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|
What is the placing reflex and when is it present?
|
4 days: Holding infant upright touch dorsal side of foot to table edge => flexion of hips & knees & lifting of foot. Dissapearance varies.
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|
What is the stepping reflex and when is it present?
|
Birth/8 weeks: Holding infant upright allow soles of feet to touch surface of table => alternate flexion and extension of legs (like walking). Dissapears before voluntary walking.
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|
What is the asymmetric tonic neck or "fencing" reflex and when is it present?
|
2-3mo: Infant lying down, turn head to one side => extension of arm and leg on the side to head turning, flexion of opposite arm/leg => reversal. Diminishes at 3/4mo and disappears by 6mo. If infant doesnt have reflex/ or is locked in reflex => infant may be not able to roll over
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|
What do you use to check cortical sensory integration?
|
Geometric figures (not numbers) to evaluate graphesthesia. Draw a figure twice and ask child if they are the same or different with eyes closed, and repeat with eyes open.
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|
|
How do you evaluate CN II in a young child?
|
Snellen E, HOTV, or picture chart to test vision. Immobilize head for visual field testing.
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|
How do you evaluate CN III, IV, VI in a young child?
|
Follow object w/ eyes immobilizing head. Move object thorugh H to test EOMI
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|
|
How do you evaluate CN V in a young child?
|
Observe child chewing cookie/cracker noting BL jaw strength. Touch cheeks/forehead w cotton or string and watch child bat it away.
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|
|
How do you evaluate CN VII in a young child?
|
Observe smiling, frowning, crying. Ask child to show teeth. Have child copy you puffing your cheeks
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|
How do you evaluate CN VIII in a young child?
|
Observe turning to sounds like bell/whisper. Whisper behind child and have them repeat the word. Audiometric testing.
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|
|
How do you evaluate CN IX and X in a young child?
|
Elicit gag reflex
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|
How do you evaluate CN II XI and XII in a young child?
|
Stick out tongue/ shrug shoulders/ raise arms
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|
What do you start with when doing a neuro exam on a Preggo?
|
DTR's as baseline
|
|
|
What assessment is essential to determine impact of illness on a patient?
|
Functional status
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|
|
What is the leading cause of death and adult disability?
|
Stroke
|
|
|
What are the lifestyle modifications that can reduce the risk for stroke?
|
weight reduction, adherence to a diet that is low-fat, low-sodium, and rich in fruits, vegetables, and dairly products, 30 mins of aerobic exercise daily, moderate alcohol consupmtion, no smoking.
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|
|
What medical conditions can be treated to avoid stroke?
|
HTN, heart disease, DB, hyperlipidemia, carotid stenosis
|
|
|
What can medications do to the nervous system?
|
Impaire CNS function, cause slow reaction time, tremors (rhythmic, oscillating, involuntary purposeless movements), and anxiety.
|
|
|
Why do problems with medications develop?
|
Dosage, number, or interaction of Rx and non-Rx meds
|
|
|
What senses are diminished in an older adult?
|
Smell and taste, butter and sour go first.
|
|
|
What CN changes occur in an older adult?
|
Impaired color differentiation, upward gaze, adjustment to light changes, decreased corneal reflex, middle-high frequency hearing loss, reduced gag reflex
|
|
|
What happens to a person's gait with advancing age?
|
Shorter steops, less lifting of feet (loss of proprioception), shuffeling, decrease of speed/balance/grace. Arms more flexed, legs flexed at hips/knees.
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|
|
What is a simple screening test for balance/strength/cerebellar fxn?
|
Arise from a chair without using arms; walk normally; stand with feet together eyes open/closed; stand on heels/toes; sit back down no arms
|
|
|
What is the Tinetti Balance and Gait Assessment tool?
|
8 positions and position changes are evaluated. 1) sitting balance; 2) rising without arms out of chair; 3) attempts to rise; 4) Immediate standing balance (5sec); 5) Standing balance; 6) Nudged; 7) Eyes closed; 8) Turning 360 degrees; 9) sitting down.....score out of 16
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|
|
How is sitting balance graded in the tinetti assessment'?
|
0 = leans or slides in chair; 1= steady, safe
|
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|
How is rising out of chair graded in the tinetti assessment?
|
0 = unable without help; 1 = able, uses arms; 2 = able without help
|
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|
How is attempting to rise graded in the tinetti assessment?
|
0 = unable without help; 1 = able but requres more than one attempt; 2 = able to arise, one attempt
|
|
|
How is immediate standing balance graded in the tinetti assessment?
|
0= unsteady; 1 = steady but needs walker/support; 2 = steady without support
|
|
|
How is Standing balance graded in the tinetti assessment?
|
0 = Unsteady; 1 = Steady but wide stance (heels more than 4in apart)/needs support; 2 = narrow stance without support
|
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|
How is Nudged graded in the tinetti assessment?
|
0 = begins to fall; 1 = staggers, grabs, catches self; 2= steady
|
|
|
How is Eyes closed graded in the tinetti assessment?
|
0 = unsteady; 1 = steady
|
|
|
How is Turning 360 graded in the tinetti assessment?
|
0 = discontinuous steps/ unsteady; 1 = continuous steps/steady
|
|
|
How is Sitting down graded in the tinetti assessment?
|
0 = Unsafe (misjudges distance, falls in chair); 1 = Uses arm/unsmooth motion; 2 = safe, smooth motion
|
|
|
What is the Gait Test?
|
8 components of gait are observed, patient has to walk 10ft normally and then back using rapid pace. 1) initation of gait; 2) step length 3) step height; 4) Step symmetry; 5) step continuity; 6) Path; 7) Trunk; 8) walking stance........gait score of 12
|
|
|
How is initiation of gait graded in the gait assessment?
|
0 = Any hesitancy or multiple attepmts to start; 1 = no hesitancy
|
|
|
How is step length/height graded in the gait assessment?
|
0 = Right swing foot does not pass left foot with stance; 1 = passes left stance foot; 0 = right fot does not clear floowr completely with step; 1 = Right foot completely clears floor; 0 = Left swing foot does not pass right stance foot with step; 1 = Passes right stance foot; 0 = Left foot does not clear floor completely with step; 1 = Left foot completely clears floor
|
|
|
How is step symmetry graded in the gait assessment?
|
0 = Right and left step length not equal (estimate); 1 = Right and left step length appear equal
|
|
|
How is step continuity graded in the gait assessment?
|
0 = stopping or discontinuity between steps; 1 = steps appear continuous
|
|
|
How is path graded in the gait assessment?
|
0 = marked deviation; 1 = mild/moderate deviation or uses walking aid; 2 = straight without walking aid
|
|
|
How is trunk graded in the gait assessment?
|
0 = marked sway or uses walking aid; 1 = No sway, but flexion of knees or back, or spreads arms out (while walking); 2 = No sway, no flexion, no use of arms, and no use of walking aid
|
|
|
How is walking stance graded in the gait assessment?
|
0 = heels apart; 1 = heels almost touching while walking
|
|
|
What balance and gait score indicates a risk for falls?
|
Score of < 19
|
|
|
What balance and gait score indicates there is a greater chance of falls but not high risk?
|
Score of 19-24
|
|
|
How can you observe fine motor abilites in an elderly person?
|
Observing the patient dress/undress
|
|
|
What are DTR's like in an older adult?
|
Less brisk or absent reflexes with response diminishing in the LEs before UEs. Achilles/plantar diminished. Superficial reflexes dissapear.
|
|
|
What increases with aging?
|
Bening essential tremor. Fine motor coordination and agility.
|
|
|
What is a static problem in the nervous system?
|
Develops at any age and does not get better or worse but the clinical manifestation should change over time (nerve deafness/birth truama)
|
|
|
What is a degenerative condition in the nervous system?
|
Person was well until function was lost, and it gets worse.
|
|
|
What is MS?
|
A progressive autoimmune disorder characterized by a combo of inflammation & degneration of myeling of white matter => decreased brain mass/obstructed transmission of nerve impulses
|
|
|
What is the pathophysiology of MS?
|
Infectious agents triggering autoimmune rxn in susceptible people
|
|
|
When do the symptoms of MS occur?
|
Btwn 20-40; women twice as often as men
|
|
|
What are the subjective findings in MS?
|
Fatigue, urinary frequency, urgency, hesitancy, sexual dysfunction, vertigo, weakness, numbness, blurred vision diplopia, loss of vision, emotional changes
|
|
|
What are relapse symptoms like for someone with MS?
|
Relapse symptoms develop rapidly (hours-days) and take weeks to recede
|
|
|
What would the PE reveal in someone with MS?
|
Muscle weakness, ataxia, hyperactive DTR, parentheisas/sensory loss, intention tremor, optic neuritis, cognitive changes, MRI lesions
|
|
|
What does the MRI look like for someone with lesions from MS?
|
Periventricular, ovoid, perpendicular to ventricles; SC lesions may also be found
|
|
|
What is epilepsy?
|
Chronic disorder characterized by recurrent, unprovoked generalized seizures secondary to underlying brain abnormality.
|
|
|
What causes epilepsy?
|
Episodic abnormal electical discharges (excessive concurrent firing) of cerebral neurons that can be caused by a disorder, a defect, injury, toxins, brain tumor, hypoxia
|
|
|
What are the subjective findings in epilepsy?
|
Hx of seizures, premonition/aura, stiff/rigid body, jerking motions, eyes rolling up, drooling, incontinance
|
|
|
What are the phases of a seizure?
|
Tonic; Clonic; Postictal
|
|
|
What occurs in the tonic phase of a seizure?
|
Brief flexon, characteristic cry with contractionof abd muscles => generalized extension for 10-15min => loss of conciousness for 1-2 min, eyes deviate up, dilated pupils
|
|
|
What occurs in the clonic phase of a seizure?
|
Contractions alternate with muscle relaxation
|
|
|
What occurs in the postictal state?
|
coma followed by confusion/lethargy
|
|
|
What does the EEG look like in epilepsy?
|
Spikes and waves
|
|
|
What is acute inflammation of hte brain & SC involving the meninges?
|
Encephalitis = due to virus
|
|
|
What is an inflammatory process in the meninges only?
|
Meningitis
|
|
|
How does encephalitis occur?
|
Transmitted by the bite of an arthropod or mosquito, such as WNV, EEE, or japanese encephalitis
|
|
|
What is the cause of meningitis?
|
The bacterial, viral, or fungal organism often colonizes in the UR tract, invades the bloodstream and then crosses the BBB to infect the CSF and meninges
|
|
|
What are the subjective findings of an episode of encephalitls?
|
Mild viral illness with fever. Recovery and quiet stage followed by onset of lethargy, restlessness, and mental confusion
|
|
|
What does one find on a PE examining a case of encephalitis?
|
Altered mental status, confusion, stupor, coma. Photophobia, stiff neck, muscle weakness, paralysis, ataxia
|
|
|
What are the subjective findings in meningitis?
|
Fever, chills, headache, stiff neck, lethargy, malaise, vomiting, irritability, seizures
|
|
|
What does one find on a PE examining a case of meningitis?
|
Altered mental status, confusion, nuchal rigidity, fever, Brudzinsky/Kernig signs may be positive, petechiae/purpura, meningococcal meningitis
|
|
|
What confirms the diagnosis of menigitis?
|
LP and CSF culture
|
|
|
What is mass effect?
|
Tumor that causes displacement of tissue and pressur on the CSF circulaiton; function is threatened through compression/destruction of tiussues
|
|
|
When is the peak time for prain tumors?
|
65-79y
|
|
|
What are the subjective findings in somone who has a brain tumor?
|
Persistent headache, nausea, vomiting, unsteady gait, impaired coordination, memory loss, confusion, reduced vision acuity, visual loss, behavior/personality change, seizure
|
|
|
What brain tumor symptoms occur in children?
|
Irritability, lethargy, weight loss, growth failure, precocious puberty
|
|
|
What would a PE reveal with a brain tumor?
|
Altered conciousness, confusion, papilledema, CN impairment, aphasia, langage disorder, vision loss (hemianopia/nystagmus), gait disturbance, taxia
|
|
|
What is a stroke?
|
Sudden interruption of blood supply to a part of hte brain or the rupture of a BV, spilling blood into spaces round brain cells
|
|
|
What is an ischemic stroke?
|
Occurs when a thrombus or embolism interrupts the blood supply, oxygen, and nutrients to the brain and brain cells die. (most common cause of stroke)
|
|
|
What causes 15% of hemorrhagic stroke?
|
Intracerebral or subarachnoid bleeding - distribution of anterior circulation of the brain: brain cells die due to bleeding
|
|
|
What happens to the patient when they are having a stroke?
|
Get numbness or weakness suddenly; confusion/trouble speaking or understanding speech; trouble seeing in one or both eyes; trouble with walking, dizziness, loss of balance/coordination; sudden severe headache with no known cause
|
|
|
What are the findings in a stroke?
|
High BP, altered conciousness, difficulty managing secretions, weakness/paralysis of extremities or facial muscles on one/both sides of body; aphasia (receptive/expressive); articulation impairment; impaired horizontal gaze/hemianopia
|
|
|
WHat are the neurologic signs of a blocked internal carotid artery?
|
Unilateral blindness; severe contralateral hemiplegia/hemianesthesia; profound aphasia
|
|
|
What is the supply of the internal carotid?
|
splits into opthalmic/ ipsilateral hemisphere arteriess => Cerebral hemispheres; diencephalon
|
|
|
What are the neuro signs of a blocked MCA?
|
Altered communication, coginition, mobility, sensation; contralateral homonymous hemianopia; contralateral hemiplegia/hemiparesis, motor/sensory loss greater in face & arm than the leg
|
|
|
What is the supply of the MCA?
|
Frontal, parietal lobes; cortical surface of temporal lobe => communication areas; language, interpretation, perception, interpretation of space, sensation, form, voluntary movement
|
|
|
What is are the neuro signs of a blocked ACA?
|
Emotional lability; confusion, amnesia, personality changes; urinary incontinence; contralateral hemiplegia/hemiparesis, greater in LE than UE
|
|
|
What are the neuro signs of a blocked PCA?
|
Hemianesthesia; contralateral hemiplegia, greater in face and UE than in LE; cerebellar ataxia, tremor; visual loss (homonymous/hemianopia/cortical blindness); receptive aphasia; memory deficits
|
|
|
What are the neuro signs of a partial blockage of vertebral/basilar arteries (brainstem/cerebellum supply)?
|
Transient and ischemic attacks; unilateral/BL weakness of extremities; UMN weakness involving face, tongue, and throat; loss of vibratory sense, 2-point discrimination adn position sense; diplopia, homonymous, hemanopia; nausea, vertigo, tinnitus, syncope; dysphagia, dysarthria; sometimes confusion and drowsiness
|
|
|
What are the neuro signs of a blocked PICA?
|
Wallenberg syndrome; dysphagia, dysphonia; ipsilateral anesthesia of face/cornea for pain& temp (touch preserved); ipsilateral horner syndrome; contralateral loss of pain & temp sensation in trunk & extremeties; ipsilateral decompensation of movement
|
|
|
What are the neuro signs of a blocked AICA?
|
Difficulty in articulation, swallowing, gross movements of limbs; nystagmus
|
|
|
What are the neuro signs of a blocked SCA?
|
Difficulty in articulation, swallowing, gross movements of limbs; nystagmus
|
|
|
What are the neuro signs of a blocked anterior spinal artery?
|
Flaccid paralysis, below level of lesion; loss of pain, touch, temp sensaton (proprioception perserved)
|
|
|
What are the neuro signs of a blocked posterior spinal artery?
|
Sensory loss, particularly proprioception, vibration, touch, and pressure (movement preserved)
|
|
|
What are the neuro signs of a blocked vert/basilar (anterior pons supply)?
|
Locked-in syndrome - no movement except eyelids; sensation and conciousness preserved
|
|
|
What are the neuro signs of vert/basilar (complete occlusion)?
|
Coma; mitotic pupils; decerebrate rigidity; respiratory and circulatory abnormalities; death
|
|
|
Supply of ACA?
|
Supplies superior surfaces of frontal/parietal lobes, and medial surface of cerebral hemispheres, BG, corpus callosum => motor/somesthetic cortex serving the legs
|
|
|
Supply of PCA?
|
Supplies medial/inferior temporal lobes, medial occipital lobe, thalamus, posterior hypothalamus, visual receptive area
|
|
|
Supply of vertebral/basilar arteries?
|
Brainstem/cerebellum; anterior portion of pons
|
|
|
Supply of PICA?
|
Lateral/posterior portion of the medulla
|
|
|
Supply of AICA/SCA?
|
Cerebellum
|
|
|
Supply of anterior spinal artery?
|
Anterior SC
|
|
|
Supply of posterior spinal artery?
|
Posterior SC
|
|
|
What is MG?
|
Autoimmune disorder of NM transmission involving the produciton of autoantibodies directed against the nicotinic Ach recpetor => destruction & inflammatory changes in the postsynaptic membranes
|
|
|
Where is MG confined in 15% of cases?
|
Ocular muscles
|
|
|
What are the symptoms of MG?
|
Drooping eyelids; double vision; difficulty swallowing/speaking; fluctuating fatigue/weakness; inability to work with arms raised above head; difficulty walking; symptoms are worse later int he day and improve with rest
|
|
|
What are the objective findings in MG?
|
Ptosis that develops within 2 min of upward gaze; facial weakness when puffing out cheeks; hypophoia; difficulty managing secretions; repiratory compromise or failure; wekness of skeletal muches without reflex, sensory, or coordination abnormalities
|
|
|
What is guillain-barre?
|
Autoimmune destruction of peripheral nerve myelin sheaths and inflammation of nerve roots following a GI infection or URI 1-3 weeks earlier or following an immunization
|
|
|
What is the result of Guillain barre?
|
Impaired condction of nerve impulses between the nodes of Ranvier
|
|
|
What are the subjective findings in Guillain barre?
|
Hx of recent ilness; progressive weakness (more in legs); difficulty walking; paresthesia; pain in shoulder, back, posterior thigh; double vision
|
|
|
Whate are the objective findings in Guillain barre?
|
Distal weakness (BL, symmetric, diminished DTR); ataxia; flaccid paralysis; facial nerve weakness (bells palsy); diplopia; dysphagia, difficulty handling secretions; respiratory distress
|
|
|
What is seen in a LP in someone with Guillain barre?
|
Increased protein
|
|
|
What causes Tic Douloureux?
|
Small artery that compresses CNV and wears away myelin/irritates afferent portion
|
|
|
When is tic douloureux seen?
|
40-60y women are more commonly affected than men
|
|
|
What are the symptoms of tic douloureux?
|
Sharp pain episode on one sie of face (sec-minutes); rarely BL; triggered by: chewing, swallowing, talking, washing the face, brushing teeth, cold exposrue, breeze
|
|
|
How often does tic douloureux strike?
|
Several times a day, to several times a month followed by a pain-free period
|
|
|
What are the findings in tic douloureux?
|
Slight sensory impairment in pain regions; facial nerve distribution of pain; most of the time normal neuro exam
|
|
|
What causes Bell's palsy?
|
Acute inflammation of facial nerve; viral infection (HSV); ischemia/demyelination; CNS lesions (MS, stroke, tumor); structural lesions in ear/parotid gland
|
|
|
Who gets Bell's palsy?
|
Anyone but more common in diabetes
|
|
|
What causes peripheral neuropathy?
|
DBM,; altered lipid metabolism; B12/folate deficiency
|
|
|
What polyneuropathies have an autoimmune etiology?
|
lyme disease; HIV; diabetes
|
|
|
What leads to sensory and autonomic nerve fxn deficits in peripheral neuropathy?
|
impaired blood flow, vasoconstriction, chronic ischemic changes within peripheral N fibers
|
|
|
What are the symptoms of peripheral neuropathy?
|
Gradual onset of numbness, tingling, burning, cramping (hands & feet); night pain in both feet; nusual sensations of walking on cotton, floors feel strange, inablilty to distinguish between coins by touch; sensation of burning; hyperalgesia; allodynia
|
|
|
What are the findings in peripheral neuropathy?
|
Reduced sensation w/ monofilament/waardenberg; loss of pain/sharp touch to mid-calf level; diminished/absent distal pulsse & ankle/knee reflexes; no vibratory sensation below knees, also temp; distal muscle weakness, cant stand on heels/toes; skin ulcerations
|
|
|
What is cerebral palsy?
|
Permanent disorder of movement and posture development associated with nonprogressive (static) disturbances that occured in the developing fetal or infant brain
|
|
|
What causes CP?
|
Injury to the immature periventricular white matter in fetuses and premature infants
|
|
|
What else causes CP?
|
Brain insult from complications of being a preeme; prenatal, perinatal, genetic factors; viral infection of fetus
|
|
|
What are the symptoms of CP?
|
Delay in gross motor dev; activity limitation; hearing, speech, language disorders; feeding difficulties; seizures
|
|
|
What are the signs of CP?
|
Mental retardation; learning disabilities
|
|
|
What is spastic CP?
|
hypertonicity, tremors, scissor gait, toe walking; persistent primitive reflexes, exaggerated DTRs
|
|
|
What is dyskinetic CP?
|
involuntary slow writhing movements of the extremities; tremors present; exaggerated posturing; inconsistent muscle tone that changes throughout the day
|
|
|
What is ataxic CP?
|
Abnormalities of movement involving balance and position of trunk/extremities; intention tremors; past pointing; variation in muscle tone; hypotonia as infant; instability & wide-based gait
|
|
|
What is myelomeningocele?
|
Spina bifida: congenital defect of vertebrae that allows a meningeal sac filled with SC to protrude
|
|
|
What causes SB?
|
Unknown: excessive use of alcohol, meds for seizures/acne, genetic factors, maternal nutrition
|
|
|
When does SB occur?
|
.4 to 1.43 per 1000 live births in US; declining with folic acid supplementation
|
|
|
What are the symptoms of SB?
|
Loss of bowel control/constipation; urinary incontinence/retention; mobility problems
|
|
|
When is the exposed sac apparent in SB?
|
At birth
|
|
|
Where is sensory deficit and paralyis/weakness present in SB?
|
Depends on level of defect - higher the defect, greater the dysfunction; may not be symmetric
|
|
|
What are the associated symptoms of SB?
|
Increasing head circumference = hydrocephalus; hip/foot abnormalities; learning/motor disabilities
|
|
|
What age baby usually sufferes from shaken baby syndrome?
|
Under 1 year of age
|
|
|
What happens in shaken baby syndrome?
|
Brain moves around in head => tears nerve tissue and BVs => brain damage/ subdural hematoma/ SC damage with head movement
|
|
|
What are the sings of shaken baby?
|
Fever, irritability, lethargy, decreased food intake, breathing difficulty/apnea, seizure, losso of conciousness
|
|
|
What alerts the physician to shaken baby syndrome?
|
BL rentinal hemorrhages with retinal detachments/folds; no truama to head but fingerprint bruises present; bite marks/burns/bruising
|
|
|
What does a CT scan show in shaken baby?
|
Subdural/subarachnoid hemorrhage
|
|
|
What can an Xray reveal about shaken baby?
|
Old/new fractures of long bones/ribs
|
|
|
What is intrapartum maternal lumboscaral plexopathy?
|
Neuropathy that occurs duirng late pregnancy and early delivery
|
|
|
Where does IMLP occur?
|
Lumbosacral trunk/ superior gluteal/ obturator nerves => get compressed between maternal pelvic rim and fetal head
|
|
|
What are the symptoms of IMLP?
|
Intermittent pain radiation from butt to leg during late pregnancy. Mom too small; mom has prolonged labor; foot drop after birth
|
|
|
What distribution of pain is a sign of IMLP?
|
Lumbar 5
|
|
|
How long does IMLP last?
|
Foot drop may take weeks to resolve
|
|
|
What causes parkinsons disease?
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Hx of encephalitis, drug use, CV disease, genetic, environmental, viral, vascular, toxic
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Who gets PD?
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Over 50 y
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What are the symptoms of PD?
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Tremor (unilateral) at rest and with fatigue; intended movement and sleep resolve tremor; pill orlling BL of fingers; head tremor; slowing of voluntary/automatic movements; numbness, aching, tingling, muscle soreness
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What findings are there in someone with PD?
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Tremor, rigidity, stooped posture, instability, short-shuffeling-freezing gait; difficultly swallowing; drooling; sweating; voice softens; slurred, monotonous speech; impaired cognition => dementia
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What is normal pressure hydrocephalus?
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Syndrome simulating degenerative disease that is caused by noncommunicating hydrocephalus => dilated ventricles with normal ICP
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What causes NP hydrocephalus?
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Slightly elevated baseline CSF; increased CSF pressure waves OR compression of brain tissue, dcreased cerebral blood flow lead to signs/symptoms
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What are the symptoms in NP hydrocephalus?
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Gait impairment = 1st symptom! unsteadyness, difficulty turning; cognitive impairment; urinary freq => incontinence
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What are the findings in NP hydrocephalus?
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Gait impariment, wide based stance, short small steps, reduced clearance during foot swing; NO tremor/sensory impairment; executive fxn IS impaired
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What is postpolio syndorme?
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Reappearance of neuro signs in survivors of polio epidemics
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What makes postpolio syndrome happen?
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Damaged neurons sent out axonal links during recovery to activate muscle fibers where neurons were killed by the virus => remaining motor neurons activated many more muscle fibers than they could handle => overloaded/damaged neurons died => recurrance of polio symptoms
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What are the symptoms of postpolio syndrome?
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Hx of polio in 1950s; reduced muscle strength; increased pain sensitivity; fatigue; need to use assistive devices for mobility; sleep apnea; dysphagia
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