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165 Cards in this Set
- Front
- Back
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Volume of skull
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1500mL
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Function of scalp
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moves freely to protect and cushion the head from traumatic injury
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Layers of meninges
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dura mater (outer)
arachnoid mater (middle) pia mater (inner) |
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Name of space below dura mater
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subdural space
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Space below arachnoid mater and function
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subarachnoid space
CSF is circulated and arachnoid villi which project into the subarachnoid space absorb CSF |
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Composition and function of pia mater
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thin and vascular
helps form choroid plexuses which are located in the ventricles of brain and form CSF |
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What divides the left and right hemispheres of the cerebrum?
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longitudinal fissure
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what links the L and R hemisphere?
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corpus callosum
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Composition and function of cerebral cortex
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grey matter
higher cognitive functioning: memory storage and recall, conscious understanding of sensation, vision, hearing, and motor function |
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function and location of basal ganglia
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deep within cerebral hemispheres, work with cerebral cortex and cerebellum to regulate motor activity
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Lobes of the cerebral hemispheres
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frontal
parietal temporal occipital |
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What is the limbic lobe involved in?
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emotional behaviour
self-preservation |
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Components of the diencephalon
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thalamus
epithalamus hypothalamus |
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What is the middle part of the cerebellum called and what does it do?
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vermis
maintenance of posture and equilibrium |
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Which side of the body does each cerebellar hemisphere control?
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ipsilateral - same side
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components of the brain stem
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midbrain
pons medulla oblongata |
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function of ascending RAS (reticular activating system)
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arousal from sleep
maintaining attention perception of sensory output |
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What does the medulla oblongata control?
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sneezing
coughing swallowing vomiting centres that regulate respiratory and CV systems |
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Which cranial nerve nuclei are located in the midbrain?
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III - oculomotor
IV - trochlear |
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Which cranial nerve nuclei are located in the pons?
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V - trigeminal
VI - abducens VII - facial VIII - acoustic |
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Which cranial nerve nuclei are located in the medulla?
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IX - glossopharyngeal
X - vagus XI - spinal accessory XII - hypoglossal |
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Matter inside SC
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grey in shape of H surrounded by white matter
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Parts of the "H" of grey matter in the SC
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posterior - dorsal horn
anterior - ventral horn also small lumbar horns in thoracic and upper lumbar sections |
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What do the ventral and dorsal horns contain?
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ventral - cell bodies of motor neurons (efferent) which send axons into the spinal nerves and innervate skeletal muscles
dorsal - cell bodies of sensory (afferent) neurons which receive and transmit sensory messages from the afferent fibres in the spinal nerve |
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motor pathways in the CNS
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corticospinal/ pyramidal tract
extrapyramidal tract cerebellum |
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Describe the pyramidal tract
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- from motor area of the cerebral cortex through midbrain, pons, medulla
- at medulla 90% of fibres cross to travel down opposite side of spinal cord becoming the lateral corticospinal tract and synapse in the anterior horn -the remaining travel down the anterior corticospinal tract |
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Describe the extrapyramidal tract
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- all motor neurons in the motor cortex, basal ganglia, brain stem, and spinal cord that are outside the corticospinal tract
-responsible for controlling body movement and controlling muscle tone |
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Types of sensory afferent neurons
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somatic afferent - originate in skeletal muscles, joints, tendons, skin
Visceral afferent - originate in viscera both carry impulses from external and internal environments to CNS |
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Blood supply to the brain
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TO the brain
internal carotid (anterior circulation) vertebral arteries (posterior circulation) Circle of Willis at the base of the brain which links anterior and posterior blood supply |
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How many spinal nerves are there and what is the distribution?
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31
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal |
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Where do the spinal nerves sit in relation to the vertebrae?
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cervical sit one above, the rest sit one below
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Cranial Nerves
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I - Olfactory
II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducens VII - Facial VIII - Acoustic IX - Glossopharyngeal X - Vagus XI - Spinal Accessory XII - Hypoglossal |
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Which cranial nerves are sensory, motor, or both? What is the mnemonic?
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Some Say Marry Money But My Brother Says Bad Business Marry Money
I - S II - S III - M IV - M V - B VI - M VII - B VIII - S IX - B X - B XI - M XII - M |
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Classes of reflexes
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Muscle stretch/deep tendon reflexes
superficial reflexes pathological reflexes |
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Health History: Age
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MS (20-40)
Myasthenia gravis (20-30) Fibromyalgia (25-50) Syringomyelia (30) Huntington's chorea (30-40) Parkinson's disease (>50) Alzheimer's disease (middle-old age) |
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Health History: Female
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MS
myasthenia gravis meningiomas pseudotumour cerebr migraines fibromyalgia |
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Health History: Male
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C-Spine injuries
cluster headache dyslexia |
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Health History: Caucasian
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MS
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Health History: jewish
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Tay-Sachs
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Health History: aboriginal, black, hispanic, south asian
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risk for conditions that lead to stroke
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Health History: Chief concern
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headache
seizure syncope pain paresthesia gait disturbances visual changes vertigo memory disorders difficulty swallowing or speaking |
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Health History: Medical history neuro specific
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ALS, MS, tumours, Guillain-Barre, cerebral aneurysm, AVM, stroke, migraine, alzheimers, muasthenia gravis, congential defects, metabolic disorders, childhood seizures, head trauma, neuropathies, peripheral vascular disease, Parkinson's
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Health History: Medical history non-neuro specific
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HTN
Heart disease cardiac surgery invasive procedures diabetes mellitus leukemia hypoglycemia |
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Health History: Medications
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anti-depressants
antiseizure narcotics antianxiety antipsychotic |
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Health History: Communicable diseases
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encephalitis
meningitis or poliomyelitis AIDS dementia botulism syphilis cat scratch disease rickettsial infections toxoplasmosis |
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Health History: Family History
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congenital defects
hydrocephalus AVM headaches epilepsy Alzheimer's Huntington's MD lipid storage diseases Gaucher's disease Niemann-Pick's disease |
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Neurological Assessment Components
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level of consciousness
mental status sensory system cranial nerves motor system and cerebellar function reflexes |
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components of mental status assessment
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Posture and movements
Dress, grooming, personal hygiene Facial expression Affect Communication LOC Attention Memory Judgement Insight Spatial perception calculation abstract reasoning thought process and content suicidal ideation mental illness |
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Assessing physical appearance and behaviour & normal findings
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posture and movements
-ability to wait patiently -note if posture is relaxed, slumped, or stiff -observe movements for control and symmetry -observe gait normal findings: patient appears relaxed with appropriate amount of concern for the assessment. Erect posture, smooth gait, symmetrical body movements Dress, grroming, personal hygiene - cleanliness, condition, age appropriateness, weather appropriateness, appropriateness for socioeconomic group of clothing; observe personal grooming for adequacy, symmetry, odour Normal: clean and well groomed, appropriate clothing for age, weather, SES Facial expression - appropriateness of, variations in, symmetry of normal: facial expressions appropriate to the content of the conversation, symmetrical Affect - verbal and non-verbal behavious, variations in affect with topic, any extreme emotional responses during the interview Normal: appropriateness and degree of affect vary with topics and cultural norms |
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What could restlessness, tenseness, and pacing indicate?
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metabolic disorders
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Assessing communication skills & normal findings
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voice quality
articulation, fluency, rate of speech ability to carry out requests reading ability spelling, grammatical accuracy, logical thought process normal: able to produce spontaneous, coherent speech. speech has effortless flow with normal inflections, volume, pitch, articulation, rate, rhythm. content makes sense. language comprehension in tact. ability to read and write matches education level |
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aphasia
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impairment of language functioning
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relationship between handedness and language testing
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handedness and cerebral dominance are closely allied - patients with dominant hemisphere lesions will frequently show communication abnormalities
ex. right handed aphasia almost always indicates left-hemisphere pathology |
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dysphonia risks
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impaired laryngeal speech that can progress to aphonia (total loss of voice) caused by lesions of CN X or swelling and inflammation of larynx
at high risk for dysphagia and therefore aspiration |
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dysarthria
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disturbance in muscular control due to ischemia of affecting motor nuclei of CN X and XII, defects in premotor or motor cortex that provide major input for the face, throat, mouth, or cerebellar disease
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apraxia
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inability to convert intended speech into the motor act of speech - due to dysfunction of precentral gyrus of frontal lobe
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agraphia
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loss of ability to write
caused by lesions of Broca`s and Wericke`s areas in dominant side of brain |
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Alexia
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inability to grasp meaning of written words and sentences, due to a lesion of the angular gyrus and the occipital lobe
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What does the reticular activating system do?
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controls arousal by activating the cortex after receiving stimuli from the somatic and special sensory pathways
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What controls awareness?
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cerebral cortex - interprets incoming sensory stimuli
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Assessing LOC
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1) observe patient's eyes when entering the room and note whether they are open or if they open when you enter, note patient's response to any general environmental stimuli
2) if eyes are closed, call our patient's name and look for eves opening, if responds verbally, if follows verbal commands 3) if no response to verbal, shake gently or lightly touch 4) painful stimulus - apply pressure with pen to nailbed of each extremity or firmly pinch trapezius or apply pressure to supraorbital ridge or manubrium 5) observe for response to pain, if patient can localize it - check strength, any verbal response 6) assess orientation - person, place, time 7) determine GCS score |
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components of Glasgow Coma Scale
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eye opening
verbal response motor response |
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AVPU
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used in emergencies
alert, pain, voice, unresponsive |
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Scoring of GCS
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15 - highest
14 - confusion 13-14 - lethargy 12-13 - stupor 8-10 - permanent vegetative state 6 - locked-in syndrome 3-6 - coma 3 - lowest, brain death |
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components of cognitive abilities and mentation
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attention
memory judgement insight spatial perception calculation abstraction thought processes thought content |
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Mini Mental State Exam
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tool for assessing cognitive mental status, detecting impairment, following the course of an illness, monitoring response to treatment - most useful in screening for delirium and dementia
contains 11 cognitive taks and takes 5-10 mins max score is 30 and scores >24 are considered within normal range |
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Assessing attention
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pronounce a list of numbers slowly increasing amount - ask to repeat backward and forward
serial 7s serial 3s normal - repeat number sequences, be able to do serial numbers into 40s or 50s from 100 within 1 minute |
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What can impair attention?
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dementia, neurological injury, mental retardation
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Assessing memory
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give list of 3 items for patient to remember and repeat right away and repeat in 5 mins
long term recall - name of spouse, spouse's bday, mother's maiden name, etc. |
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What could cause memory loss?
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nervous system infection
trauma stroke tumours Alzheimer's seizure disorders alcohol drug toxicity |
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Assessing judgement
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assess whether responding appropriately to situations that are discussed, whether decisions are made on sound reasoning and decision making, present hypothetical situations, interview patient's family or observe patient
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Assessing insight
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ask patient to describe personal health status, reason for seeking care, symptoms, current life situation, etc.
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What can abnormal perceptions of self indicate?
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euphoric stages of bipolar affective disorders, endogenous anxiety states, depressed states
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assessing spatial perception
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copy figures previously drawn
draw clock face ask patient to identify familiar sound while keeping eyes shut have patient identify left from right body parts |
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agnosia
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inability to recognize the form and nature of objects or persons - can be visual, auditory, or somatosensory - can be caused by lesions
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apraxia
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inability to perform purposeful movements despite preservation of motor ability and sensation
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constructional apraxia
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inability to reproduce figures on paper
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Assessing calculation
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serial 7s
adding 100+ 3 +3... should be able to calculate correct numbers within educational abilities and with fewer than 3-4 errors in less than 1 1/2 mins |
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dyscalculia
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inability to perform calculations
-may be caused by depression, anxiety, dementia, mental retardation |
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assessing abstract reasoning
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ask patient to describe the meaning of a familiar fable, proverb, or metaphor - make sure meaningful in patient's culture and langauge
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assessing thought process and content
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observe pattern of thought for relevance, consistency, coherence, logic, organization
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confabulation
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making up answers unrelated to facts - often related to aging, memory loss, disorientation, psychopathic disorders
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echolalia
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involuntary repetition of a word or sentence uttered by another person - dementia, schizophrenics
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Neologism
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a word coined by the patient that is only meaningful to the patient - schizophrenic, delirious
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suicide rate in canada
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men 19.5/100,000
women 5.1/100,000 |
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2nd leading cause of death in youth 10-24
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suicide
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who is more likely to commit suicide in Canada?
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natives
inuit |
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Who is least likely to commit suicide in Canada?
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immigrants who move into tight knit communities in urban centers
farm operators |
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risk factors for suicide
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male (more success)
female (more attempts) aboriginal, gay, lesbian teens (depending on community and self-esteem) prior suicide attempts family member with attempt history drug abuse mental illness unwillingness to seek help because of stigma barriers to accessing mental health treatment stressful life events or loss feeling isolated and hopeless easy access to lethal methods suicidal ideation with or without a plan |
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10 Warning signs of Alzheimer's Disease
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memory loss that affects day-to-day function
difficulty performing familiar tasks problems with language disorientation of time and place poor or decreased judgement problems with abstract thinking misplacing things changes in mood and behaviour changes in personality loss of initiative |
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Depression acronym
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IN - interest
S-sleep disturbance A-appetite change D- depressed mood C- concentration difficulties A-activity level G-guilt feelings (low self-esteem) E- energy loss S - suicidal ideation |
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Components of sensory assessment
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exteroceptive sensation
-light touch -superficial pain -temperature Proprioceptive sensation -motion and position -vibration Cortical Sensation -stereognosis -graphesthesia -2-point discrimination -extinction |
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anesthesia
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absence of touch sensation
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dysesthesia
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abnormal interpretation of a stimulus such as burning or tingling from a stimulus such as touch or superficial pain
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analgesia
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insensitivity to pain
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abbreviated cranial nerve screening
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II
III IV VI VII VIII IX X XII |
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Testing Cranial Nerve I
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ask patient to close eyes
occlude one nostril at a time and inhale deeply to cause odour to surround mucous membranes present one odour at a time and alternate from nostril to nostril - note any differences between right and left nostril |
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ansomia
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loss of sense of smell
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Testing Cranial Nerve II
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visual acuity
visual fields funduscopic examination |
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Testing Cranial Nerve III
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cardinal fields of gaze
eyelid elevation pupil reactions |
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Testing Cranial Nerve III
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Cardinal fields of gaze
eyelid elevation pupil reactions (direct, consensual, accommodation) |
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Testing Cranial Nerve IV
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cardinal fields of gaze
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doll's eyes phenomenon
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assess in unconscious patient
tests intactness of the vestibular and oculomotor pathways hold eyelids open and rotate head from centre to one side and then opposite side and look for eye movement eyes should deviate opposite of direction of head - if remain fixed the patient exhibits doll's eyes phenomenon due to low brainstem lesions |
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Testing Cranial Nerve V
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motor
-clench jaw, palpate temporalis and masseter muscles -move jaw from side to side against resistance -test muscles of mastication - bite on tongue blade -observe for fasciculation, note bulk, contour, tone of muscles of mastication sensory -light touch -superficial pain -temperature -corneal reflex |
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what should normal results of testing corneal reflex be?
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bilateral blinking
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Testing Cranial Nerve VI
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cardinal fields of gaze
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Testing Cranial Nerve VII
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motor
-observing for symmetry, mobility, one-sided blinking -frown, smile, whistle, purse lips, keep eyes closed against resistance, raise eyebrows, wrinkle forehead, puff out cheeks against resistance Sensory -taste test -tip for salty and sweet borders and tip for sour, back and soft palate for bitter taste |
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Testing Cranial Nerve VIII
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cochlear division
-Hearing -Rinne and Weber Tests Vestibular Division -during history ask if vertigo is experienced, note any evidence of equilibrium disturbances, note presence of nystagmus |
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Testing Cranial Nerve XI & X
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-examine soft palate and uvula movement, gag reflex
-quality of speech for nasal quality or hoarseness -gutteral and palatal sounds -ability to swallow a small amount of water -sensory: taste on posterior 1/3 of tongue |
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Testing Cranial Nerve XI
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-inspect SCM for contour, volume, fasciculations
-strength of SCM -palpate SCM for strength and contraction, inspect, compare both sides -shrug shoulders against resistance -observe movements and palpate the contraction of the trapezius muscles - compare the strength of the 2 sides |
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Testing Cranial Nerve XII
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assess tongue movement
assess lingual sounds - lalala |
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Decerebrate Rigidity
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rigidity and sustained contraction of extensor muscles. Arms are adducted, extended, and hyperpronated. Legs are stiffly extended and feet plantar flexed. Back and neck may be arched and teeth clenched
-found in unconscious patients with deep, bilateral, diencephalic injury that progresses to midbrain dysfunction -may be caused by severe metabolic disorders |
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Decorticate Rigidity
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characterized by hyperflexion of the arms, hyperextension and internal rotation of the legs, plantar flexion
-found in unconscious patients with cerebral hemisphere lesions that interfere with the corticospinal tract |
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what can pronator drift indicate?
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hemiparesis such as in stroke
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3 syndromes of incoordination
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cerebellar
vestibular posterior column |
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station
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refers to the patient's posture
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dyssynergy
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lack of coordinated action of the muscle groups - movements are jerky, uncoordinated, irregular
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dysmetria
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impaired judgement of distance, range, speed, and force of movement - misjudge distance and overshoot
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dysdiadochokinesia
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inability to perform rapid alternating movements - unable to abruptly stop one movement and begin another opposite movement
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what causes abnormal findings in coordination?
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cerebellar disease
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what does a positive Romberg test indicate?
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cerebellar disease - unsteady with eyes open and closed
posterior column disease with proprioceptive loss - patient becomes more unsteady with eye closure |
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Grading of DTRs
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1+ present but diminished
2+ normal 3+ mildly increased but not pathological 4+ markedly hyperactive, clonus may be present |
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Deep tendon reflex reinforcement
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distract conscious thought of the DTR by concentrating on another action - ex. clenching teeth, grasping thigh, pulling on wrists
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Deep tendon reflexes
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brachioradialis
biceps triceps patellar achilles |
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where is the innervation of the brachioradialis reflex
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through the radial nerve, C5, C6
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where is the innervation of the biceps reflex
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musculocutaneous nerve, C5, C6
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where is the innervation of the triceps reflex
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through radial nerve, c7, C8
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where is the innervation of the patellar reflex?
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innervation through femoral nerve, innervates L2, L3, L4
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where is the innervation of the achilles reflex?
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innervation through tibial nerve, segmental innervation of L5, S1, S2
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Superficial reflexes
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abdominal
plantar |
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where is the innervation of the abdominal reflex?
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upper - through the intercostal nerves, through T7, T8, T9
lower - lower intercostal, iliohypogastiric, ilioinguinal nerves, T10, 11, 12 |
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where is the innervation of the plantar reflex?
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innervated by tibial nerve and segmental innervation of L5, S1, S2
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pathological reflexes
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glabellar
clonus babinski |
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Glabellar reflex
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tap forehead between eyebrows - observe for hyperactive blinking
-presence indicates lesions of corticobulbar pathways from cortex to pons, Parkinson's, glioblastoma of the corpus callosum |
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Clonus Reflex
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-support supine patient's knee in a slightly flexed position, quickly dorsiflex foot and keep it there
-assess for clonus - rhythmic oscillation of involuntary muscle contraction -indicates upper motor neuron disease women with preeclampsia can also have it |
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Babinski reflex
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stroke foot with handle of reflex hammer
-normal reflec in intants and toddlers in 15-18 months of age -positive reflex when toe`s abduct (fan) and great toe dorsiflexes -demonstrated when lesions in the pyramidal system (stroke or trauma) |
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Signs of Meningeal Irritation
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Nuchal rigidity - flex neck
Kernig's sign - try to extend flexed leg Brudinski's sign - one hand under neck, other on chest, prevent elevation of body when neck is flexed |
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Gerontological variations
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-increased risk for ishemic brain injuries - decreased mental acuity, sensory perception, motor ability
-cognitive changes - decreased short term memory, increased time to process info -some neuronal degeneration - slower response -decreased neurotransmitter production - affects sleep, temperature, mood -sensory alterations - proprioception balance and coordination, vision, hearing |
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Abnormal GCS findings
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-no eye opening to verbal or painful stimuli
-unresponsive to commands -responsive but confused -not oriented to time/place/person -hemiplegia -decroticate rigidity -decerebrate rigidity |
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illusion
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false perception; mistaking something for what it is not
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delusion
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false belief or judgement despite contrary evidence
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hallucination
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false sensory perception, strong perception of an object when no such object is present
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circumlocution
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substitute word/phrase for word you cannot think of
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perseveration
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persistently repeat word or idea
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blocking
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lose thought
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clanging
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- word sounds, not meaning
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Abnormal thought processes
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lack of meaningful connection - loose associations, flight of ideas, incoherence, neologisms
-echolalia -clanging - circumstantiality, blocking, confabulation, perseveration |
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Thought content abnormalities
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compulsions
obsessions phobias anxieties feeling of unreality feelings of depersonalization delusions |
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if you suspect someone is suicidal, you should assess...
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-thinking about it
-how they would do it (the more concrete the plan, the more likely they will do it) |
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Common or concerning symptoms re: mental status
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changes in attention, mood, speech
changes in insight, judgement, orientation, memory anxiety, panic, ritualistic behaviour delirium or dementia |
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Meningitis
-what it is -etiology -peak times -most at risk -early symptoms -late symptoms -signs of ICP |
-what it is: acute inflammation of meninges and spinal cord
-etiology: bacterial and viral, bacterial is an emergency and if untreated it is almost always fatal. Spread by respiratory secretions from infected persons through upper resp. tract or blood stream -peak times: winter and spring -most at risk: infants, adolescents, young adults, elderly -early symptoms: chills, fever, headache, malaise, rash, petechial hemorrhage on skin and mucus membrane -late symptoms: severe headache accompanied by nausea and vomiting. Photophobia, dec. LOC, inc. ICP due to inc. CSF and blocked absorption -signs of ICP: headache, dec. LOC, ocular signs, dec. motor function - hemiparesis, hemiplegia, change in VS |
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complications of meningitis
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permanent hearing loss
blindness ptosis facial paresis (incomplete paralysis) dysphagia |
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Blood supply
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internal carotid arteries
vertebral arteries cerebral arteries circle of willis |
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TIA
-definition -signs and symptoms |
-definition: temporary loss of function due to ischemia in a region of the brain possibly from microemboli. Lasts 15 mins to 24 hours
-signs and symptoms:depends on area of brain affected - may include temporary loss of vision, transient hemiparesis, unilateral or bilateral numbness, weakness or loss of sensation, sudden difficulty speaking, tinnitus, vertigo |
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Modifiable risk factors for stroke
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cardiovascular disease
smoking sleep apnea diabetes mellitus high dose oral contraceptive overweight/high cholesterol excess alcohol intake hypercoagulation factors |
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Non-modifiable risk factors for stroke
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age
gender - males>females race/ethnicity - african, SE Asian, hispanic -postmenopausal |
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Types of cerebrovascular accident
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ischemic - thombotic or embolic
hemorrhagic - intracerebral or subarachnoid |
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clinical manifestations of cerebrovascular accident
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varies with affected area
impaired motor function, difficulty controlling emotions and communicating, impaired memory and judgement, alterations in spatial-perceptual function elimination |
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effects of stroke on motor function
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loss of skilled voluntary movement, coordination, muscle tone and reflexes (initial hyporeflexia followed by hyperreflexia later), contralateral weakness and paralysis, flaccid or spastic muscles, internal rotation of shoulder and external rotation of hips
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effects of stroke on communication
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difficulty understanding or expressing self
-aphasia dysphasia dysarthria |
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warning signs of stroke
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sudden weakness, paralysis, numbness in face, arms, or legs
sudden dim vision or loss of vision sudden loss of speech, confusion, difficulty speaking or understanding speech unexplained sudden diziness, unsteadiness, loss of balance or coordination sudden severe headache |
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number and distribution of spinal nerves
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31 pairs
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal |
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common chief complaints
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headache
seizure syncope pain paresthesia gait disturbances visual changes vertigo memory disorders difficulty swallowing or speaking |
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Causes of migraines
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neurological, vascular, hormonal
often diet related, stress, strong family history |
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typical manifestations of migraines
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aura
unilateral or bilateral facial weakness or numbness photosensitivity, irritability, pallor throbbing unilateral or bilateral pain |
