Introduction To Neurology I & Ii

Front 1

Basic Neurologic Exam

Back 1

1. Mental status
2. Cranial nerves I-XII
3. Motor
4. Sensory
5. Coordination
6. Parietal
7. Gait
8. Reflexes (DTRs

Front 2

Mental Status Assessment

Back 2

1. Assess patient's level of consciousness

2. Assess patient for disorientation, confusion, or a behavior abnormality

3. Assess patient for language skills

4. Perform memory testing

Front 3

Mental Status
level of consciousness

Back 3

1. Concentration
a. Is a patient alert, lethargic, stupors, or comatose?
b. Can the patient count from 20 to 1, and recite the months in reverse.
2. Lethargy
a. Patient cannot be fully awakened
3. Stupor
a. The need for painful stimuli to obtain a response
4. Coma
a. Lack of responsiveness even to painful stimuli
5. Inattention
a. Is a patient attentive to you?

Front 4

Mental Status
assessment for disorientation

Back 4

1. Behavior
a. Assess activity
- agitation
- abulia = decreased ability to act or make decisions
b. Assess emotional responses
- elation
- sadness
- anger or flattening

2. Orientation = a, place, time and situation.

Front 5

Mental Status
assessment of language

Back 5

Aphasia

1. Fluency = rate/flow of speech

2. Comprehension = 1 and 2 step commands

3. Naming = name high/low frequency objects

4. Repetition = repeat a single sentence

Front 6

Aphasias

Back 6

1. Brocha's aphasia

2. Wernicke's aphasia

3. Transcortical motor aphasia

4. Transcortical sensory aphasia

5. Global aphasia

6. Anomic aphasia

Front 7

Broca's Aphasia

Back 7

Fluency Comprehension Naming Repetition

abnormal normal abnormal abnormal


1. Can comprehend but deficient in motor output

Front 8

Wernicke's Aphasia

Back 8

Fluency Comprehension Naming Repetition

normal abnormal abnormal abnormal


1. Speak well but deficient in comprehension, naming, and repetition.

Front 9

Transcortical Motor Aphasia

Back 9

Fluency Comprehension Naming Repetition

abnormal normal abnormal normal


1. Can comprehend and repeat but deficient in fluency and naming

Front 10

Transcortical Sensory Aphasia

Back 10

Fluency Comprehension Naming Repetition

normal abnormal abnormal normal


1. Speak fluently and can repeat but deficient in comprehension and naming.

Front 11

Global Aphasia

Back 11

Fluency Comprehension Naming Repetition

abnormal abnormal abnormal abnormal


1. Deficient in fluency, comprehension, naming, and repetition.

Front 12

Anomic aphasia

Back 12

Fluency Comprehension Naming Repetition

normal normal abnormal normal


1. Can comprehend, speak fluently, and repeat but deficient in naming.

Front 13

Memory Testing

Back 13

1. Immediate memory
a. Deficits usually are result of attention
b. Can be amnesia

2. Short-term memory
a. Tested with recall of three words

3. Long-term memory
a. Tested with knowledge of events (personal/historical)

Front 14

" some say money matters but my baby says big booty matter most "

Back 14

CN I = sensory CN VII = both
CN II = sensory CN VIII = sensory
CN III = motor CN IX = both
CN IV = motor CN X = both
CN V = both CN XI = motor
CN VI = motor CN XII = motor

Front 15

CN II function and clinical testing

Back 15

Vision

1. Check fundus
2. Visual acuity
3. Visual fields
4. Color vision

Front 16

CN III Function and clinical testing

Back 16

Eyelid and eye movement

1. Check for ptosis, pupils and extraocular movements

Front 17

CN IV function and clinical testing

Back 17

1. Innervate superior oblique

2. turns eye downward and laterally

Front 18

CN V Function and clinical testing

Back 18

Chewing

Face and mouth touch and pain

Check with facial sensation and corneal reflex

Front 19

CN VI function in clinical testing

Back 19

1. Turns eye laterally check with extraocular movements.

Front 20

CN VII function and clinical testing

Back 20

controls most facial expressions, taste, and secretion of tears and saliva

Front 21

CN IX function and clinical testing

Back 21

Taste and senses carotid blood-pressure

Check gag reflex - afferent IX, efferent X

Front 22

CN X Function and clinical testing

Back 22

1. Senses aortic blood pressure

2. Slows heart rate

3. Stimulate digestive organs

4. Taste

Front 23

CN XI function and clinical testing

Back 23

1. Controls trapezius and sternocleidomastoid

2. Turns head to contralateral side

Front 24

Optic pathways examination

Back 24

1. Test by confrontation

2. Test one eye at a time

Front 25

CN 3,4,and 6

Back 25

1. CN III injury
a. Ptosis
b. Horner's syndrome = ptosis, miosis, facial anhidrosis
c. Injury to sympathetic pathways

2. Anisocoria = pupillary asymmetry

3. Fixation abnormalities
a. Nystagmus
b. Opsoclonus
c. Saccades

Front 26

Saccades

Back 26

1. Rapid intermittent eye movement, when the eye fixates on one point after another.

2. Voluntary = frontal

3. Reflexive = parietal

Front 27

Optokinetic Reflex (OKN)

Back 27

1. Allows eyes to follow objects in motion with a head remaining stationary area

Front 28

Smooth Pursuit

Back 28

1. The ability of the eyes to smoothly follow a moving object.

2. Localized to the occipital lobe

Front 29

Cranial Nerve Reflexes

Back 29

1. Corneal reflex

2. Gag reflex

Front 30

Corneal Reflex

Back 30

1. Touch the sclera = VI (afferent)

2. Eye closure = VII (efferent)

Front 31

Gag Reflex

Back 31

1. Touch posterior oropharynx = IX (afferent)

2. Gag response = X (efferent - brainstem reflex)

Front 32

Motor Examination

Back 32

1. Inspect for atrophy, and fasiculations

2. Check for hypertonia and hypotonia

3. Pronator drift

4. Rapid finger taps = fine motor

Front 33

Motor Examination Power Scale

Back 33

0 = no muscle contraction

1 = trace of contraction

2 = movement occurs in plane of gravity

3 = active movement against gravity but not resistance

4 = active movement against resistance

Front 34

Deep Tendon Reflex Scale

Back 34

0 = absent

1+ = diminished

2+ = normal

3+ = increase (may spread to adjacent muscles)

4+ = clonus

Front 35

Plantar Reflex

Back 35

1. Extension (Babinski) = abnormal

Front 36

Modalities of Primary Sensation

Back 36

1. Light touch

2. Pinprick
a. hyperalgesia = exaggerated painful sensation
b. hyperpathia = abnormal sensation

3. Temperature

4. Vibration

5. Joint position (proprioception)

Front 37

Modalities of Cortical Sensation

Back 37

1. Double simultaneous stimulation
a. Touch 2 contralateral body parts
- abnormal = parietal lobe lesion

2. Graphesthesia

3. Stereognosis

Front 38

Coordination Exam

Back 38

1. Finger to nose test

2. Rapid alternating movements
a. disruption = dysdiadochokinesis

3. Heel to shin

Front 39

Gait Examination

Back 39

1. Natural gait

2. Tandem gait

3. Toe walking

4. Heel walking

5. Romberg test

Front 40

Cortical Region

Back 40

1. Aphasia or nondominant hemispheric dysfunction

Front 41

Subcortical Region

Back 41

1. Internal capsule

2. Basal ganglia

3. Thalamic dysfunction

Front 42

Brainstem Region

Back 42

1. Cranial nerves signs often with crossed hemiplegia

Front 43

Spinal Cord Region

Back 43

1. Face not involved

2. Paralysis on the same side of the lesion

Front 44

Upper Motor Neuron Involvement

Back 44

1. Cerebral cortex

2. Brainstem

3. Spinal cord

Front 45

Lower Motor Neuron Involvement

Back 45

1. Nucleus = spinal or cranial

2. May be peripheral

Front 46

Rule #1

Back 46

Right side lesions (cerebral cortex) = left side deficit

Front 47

Rule #2

Back 47

CN VII = lesions in the cerebral cortex and brainstem

Front 48

Central VII Facial Nerve Palsy

Back 48

1. Lesion in the cerebral hemisphere

2. Involves the contralateral lower face region

Front 49

Peripheral VII Facial Nerve Palsy

Back 49

1. Involved to be entire ipsilateral face

2. Bell's palsy

Front 50

Rule #3

Back 50

Speech Centers = left hemisphere

Front 51

Rule #4

Back 51

1. + graphesthesia/stereognosis = parietal lobe - visual/spatial activities

Front 52

Rule #5

Back 52

1. Visual pathways = cortical

2. Run from the optic nerve to the occipital lobe

3. Visual fields are contralateral to the lesion

Front 53

Hemisphere Findings

Back 53

1. Contralateral weakness of arm/leg

2. Contralateral weakness of the lower face

3. Language problems = aphasia

4. Parietal findings = graphesthesia/stereognosis

5. Visual field cuts = contralateral hemianopsia

Front 54

Crossed Findings

Back 54

1. Ipsilateral CN palsy

2. Contralateral weakness

Front 55

Spinal Cord

Back 55

1. Posterior columns

2. Spinothalamic tract

3. Corticospinal tract

Front 56

Posterior Columns

Back 56

1. Fasciculus Gracilis and Cuneatus

2. Carries information about vibration and position sense

3. Cross at the lever of the lower brainstem (medulla)

Front 57

Spinothalamic Tract

Back 57

1. Transmits pain and temperature sensation

2. Crosses immediately upon entering the spinal cord

Front 58

Corticospinal Tract

Back 58

1. Carries motor fibers

2. Crosses at the level of the medulla (lower portion of the brainstem)

Front 59

Brown Sequard Syndrome

Back 59

1. Incomplete spinal cord lesion = hemi section of the spinal cord in the cervical region