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59 Cards in this Set

  • Front
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Basic Neurologic Exam
1. Mental status
2. Cranial nerves I-XII
3. Motor
4. Sensory
5. Coordination
6. Parietal
7. Gait
8. Reflexes (DTRs
Mental Status Assessment
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
Mental Status
level of consciousness
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?
Mental Status
assessment for disorientation
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.
Mental Status
assessment of language
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
Aphasias
1. Brocha's aphasia

2. Wernicke's aphasia

3. Transcortical motor aphasia

4. Transcortical sensory aphasia

5. Global aphasia

6. Anomic aphasia
Broca's Aphasia
Fluency Comprehension Naming Repetition

abnormal normal abnormal abnormal


1. Can comprehend but deficient in motor output
Wernicke's Aphasia
Fluency Comprehension Naming Repetition

normal abnormal abnormal abnormal


1. Speak well but deficient in comprehension, naming, and repetition.
Transcortical Motor Aphasia
Fluency Comprehension Naming Repetition

abnormal normal abnormal normal


1. Can comprehend and repeat but deficient in fluency and naming
Transcortical Sensory Aphasia
Fluency Comprehension Naming Repetition

normal abnormal abnormal normal


1. Speak fluently and can repeat but deficient in comprehension and naming.
Global Aphasia
Fluency Comprehension Naming Repetition

abnormal abnormal abnormal abnormal


1. Deficient in fluency, comprehension, naming, and repetition.
Anomic aphasia
Fluency Comprehension Naming Repetition

normal normal abnormal normal


1. Can comprehend, speak fluently, and repeat but deficient in naming.
Memory Testing
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)
" some say money matters but my baby says big booty matter most "
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
CN II function and clinical testing
Vision

1. Check fundus
2. Visual acuity
3. Visual fields
4. Color vision
CN III Function and clinical testing
Eyelid and eye movement

1. Check for ptosis, pupils and extraocular movements
CN IV function and clinical testing
1. Innervate superior oblique

2. turns eye downward and laterally
CN V Function and clinical testing
Chewing

Face and mouth touch and pain

Check with facial sensation and corneal reflex
CN VI function in clinical testing
1. Turns eye laterally check with extraocular movements.
CN VII function and clinical testing
controls most facial expressions, taste, and secretion of tears and saliva
CN IX function and clinical testing
Taste and senses carotid blood-pressure

Check gag reflex - afferent IX, efferent X
CN X Function and clinical testing
1. Senses aortic blood pressure

2. Slows heart rate

3. Stimulate digestive organs

4. Taste
CN XI function and clinical testing
1. Controls trapezius and sternocleidomastoid

2. Turns head to contralateral side
Optic pathways examination
1. Test by confrontation

2. Test one eye at a time
CN 3,4,and 6
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
Saccades
1. Rapid intermittent eye movement, when the eye fixates on one point after another.

2. Voluntary = frontal

3. Reflexive = parietal
Optokinetic Reflex (OKN)
1. Allows eyes to follow objects in motion with a head remaining stationary area
Smooth Pursuit
1. The ability of the eyes to smoothly follow a moving object.

2. Localized to the occipital lobe
Cranial Nerve Reflexes
1. Corneal reflex

2. Gag reflex
Corneal Reflex
1. Touch the sclera = VI (afferent)

2. Eye closure = VII (efferent)
Gag Reflex
1. Touch posterior oropharynx = IX (afferent)

2. Gag response = X (efferent - brainstem reflex)
Motor Examination
1. Inspect for atrophy, and fasiculations

2. Check for hypertonia and hypotonia

3. Pronator drift

4. Rapid finger taps = fine motor
Motor Examination Power Scale
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
Deep Tendon Reflex Scale
0 = absent

1+ = diminished

2+ = normal

3+ = increase (may spread to adjacent muscles)

4+ = clonus
Plantar Reflex
1. Extension (Babinski) = abnormal
Modalities of Primary Sensation
1. Light touch

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

3. Temperature

4. Vibration

5. Joint position (proprioception)
Modalities of Cortical Sensation
1. Double simultaneous stimulation
a. Touch 2 contralateral body parts
- abnormal = parietal lobe lesion

2. Graphesthesia

3. Stereognosis
Coordination Exam
1. Finger to nose test

2. Rapid alternating movements
a. disruption = dysdiadochokinesis

3. Heel to shin
Gait Examination
1. Natural gait

2. Tandem gait

3. Toe walking

4. Heel walking

5. Romberg test
Cortical Region
1. Aphasia or nondominant hemispheric dysfunction
Subcortical Region
1. Internal capsule

2. Basal ganglia

3. Thalamic dysfunction
Brainstem Region
1. Cranial nerves signs often with crossed hemiplegia
Spinal Cord Region
1. Face not involved

2. Paralysis on the same side of the lesion
Upper Motor Neuron Involvement
1. Cerebral cortex

2. Brainstem

3. Spinal cord
Lower Motor Neuron Involvement
1. Nucleus = spinal or cranial

2. May be peripheral
Rule #1
Right side lesions (cerebral cortex) = left side deficit
Rule #2
CN VII = lesions in the cerebral cortex and brainstem
Central VII Facial Nerve Palsy
1. Lesion in the cerebral hemisphere

2. Involves the contralateral lower face region
Peripheral VII Facial Nerve Palsy
1. Involved to be entire ipsilateral face

2. Bell's palsy
Rule #3
Speech Centers = left hemisphere
Rule #4
1. + graphesthesia/stereognosis = parietal lobe - visual/spatial activities
Rule #5
1. Visual pathways = cortical

2. Run from the optic nerve to the occipital lobe

3. Visual fields are contralateral to the lesion
Hemisphere Findings
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
Crossed Findings
1. Ipsilateral CN palsy

2. Contralateral weakness
Spinal Cord
1. Posterior columns

2. Spinothalamic tract

3. Corticospinal tract
Posterior Columns
1. Fasciculus Gracilis and Cuneatus

2. Carries information about vibration and position sense

3. Cross at the lever of the lower brainstem (medulla)
Spinothalamic Tract
1. Transmits pain and temperature sensation

2. Crosses immediately upon entering the spinal cord
Corticospinal Tract
1. Carries motor fibers

2. Crosses at the level of the medulla (lower portion of the brainstem)
Brown Sequard Syndrome
1. Incomplete spinal cord lesion = hemi section of the spinal cord in the cervical region