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94 Cards in this Set
- Front
- Back
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Cerebellum
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-motor coordination of voluntary movements, equilibrium and muscle tone
-does not initiate mvmt, but coordinates and smooths -ex: many muscles needed in piano, swimming, juggling -test with balance, gait, tandem walking, RAM, finger to finger, finger to nose, heel to shin |
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Spinothalamic Tract
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-transmit pain, temp and crude or light touch (not precisely localized)
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Posterior (dorsal) columns
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-proprioception, vibration, finely localized touch (stereognosis)
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CN 1
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-Olfactory
-Smell -Sensory |
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CN 2
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-Optic
-Vision -Sensory |
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CN 3
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-Oculomotor
-Most EOM mvmt (motor) -parasympathetic pupil constriction and lens shape -Mixed |
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CN 4
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-Trochlear
-Down and inward mvmt of eye -Motor |
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CN 5
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-Trigeminal
-Mastication muscles (motor) -Sensation of face/scalp (sensory) -Corneal reflex -Mixed |
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CN 6
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-Abducens
-Lateral mvmt of eye -Motor |
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CN 7
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-Facial
-Facial muscles (motor) -Taste on anterior (sensory) -Parasympathetic saliva and tear secretion -Mixed |
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CN 8
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-Acoustic
-Hearing and equilibrium -Sensory |
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CN 9
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-Glossopharyngeal
-Pharynx (motor) -Taste on posterior (sensory) - can't test -Parasympathetic parotid gland, carotid reflex -Mixed |
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CN 10
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-Vagus
-Pharynx/Larynx talking/swallowing (motor) -General sensation (sensory) -Parasympathetic carotid reflex -Mixed |
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CN 11
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-Spinal
-Trapezius and sternomastoid mvmt -Motor |
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CN 12
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-Hypoglossal
-Tongue (light, tight, dynamite) -Motor |
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Spinal Nerves
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-31 pairs
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Romberg test
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-Stand, close eyes
-positive sign is loss of balance -Cerebellar ataxia (MS, alcohol), loss of proprioception, loss vestibular function |
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Testing spinothalamic tract
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pain (sharp vs. soft), temperature, light touch
-analgesia, anesthesia |
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Testing Posterior Column tract
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Vibration, kinesthesia (move finger up or down), sterognosis, graphesthesia, two point descrimintation, extinction, point location
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Paresis
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weakness rather than paralysis
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Myoclonus
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-rapid, sudden jerk
-hiccup, arm or leg jerk while falling asleep -severe with grand mal seizures |
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Essential tremor
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type of intention tremor, most common tremor with older people
-benign, not associated with disease, but stress -improves with sedatives, alcohol |
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Athetosis
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-Slow, twisting, writhing, snake/worm
-cerebral palsy |
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Decorticate Rigidity
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-Flexion of arm, adduction of arm, extension & internal rotation of leg
-lesion of cerebral cortex |
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Decerebrate Ridigity
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-Extension, aduction, internal rotation of arms, extension of legs, teeth clenched, hyperextended back
-more ominous -lesion in brainstem |
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Thumb, middle finger and 5th finger
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C6. C7. C8
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axilla
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T1
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nipple
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T4 (5th ICS)
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umbilicus
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T10
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Groin
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L1
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Knee
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L4
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4th most common cause of death in US
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Stroke
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Sequence for complete neurologic exam
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1. Mental Status
2. Cranial nerves 3. motor system 4. Sensory system 5. Reflexes |
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DTR grading
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4 - very brisk
3 - brisker (normal patellar) 2 - average, normal 1 - dimished 0 - no response |
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Cremasteric reflex
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elevation of the ipsilateral testical
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Key sign with alzheimer's
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memory loss
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Anosmia
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loss of smell
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Visual acuity
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tests for defect or absent central vision
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Fasciculation
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-Twitching
occurs with cold exporsure or fatigue -not significant |
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Tremor
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involuntary contraction of opposing muscle groups
all disappear while sleeping |
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Rest tremor
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-when muscles are quiet and -supported against gravity
course and slow -"pill rolling" parkinsonism |
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Intention tremor
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cerebellar disease and MS
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Festinating
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-posture stooped, trunk pitched forward
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Kernig
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-flat supine, raise leg straight or flex thigh on abdomen, and extend knee
-resistance to straightening (hamstring spasm) -Menigitis |
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Brudzinski
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-one hand under neck, hand on chest, flex chin on chest
-flexion of hips -meningitis |
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Ptosis
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* positional defect gives sleepy appearance and impairs vision * causes - neuromuscular weakness (myasthenia gravis) - CN 3 dysfunction - Horner syndrome (sympathetic nerve damage) - |
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neurogenic anosmia
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unilateral loss of smell (in absence of nasal disease) |
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abnormalities for CN 2
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visual field loss papilledema w/ increased ICP optic atrophy (decreases visual acuity, color vision and contrast sensitivity) |
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pupil abnormalities
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increasing ICP causes sudden unilateral, dilated nonreactive pupil |
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strabismus
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deviated gaze limited movement (inward/outward turning of eye) |
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abnormalities of CN 5
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MOTOR decreased strength on one or both sides asymmetry in jaw movement pain with clenching of teeth SENSORY decrease/unequal sensation in stroke, sensation lost on opposite side |
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abnormalities of CN 7
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muscle weakness (lower eyelid sagging, escape of air from only one cheek pressed in, drooping on one side) CNS - Stroke - affects lower face on one side Peripheral system - Bell Palsy - affects upper AND lower face on one side |
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abnormalities of 9/10
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absense/asymmetry of soft palate movement or tonsillar pillar movement in stroke, dysfunction in swallowing (risk for aspiration) hoarse/brassy voice (vocal cord dysfunction) nasal twang (weak soft palate) |
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abnormalities of CN 9
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atrophy muscle weakness / paralysis occurs with stroke or after injury to peripheral nerve (ex. lymph node removal) |
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abnormalities of CN 12
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atrophy fasciculations tongue deviates to side with lesions on nerve --> deviation toward paralyzed side |
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abnormalities of motor system
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atrophy --> disuse, injury, LMN disease (polio, diabetic neuropathy) hypertrophy - with isometric exercise paresis / weakness - diminished strength paralysis / plegia - absence of strength limited ROM Pain w/ motion flaccidity (hypotonia with peripheral weakness) spasticity /rigidity - occurs with central weakness |
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types of involuntary movements
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tics tremors fasciculations myoclonus chorea athetosis |
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abnormalities of RAM (rapid alternating movement)
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lack of coordination slow, clumsy, sloppy response (dysdiadochokinesia) occurs w/ cerebellar disease |
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abnormalities of finger to finger test
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lack of coordination dysmetria - overshooting mark (occurs w/ cerebellar disorders, acute alcohol intoxication) past pointing -constant deviation to one side intention tremor when reaching to a visually directed object |
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abnormalities of finger to nose test
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misses nose when eyes closed, worse coordination occurs with cerebellar disease or alcohol intoxication |
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abnormalities of heel to shin test
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lack of coordination heel falls off shin occurs with cerebellar disease |
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abnormalities of gait
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stiff, immobile posture staggerring or reeling wide base of support lack of arm swing / rigid arms unequal rhythm of steps / foot slapping / scraping of toe of shoe ataxia - uncoordinated / unsteady gait |
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abnormalities of heel-to-toe / tandem walking
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crooked line of walk widens base to maintain balance staggering, reeling, loss of balance ataxia may appear here indicates upper motor neuron damage (multiple sclerosis, acute cerebellar dysfunction like alcohol intoxication) |
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abnormalities to tip-top / heel walk
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muscle weakness preventing this test sways, falls or widens base of feel to avoid falling |
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positive Romberg signs
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loss of balance with closed eyes (limits compensation / orientation of eyes) occurs with cerebella ataxia (multiple sclerosis, alcohol intoxication), loss of proprioception, loss of vestibular function |
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abnormalities of shallow knee bend / hop in place
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unable to perform due to weakness in quads, hip extensors
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abnormalities of sensory system
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note if distal sensory loss or specific dermatome
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abnormalities of spinothalamic test
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hypoalgesia - decreased pain sensation hyper " - increased pan sensation anal " - absent pain sensation |
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Abnormalities of ligh touch
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Hypoesthesia - decreased touch sensation hyper - increased touch sensation anes- absent touch sensation |
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abnormalities of posterior (dorsal) column tract
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unable to feel vibration occurs with peripheral neuropathy (diabetes , alcoholism) --> often 1st sensation lost p.n. worse at feet and gradually improves up the leg |
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abnormalities of kinesthesia position test
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loss of position sense
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abnormalities of tactile discrimination (fine touch test)
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problems with tactile discriminiation occur with sensory cortex or posterior column lesions |
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abnormalities of stereognosis
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inability to identify object correctly (astereognosis) occurs in sensory cortex lesions |
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abnormalities of graphesthesia
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inability to distinguish number occurs with lesion of sensory cortex |
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abnormalities of two point discrimination
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an increase in distance it normally takes to identify 2 separate points occurs with sensory cortex lesions |
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abnormalities of extinction
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recognizes only 1 stimuli occurs with sesory cortex lesion stimulus extinguishes on opposite side of lesion |
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abnormalities of point locaiton
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person cant localize sensation accurately, even with light touch occurs with sensory cortex lesion |
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abnormalities of reflexes
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clonus - set of rapid, rhythmic contractions of same muscle hyperreflexia - exaggerated reflex when monosynaptic reflex arc is released from inhibiting influece of higher cortical levels occurs with upper motor neuron lesions (stroke) hypo - absence of a reflex (lower motor prob) interruption of sensory afferents or destruction of motor efferents and anterior horn cells (spinal cord injury) |
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abnormalities of abdominal reflexes
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superficial reflexes absent (w/ pyramidal tract disease) - absent on contralateral side with stroke |
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abnormalities of L1 and L2 reflexes (cremasteric) |
absent in both UMN and LMN lesions |
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abnormalities of plantar reflect (L4 to S2)
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abnormal response - dorsiflexion (except kids) of big toe/ toe fanning (positive Babinski sign), occurs w/ UMN disease of corticospinal/pyrimidal tract |
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abnormalities of birth - 12 mo. development
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_ high pitched, shrill cry - CNS damage - persistence of reflex behavior beyond normal time - failure to attain a skill by expected time - weak, groaning cry or expiratory grunt (respiratory distress) - lethargy, hyporeactivity, hyperirritability, significant behavior change all warrant referral |
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abnormalities of motor system (infants)
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- delay in motor activity (occurs w/ brain damage, mental disability, peripheral neuromuscular damage, prolonged illness, parental neglect - postures: * frog (hips abducted, almost flat against table, externally rotated (normal only for breech) * Opisthotonos - head arches back, stiff neck, extends arms/legs (occurs w/ brain stem or meningeal irritation or kernicterus) * limb extension may occur w/ intercranial hemorrhage * any continual asymmetry occurs w/ brachial plexus palsy |
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abnormalities of spasticity (infants)
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* early sign of cerebral palsy * after releasing flexed knees, legs quickly extend and adduct, even to scissoring motion * baby also resists head flexion and extends back against hand |
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abnormalities of reach of objects (infant)
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persistent one-hand preference 18 mo and younger may indicate motor deficit on opposite side |
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abnormalities of landau reflect (infant head raise)
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head lag - limp, floppy trunk, dangling arms and legs indicates motor weakness, upper motor neuron disease, mental disability |
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abnormalities of sensory test (infants)
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unusual rapid withdrawal (hyperesthesia) occurs w/ spinal cord lesions, CNS infections, increased ICP, peritonitis NO withdrawal = decreased sensation occurs w/ decreased consciouslness, mental deficiency, spinal cord or peripheral nerve lesions |
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abnormalities of Babinski reflex (infant)
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after 2 or 2.5 y/o, fanning doesnt disappear occurs with pyramidal tract disease |
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abnormalities of tonic neck reflex
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persistance after 4 to 6 months occurs in brain damage
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abnormalities of moro reflex
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moro absense or persistence after 5 mo. indicates severe CNS injur * absence of movement in 1 arm --> fracture of humerus or clavicle and brachial nerve palsy * absense of movement in 1 leg --> lower spinal cord problem, dislocated hip * hyperactive movement (tetany or CNS infection) |
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abnormalities of stopping reflex
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extensor thrust or scissoring, crossing lower extremities
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abnormalities of motor assessment (preschool / school age)
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muscle hypertrophy or atophy (muscular dystrophy), muscle weakness incoordination-staggering, falling, weakness climbing up/downstairs (muscular dystrophy), broad based gate/scissor after 5 y/o, failure to hop --> gross motor skill incordination |
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abnormalities of pelvic muscles (PS / School age)
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weak pelvic muscles (sign of muscular dystrophy) child rolls to one side with supine bend fwd to all 4 extremities plan hands on legs, climb up themself |
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abnormalities of finger to nose test
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test failure -eyes open --> gross incoordination test failure, eyes closed --> minor incoordination |
