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262 Cards in this Set
- Front
- Back
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What Brodmann area for primary vision?
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Brodmann area 17
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How much cardiac output does the brain receive?
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15%-20% of total CO
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What arteries supply the brain?
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two internal carotid arteries and two vertebral arteries that join to form the basilar artery
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How does the blood supply of the brain drain
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venous plexuses and dural sinuses that empty into the internal jugular veins
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The internal carotid arteries supply __% and the vertebral basilar arteries supply __%.
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80% and 20%
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The gray outer layer, the ___, houses the higher mental functions and is responsible for general movement, visceral functions, perception, behavior, and the integration of these functions
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cerebral cortex
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____ interconnect the counterpart areas in each hemisphere, unifying the cerebrum's higher sensory and motor functions
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Commissural fibers (corpus callosum)
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The ___ contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements.
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frontal lobe
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The ___ tracts extend from the primary motor area into the spinal cord.
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corticospinal
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The ___ lobe is primarily responsible for processing sensory data as it is received
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parietal
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Recognition of body parts and awareness of body position (proprioception) are dependent on the ___ lobe
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parietal
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The ___ lobe contains the primary vision center and provides interpretation of visual data.
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occipital
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The ___ lobe is responsible for the perception and interpretation of sounds and determination of their source
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temporal
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reception of speech and interpretation of speech is located in ___ area
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Wernicke
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The ___ mediates the sense of smell and certain patterns of behavior (primitive behaviors, visceral response to emotional and biologic rhythms) that determine survival, such as mating, aggression, fear, and affection
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limbic system
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Interference with the physiology of the limbic system results in ___ and ___.
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distorted perception and inappropriate behavior
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The ___ aids the motor cortex of the cerebrum in the integration of voluntary movement.
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cerebellum
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Integrated with the vestibular system, the ___ uses the sensory data for reflexive control of muscle tone, equilibrium, and posture to produce steady and precise movements.
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cerebellum
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The ___ is the pathway between the cerebral cortex and the spinal cord, and it controls many involuntary functions
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brainstem
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4 structures of the brainstem
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medulla oblongata, pons, midbrain, and diencephalon
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The ____ contains a network that provides constant muscle stimulation to counteract gravitational forces and regulates cardiovascular functioning and respiration
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reticular formation
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The reticular formation has fibers that conduct impulses from below the brainstem and up into the cerebral cortex called the ____.
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reticular activating system
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The ____ is the major integrating center for perception of various sensations such as pain and temperature (along with the cortical processing for interpretation), serving as the relay center between the basal ganglia and cerebellum
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thalamus
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The ___ transmits information between the brainstem and the cerebellum, relaying motor information from the cerebral cortex to the contralateral cerebellar hemisphere
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pons
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The ____ is the site where the descending corticospinal tracts decussate (cross to the contralateral side)
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medulla oblongata
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The ____ function as the extrapyramidal system pathway and processing station between the cerebral motor cortex and the upper brainstem
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basal ganglia or cerebral nuclei
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They contribute input from visual, labyrinthine, and proprioceptive sources that allow gross intentional movement without conscious thought by exerting a fine tuning effect on motor movements
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basal ganglia
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Relays impulses between cerebrum, cerebellum, pons, and medulla
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Diencephalon
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Hormonal control of growth, lactation, vasoconstriction, and metabolism
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Pituitary gland
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CN? Sensory: smell reception and interpretation
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Olfactory (I)
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CN? Sensory: visual acuity and visual fields
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Optic (II)
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CN? Motor: raise eyelids, most extraocular movements
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Oculomotor (III)
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CN? Parasympathetic: pupillary constriction, change lens shape
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Oculomotor (III)
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CN? Motor: downward, inward eye movement
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Trochlear (IV)
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CN? Motor: jaw opening and clenching, chewing and mastication
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Trigeminal (V)
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CN? Sensory: sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, teeth, tongue, ear, facial skin
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Trigeminal (V)
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CN? Motor: lateral eye movement
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Abducens (VI)
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CN? Motor: movement of facial expression muscles except jaw, close eyelids, labial speech sounds (b, m, w, and rounded vowels)
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Facial (VII)
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CN? Sensory: taste-anterior two thirds of tongue, sensation to pharynx
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Facial (VII)
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CN? Parasympathetic: secretion of saliva and tears
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Facial (VII)
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CN? Sensory: hearing and equilibrium
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Acoustic (VIII)
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CN? Motor: voluntary muscles for swallowing and phonation
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Glossopharyngeal (IX)
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CN? Sensory: sensation of nasopharynx, gag reflex, taste-posterior one third of tongue
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Glossopharyngeal (IX)
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CN? Parasympathetic: secretion of salivary glands, carotid reflex
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Glossopharyngeal (IX)
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CN? Motor: voluntary muscles of phonation (guttural speech sounds) and swallowing
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Glossopharyngeal (IX)
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CN? Sensory: sensation behind ear and part of external ear canal
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Vagus (X)
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CN? Parasympathetic: secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract
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Vagus (X)
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CN? Motor: turn head, shrug shoulders, some actions for phonation
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Spinal accessory (XI)
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CN? Motor: tongue movement for speech sound articulation (l, t, d, n) and swallowing
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Hypoglossal (XII)
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How long is the spinal cord?
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40-50cm
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What V lvl does the spinal cord terminate at?
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L1/L2
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The myelin-coated white matter of the spinal cord contains the ___
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ascending and descending tracts
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What is the gray matter in the spinal cord?
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contains nerve cell bodies
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The ___ originate in the brain and convey impulses to various muscle groups by inhibiting or exciting spinal activity
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descending spinal tracts (corticospinal, reticulospinal, vestibulospinal)
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The ___ tract permits skilled, delicate, and purposeful movements
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corticospinal (pyramidal)
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The ___ tract causes the extensor muscles of the body to suddenly contract when an individual starts to fall
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vestibulospinal
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The ___ tract arising from the brainstem innervates the motor functions of the cranial nerves.
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corticobulbar
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The ___ spinal tracts mediate various sensations
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ascending(spinothalamic, spinocerebellar)
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The ___ column spinal tract carries the fibers for the discriminatory sensations of touch, deep pressure, vibration, position of the joints, stereognosis, and two-point discrimination.
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posterior (dorsal) (fasciculus gracilis and fasciculus cuneatus)
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The ___ tracts carry the fibers for the sensations of light and crude touch, pressure, temperature, and pain.
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spinothalamic
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___ are motor pathways that all originate and terminate within the central nervous system.
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Upper motor neurons
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Which motor tract primary role is influencing, directing, and modifying spinal reflex arcs and circuits
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Upper motor neurons
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The___, cranial and spinal motor neurons, originate in the anterior horn of the spinal cord and extend into the peripheral nervous system.
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lower motor neurons
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Injury to the upper motor neurons results in initial ___ followed by ___ over an extended period
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paralysis, partial recovery
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Injury to the lower motor neurons often results in _____ .
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permanent paralysis
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The motor or efferent fibers of the ___ root carry impulses from the spinal cord to the muscles and glands of the body
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anterior (ventral)
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The sensory or afferent fibers of the ___root carry impulses from sensory receptors of the body to the spinal cord.
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posterior (dorsal)
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The following primitive reflexes are present in the newborn: 6
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yawn, sneeze, hiccup, blink at bright light and loud sound, pupillary constriction with light, and withdrawal from painful stimuli.
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Brain growth continues until ___ of age
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12 to 15 years
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Motor maturation proceeds in a ___ direction
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cephalocaudal
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common physiologic alterations that may occur during pregnancy are
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contraction or tension headaches (worsened by postural changes and new situational problems); and acroparesthesia (numbness and tingling of the hands)
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Acroparesthesia can be worse in the __ position and severely interrupt or disrupt __
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supine, sleep
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The number of cerebral neurons is thought to decrease by __% a year beginning at 50 years of age
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1%
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The velocity of nerve impulse conduction declines __% between 30 and 90 years of age, so responses to various stimuli take longer
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10%
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When assessing patients with severe, unremitting headaches, the experienced examiner evaluates movement of the eyes for the presence or absence of____ .
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lateral (temporal) gaze.
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The ___ cranial nerve is commonly one of the first to lose function in the presence of increased intracranial pressure.
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sixth
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Muscle weakness is evidenced by one side of the ____, ___, ___.
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mouth drooping, a flattened nasolabial fold, and lower eyelid sagging
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evaluating taste, a sensory function of cranial nerves __ and ___
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VII and IX
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Vestibular function is tested by the ___ test
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Romberg
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The sensory function of taste over the posterior third of the tongue, which CN
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IX
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To evaluate nasopharyngeal sensation, tell the patient you will be testing the ___.
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gag reflex
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Which CN for lingual speech sounds (l, t, d, n)
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CN XII
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Loss of balance, a positive Romberg sign, indicates __, __, __
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cerebellar ataxia, vestibular dysfunction, or sensory loss
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The affected leg is stiff and extended with plantar flexion of the foot; movement of the foot results from pelvic tilting upward on the involved side; the foot is dragged, often scraping the toe, or it is circled stiffly outward and forward (circumduction); the affected arm remains flexed and adducted and does not swing
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Spastic hemiparesis
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The patient uses short steps, dragging the ball of the foot across the floor; the legs are extended, and the thighs tend to cross forward on each other at each step, due to injury to the pyramidal system
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Spastic diplegia (scissoring)
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The hip and knee are elevated excessively high to lift the plantar flexed foot off the ground; the foot is brought down to the floor with a slap; the patient is unable to walk on the heels
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Steppage
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The legs are kept apart, and weight is shifted from side to side in a waddling motion due to weak hip abductor muscles; the abdomen often protrudes, and lordosis is common
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Dystrophic (waddling)
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The legs are positioned far apart, lifted high and forcibly brought down with each step; the heel stamps on the ground.
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Tabetic
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The patient's feet are wide-based; staggering and lurching from side to side is often accompanied by swaying of the trunk
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Cerebellar gait (cerebellar ataxia)
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The patient's gait is wide-based; the feet are thrown forward and outward, bringing them down first on heels, then on toes; the patient watches the ground to guide his or her steps; a positive Romberg sign is present
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Sensory ataxia
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The patient's posture is stooped and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping
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Parkinsonian gait
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Jerky, dancing movements appear nondirectional.
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Dystonia
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Uncontrolled falling occurs.
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Ataxia
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The patient limits the time of weight bearing on the affected leg to limit pain.
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Antalgic limp
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Deep pressure sensation is tested by squeezing the __, __ and __ muscle
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trapezius, calf, or biceps
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Loss of sensory modalities may indicate ___
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peripheral neuropathy
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Symmetric sensory loss indicates a ___
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polyneuropathy
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Tactile agnosia, an inability to recognize objects by touch, suggests a ___ lobe lesion.
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parietal
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Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Superficial pain, Temp
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Lateral spinothalamic
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Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Superficial touch, Deep pressure, Vibration
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Anterior spinothalamic
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Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Vibration, Deep pressure, Position sense, Stereognosis, Point location, Two-point discrimination
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Posterior column
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Which ASCENDING TRACTS-FOR LOWER MOTOR NEURON DISORDERS is tested with: Proprioception
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Anterior and dorsal spinocerebellar
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Which DESCENDING TRACTS-FOR UPPER MOTOR NEURON DISORDER is tested with; Rapid rhythmic alternating movements, Voluntary movement, DTR, Plantar
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Lateral and anterior corticospinal
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Which DESCENDING TRACTS-FOR UPPER MOTOR NEURON DISORDER is tested with; Posture and Romberg, Gait, Instinctual motor reactions
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Medial and lateral reticulospinal
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Sensory loss generally less than anatomic distribution of nerve; lost sensation in central portion with a zone of partial loss due to overlap with adjacent nerves; may lose all or selected modalities of sensation.
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Single Peripheral Nerve
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Sensory loss most severe over legs and feet or over hands (i.e., glove and stocking anesthesia); change from expected to impaired sensation is gradual; usually involves all modalities of sensation.
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Multiple Peripheral Nerves (Polyneuropathy)
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Usually incomplete loss of sensation in any area of the skin when one nerve root affected; when two or more nerve roots are completely divided, there is a zone of sensory loss surrounded by partial loss; tendon reflexes may also be lost.
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Multiple Spinal Nerve Roots
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All forms of sensation are lost below the level of the lesion; loss of pain, temperature, and touch sensation occurs one to two dermatomes below the lesion.
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Complete Transverse Lesion of the Spinal Cord
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Pain and temperature sensation occur 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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Partial Spinal Sensory Syndrome (Brown-Séquard Syndrome)
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When abdominal reflexes are absent, either an___ or ___disorder should be suspected.
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upper or lower motor neuron
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Stroke the inner thigh of the male patient (proximal to distal) to elicit the cremasteric reflex.What is a normal response?
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The testicle and scrotum should rise on the stroked side
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When is Babinski sign normal?
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children younger than 2 years of age
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What does a positive Babinski sign indicate?
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pyramidal tract disease
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Absent of DTR indicates ___ or ___
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neuropathy or lower motor neuron disorder
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Hyperactivity of DTR indicates ___
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upper motor neuron disorder
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Superficial Reflex:Upper abdominal
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T7,T8, and T9
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Superficial Reflex:Lower abdominal
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T10 and T11
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Superficial Reflex:Cremasteric
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T12, L1, and L2
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Superficial Reflex:Plantar
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L4, L5, S1, and S2
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DTR: Biceps
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C5 and C6
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DTR: Brachioradial
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C5 and C6
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DTR: Triceps
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C6, C7, and C8
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DTR: Patellar
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L2, L3, and L4
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DTR: Achilles
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S1 and S2
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Muscle tone in UMN disorder
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Increased tone, muscle spasticity, risk for contractures
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Muscle atrophy in UMN disorder
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Little or no muscle atrophy, but decreased strength
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Sensation in UMN disorder
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Sensation loss may affect entire limb
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Reflex in UMN disorder
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Hyperactive deep tendon and abdominal reflexes; positive Babinski sign
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Fasciculation in UMN disorder
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No fasciculations
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Motor effect in UMN disorder
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Paralysis of voluntary movements
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Location of insult in UMN disorder
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Damage above level of brainstem affects contralateral side of body, damage below the brainstem affects the ipsilateral side of the body
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Muscle tone in LMN disorder
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Decreased tone, muscle flaccidity
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Muscle atrophy in LMN disorder
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Loss of muscle strength; muscle atrophy or wasting
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Sensation in LMN disorder
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Sensory loss following distribution of dermatomes or peripheral nerves
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Reflexes in LMN disorder
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Weak or absent deep tendon, plantar, and abdominal reflexes, absent Babinski sign, no pathologic reflexes
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Fasciculation in LMN disorder
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yes Fasciculations
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Motor effect in LMN disorder
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Paralysis of muscles
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Location of insult in LMN disorder
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Damage affects muscle on ipsilateral side of body
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When the upper motor neurons in face are affected, as in a stroke or brain attack, ___ movements are paralyzed, but ___ movements are spared
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voluntary, emotional
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In a lower motor neuron face disorder, such as Bell palsy, ____ movements on the affected side are paralyzed.
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all facial
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Expected result in Bicep reflex
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Contraction of the biceps muscle causes visible or palpable flexion of the elbow.
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Expected result in Brachioradial Reflex
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Pronation of the forearm and flexion of the elbow should occur.
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Expected result of Triceps Reflex
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Contraction of the triceps muscle causes visible or palpable extension of the elbow
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Expected result in Patellar Reflex
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Contraction of the quadriceps muscle causes extension of the lower leg.
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Expect result in Achilles Reflex
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Contraction of the gastrocnemius muscle causes plantar flexion of the foot.
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Sustained clonus is associated with ____disease.
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upper motor neuron
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What type of patient is the 5.07 monofilament used for?
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diabetes mellitus and peripheral neuropathy
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A stiff neck or nuchal rigidity is a sign associated with ___ and ___
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meningitis and intracranial hemorrhage
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Involuntary flexion of the hips and knees when flexing the neck is a positive ___ sign for ___
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Brudzinski, meningeal irritation
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Pt supine, Pain in the lower back and resistance to straightening the leg at the knee constitute a positive ___ sign, indicating ___
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Kernig, meningeal irritation
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touch one corner of the infant's mouth; the infant should open its mouth and turn its head in the direction of stimulation; if the infant has been recently fed, minimal or no response is expected
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CN V Rooting reflex
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place your finger in the infant's mouth, feeling the sucking action; the tongue should push up against your finger with good strength; note the pressure, strength, and pattern of sucking
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Sucking reflex CN V
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loudly clap your hands about 30 cm from the infant's head; avoid producing an air current; note the blink in response to the sound; no response after 2 to 3 days of age may indicate hearing problems; infant will habituate to repeated testing
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Acoustic blink reflex CN VIII
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hold the infant under the axilla in an upright position, head held steady, facing you; rotate the infant first in one direction and then in the other; the infant's eyes should turn in the direction of rotation and then the opposite direction when rotation stops; if the eyes do not move in the expected direction, suspect a vestibular problem or eye muscle paralysis.
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Doll's eye maneuver CN VIII
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Purposeful movement (e.g., reaching and grasping for objects) begins at about ___ of age
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2 months
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Hands are usually held in fists for the___ of life, but not constantly
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first 3 months
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The patellar tendon reflexes are present at ___
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birth
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Achilles and brachioradial tendon reflexes appear at ___ of age.
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6 months
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Making sure the infant's head is in midline, touch the palm of the infant's hand from the ulnar side (opposite the thumb); note the strong grasp of your finger; sucking facilitates the grasp; it should be strongest between 1 and 2 months of age and disappear by 3 months
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Palmar grasp (birth) Reflex
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Touch the plantar surface of the infant's feet at the base of the toes; the toes should curl downward; the reflex should be strong up to 8 months of age
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Plantar grasp (birth) Reflex
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With the infant supported in semisitting position, allow the head and trunk to drop back to a 30-degree angle; observe symmetric abduction and extension of the arms; fingers fan out and thumb and index finger form a C; the arms then adduct in an embracing motion followed by relaxed flexion; the legs may follow a similar pattern of response; the reflex diminishes in strength by 3 to 4 months and disappears by 6 months
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Moro (birth) Reflex
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Hold the infant upright under the arms next to a table or chair; touch the dorsal side of the foot to the table or chair edge; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table; age of disappearance varies
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Placing (4 days of age) Reflex
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Hold the infant upright under the arms and allow the soles of the feet to touch the surface of the table; observe for alternate flexion and extension of the legs, simulating walking; it disappears before voluntary walking
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Stepping (between birth and 8 weeks) Reflex
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With your index finger, briskly tap the bridge of the infant's nose between the eyes (glabella) when its eyes are open; observe the sudden symmetric blinking of the eyes; the infant will blink for the first four to five taps.
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Glabella (birth) Reflex
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Suspend the infant in prone position on one of your hands or on a flat surface; stroke one side of the infant's back between the shoulders to the buttocks, about 4 to 5 cm from the spinal cord; observe for the curvature of the trunk toward the side stroked; repeat on the other side.
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Galant or trunk incurvature (birth to 4 weeks) Reflex
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Suspend the infant in prone position on both of your hands so that the infant's legs and arms are extending over both sides of your hand; observe the infant's ability to lift its head and extend its spine on a horizontal plane; the reflex diminishes by 18 months of age and disappears by 3 years.
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Landau (birth to 6 months) Reflex
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Hold the infant suspended in prone position and slowly lower it head first toward a surface; observe the infant extend its arms and legs as if to protect itself; this reflex should not disappear.
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Parachute (4 to 6 months) Reflex
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With the infant supine, turn its head to the side; observe the infant turning its whole body in the direction the head is turned.
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Neck righting (3 months, after tonic neck disappears) Reflex
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____ is a debilitating, degenerative disorder in which the blood-brain barrier breaks down and permits immune cells to pass into the myelinated white matter of the brain or spinal cord tissue
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Multiple sclerosis
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A___ is characterized by episodic, sudden, involuntary contractions of a group of muscles, resulting from excessive discharge of cerebral neurons
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generalized seizure disorder
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____ is an acute inflammation of the brain and spinal cord, involving the meninges that is often viral in origin. An arthropod or mosquito may be the vector for the virus, such as in West Nile virus. The onset is often a mild, febrile viral illness with malaise.
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Encephalitis
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Signs and symptoms include fever, chills, nuchal rigidity, headache, seizures, and vomiting, followed by alterations in level of consciousness
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MENINGITIS
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Young infants do not demonstrate nuchal rigidity until about ___ of age
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6 to 9 months
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When a lumbar puncture is done for suspected meningitis, the odor of alcohol can indicate a ___ infection
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cryptococcal
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Lyme disease is a multisystem infection caused by the ___ spirochete, which is carried by ticks.
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Borrelia burgdorferi
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characteristic skin circular red rash that continues to grow with central clearing, giving the appearance of a bulls-eye
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Lyme disease
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signs associated with the third stage of the infection Lyme disease
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Arthritis and acrodermatitis
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Peak ages of incidence in SPACE-OCCUPYING LESIONS (INTRA-CRANIAL TUMORS)
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3 to 12 years and 50 to 70 years
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Supplies the cerebral hemispheres and diencephalon by the ophthalmic and ipsilateral hemisphere arteries
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INTERNAL CAROTID ARTERY
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Supplies frontal lobe, parietal lobe, cortical surfaces of temporal lobe (affecting structures of higher cerebral processes of communication; language interpretation; perception and interpretation of space, sensation, form, and voluntary movement)
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MIDDLE CEREBRAL ARTERY
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Supplies superior surfaces of frontal and parietal lobes and medial surface of cerebral hemispheres (includes motor and somesthetic cortex serving the legs), basal ganglia, corpus callosum
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ANTERIOR CEREBRAL ARTERY
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Supplies medial and inferior temporal lobes, medial occipital lobe, thalamus, posterior hypothalamus, and visual receptive area
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POSTERIOR CEREBRAL ARTERY
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Supply the brainstem and cerebellum
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VERTEBRAL OR BASILAR ARTERIES
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Supplies the lateral and posterior portion of the medulla
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POSTERIOR INFERIOR CEREBELLAR ARTERY
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Supply the cerebellum
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ANTERIOR INFERIOR AND SUPERIOR CEREBELLAR ARTERIES
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Supplies the anterior spinal cord
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ANTERIOR SPINAL ARTERY
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Supplies the posterior spinal cord
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POSTERIOR SPINAL ARTERY
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___ is a chronic autoimmune neuromuscular disease involving the lower motor neurons and muscle fibers. The disorder is characterized by an insidious, muscle fatigue and progressive weakness of the voluntary muscles with repetitive activity.
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Myasthenia gravis
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_____ is an acute polyradiculoneuropathy that commonly follows a nonspecific infection that occurred 10 to 14 days earlier
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Guillain-Barré syndrome (acute idiopathic polyneuritis)
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Widespread inflammation or demyelination of the ascending or descending peripheral nerves leads to impaired conduction of nerve impulses between the nodes of Ranvier. It is characterized by ascending symmetric weakness (with sensation preserved) that increases in severity over days or weeks
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GUILLAIN-BARRÉ SYNDROME
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____ is a recurrent paroxysmal sharp pain that radiates into one or more of the branches of cranial nerve V
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Trigeminal neuralgia
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Triggers of pain may include chewing, swallowing, talking, washing the face, brushing the teeth, exposure to cold, and even a breeze across the face. The usual age of onset is 40 to 60 years, and women are more commonly affected than men.
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TRIGEMINAL NEURALGIA (TIC DOULOUREUX)
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____ is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, most commonly in the hands and feet.
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Peripheral neuropathy
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Common causes of Peripheral neuropathy
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diabetes mellitus, but it may also be caused by toxins, such as kerosene, or vitamin B12 deficiency
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Cerebral palsy occurs in an estimated ___ per 1000 births.
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2 to 3
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____ is a group of brain damage syndromes in which a static and nonprogressive cerebral lesion causes significant motor delay and abnormal neuromuscular findings.
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Cerebral palsy
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Characteristic signs include retinal hemorrhages, altered consciousness with axonal injury, as well as subdural or subarachnoid hemorrhage.
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Shaken baby syndrome
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In kids, It is associated with impaired brain growth due to cerebral atrophy, progressive motor dysfunction, regression or a plateau in developmental milestones, and generalized weakness with upper motor neuron signs. Less common findings include dysphagia, gait ataxia, and seizures.
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HIV ENCEPHALOPATHY
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____ is a progressive encephalopathy of unknown cause that develops in girls between 6 and 18 months of age after normal neurologic and mental development. Head growth decelerates between 5 and 48 months of age.
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Rett syndrome
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in kids, Characteristic signs include loss of voluntary hand movement, loss of previously acquired hand skills, hand wringing movements, gradual development of ataxia and rigidity of the legs, growth retardation, seizures, loss of facial expression, and autistic behavior
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RETT SYNDROME
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___ results from compression of the lumbosacral plexus and peripheral nerves in the pelvic wall by the fetal head or forceps
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Femoral neuropathy
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____ may result from compression of nerves in the lumbosacral trunk when the fetal brow presses against the mother's sacral ala.
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Postpartum footdrop
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Compression of the ____ between the leg holders and the fibula during delivery can also cause unilateral footdrop.
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common peroneal nerve
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___ is a slowly progressive, degenerative neurologic disorder of the brain's dopamine neuronal systems
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Parkinson disease
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Symptoms (often unilateral initially) begin with tremors at rest and with fatigue, disappearing with intended movement and sleep, respectively. The disorder progresses with tremor of the head, slowing of voluntary and automatic movements (bradykinesia), and bilateral pillrolling of the fingers. Motor impairment causes delays in execution of movement, masked facial expression, and poor blink reflex
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Parkinson disease
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___ is a syndrome caused by noncommunicating hydrocephalus (i.e., dilated ventricles, but intracranial pressure is within expected ranges) that simulates degenerative diseases.
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Normal pressure hydrocephalus
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Patients have a triad of signs including a gait disorder, psychomotor slowing, and incontinence. Patients may have progressive dementia with memory loss, mild bilateral upper motor neuron signs, and fecal and urinary incontinence.
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Normal pressure hydrocephalus
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The cause is unknown, but it is thought to be caused by the inability of surviving neurons from the primary case of polio to continue developing axon sprouts because of age or overuse
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POSTPOLIO SYNDROME
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Respiratory, circulatory, and vasomotor activities; houses respiratory center
Reflexes of swallowing, coughing, vomiting, sneezing, and hiccupping Relay center for major ascending and descending spinal tracts that decussate at the pyramid |
Medulla oblongata CN IX-XII
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Reflexes of pupillary action and eye movement
Regulates respiration; houses a portion of the respiratory center Controls voluntary muscle action with corticospinal tract pathway |
Pons CN V-VIII
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Reflex center for eye and head movement
Auditory relay pathway Corticospinal tract pathway |
Midbrain CN III-IV
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Integrates impulses between motor cortex and cerebrum, influencing voluntary movements and motor response
Controls state of consciousness, conscious perceptions of sensations, and abstract feelings |
Thalamus
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Houses the pineal body
Sexual development and behavior |
Epithalamus
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Major processing center of internal stimuli for autonomic nervous system
Maintains temperature control, water metabolism, body fluid osmolarity, feeding behavior, and neuroendocrine activity |
Hypothalamus
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Test visual fields by confrontation and extinction of vision.
Inspect eyelids for drooping. Inspect pupils' size for equality and their direct and consensual response to light and accommodation. Test extraocular eye movements. |
CN III (oculomotor), IV (trochlear), and VI (abducens)
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Inspect face for muscle atrophy and tremors.
Palpate jaw muscles for tone and strength when patient clenches teeth. Test superficial pain and touch sensation in each branch (test temperature sensation if there are unexpected findings to pain or touch). Test corneal reflex. |
CN V (trigeminal)
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Inspect symmetry of facial features with various expressions (e.g., smile, frown, puffed cheeks, wrinkled forehead).
Test ability to identify sweet and salty tastes on each side of tongue. |
CN VII (facial)
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Test sense of hearing with whisper screening tests or by audiometry.
Compare bone and air conduction of sound. Test for lateralization of sound. |
CN VIII (acoustic)
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Test ability to identify sour and bitter tastes.
Test gag reflex and ability to swallow. |
CN IX (glossopharyngeal)
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Inspect palate and uvula for symmetry with speech sounds and gag reflex.
Observe for swallowing difficulty. Evaluate quality of guttural speech sounds (presence of nasal or hoarse quality to voice). |
CN X (vagus)
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Test trapezius muscle strength (shrug shoulders against resistance).
Test sternocleidomastoid muscle strength (turn head to each side against resistance). |
CN XI (spinal accessory)
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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 cheek. Evaluate quality of lingual speech sounds (l, t, d, n). |
CN XII (hypoglossal)
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Unilateral blindness
Severe contralateral hemiplegia and hemianesthesia Profound aphasia Artery Affected? |
INTERNAL CAROTID ARTERY
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What artery affected?
Alterations in communication, cognition, mobility, and sensation Contralateral homonymous hemianopia Contralateral hemiplegia or hemiparesis, motor and sensory loss, greater in face and arm than the leg |
MIDDLE CEREBRAL ARTERY
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What aretery affected?
Emotional lability Confusion, amnesia, personality changes Urinary incontinence Contralateral hemiplegia or hemiparesis, greater in lower than upper extremities |
ANTERIOR CEREBRAL ARTERY
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What artery Affected? Hemianesthesia
Contralateral hemiplegia, greater in face and upper extremities than in lower extremities, cerebellar ataxia, tremor Visual loss-homonymous hemianopia, cortical blindness Receptive aphasia Memory deficits |
POSTERIOR CEREBRAL ARTERY
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What artery affected?
Unilateral and bilateral weakness of extremities; upper motor neuron weakness involving face, tongue, and throat; loss of vibratory sense, two-point discrimination, and position sense Diplopia, homonymous hemianopia Nausea, vertigo, tinnitus, and syncope Dysphagia |
VERTEBRAL OR BASILAR ARTERIES
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What artery affect?
Wallenberg syndrome Dysphagia, dysphonia Ipsilateral anesthesia of face and cornea for pain and temperature (touch preserved) Ipsilateral Horner syndrome Contralateral loss of pain and temperature sensation in trunk and extremities Ipsilateral decompensation of movement |
POSTERIOR INFERIOR CEREBELLAR ARTERY
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What artery affected?
Difficulty in articulation, swallowing, gross movements of limbs; nystagmus |
ANTERIOR INFERIOR AND SUPERIOR CEREBELLAR ARTERIES
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What artery affected?
Flaccid paralysis, below level of lesion Loss of pain, touch, temperature sensation (proprioception preserved) |
ANTERIOR SPINAL ARTERY
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What artery affected?
Sensory loss, particularly proprioception, vibration, touch, and pressure (movement preserved) |
POSTERIOR SPINAL ARTERY
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Idiopathic, Inherited
Metabolic, Mechanical Drugs Infections Sarcoidosis Tumors Autoimmune, Allergy Lack of vitamins |
Mnemonics
Causes of Peripheral Neuropathy: I'M DISTAL |
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behavior used to limit pain, as limping reduces the time of weight bearing on an affected leg
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Antalgic
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inability to coordinate muscle activity during voluntary movement
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Ataxia
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pathway and processing station between the cerebral motor cortex and the upper brainstem
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Basal ganglia
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acts as the pathway between the cerebral cortex and spinal cord
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Brainstem
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sign characterized by involuntary flexion of the hips and knees when the neck is flexed
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Brudzinski
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works with the motor cortex of the cerebrum; involved in voluntary movement; processes information from eyes, ear, and touch
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Cerebellum
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contains the motor cortex; associated with voluntary skeletal movement
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Frontal lobe
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tactual ability to recognize writing on the skin
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Graphesthesia
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maintains temperature control, water metabolism, and neuroendocrine activity
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Hypothalamus
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attempt to straighten a leg of a supine patient with leg flexion at the knee and hip
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Kernig sign
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mediates primitive behaviors that determine survival
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Limbic system
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absence of deep tendon reflexes may be an indication of this type of neuron disorder or of peripheral neuropathy
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Lower motor
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acts as as the respiratory center and relay center for major ascending and descending spinal tracts
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Medulla oblongata
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stiff neck; associated with meningitis
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Nuchal rigidity
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contains the primary visual center and interpretation of visual data
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Occipital lobe
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patient standing with eyes closed is unable to maintain balance when pushed slightly
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Romberg
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unexpected gait pattern manifested by an excessive lift of the hip and knee and an inability to walk on the heels
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Steppage
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ability to identify an object by touch
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Stereognosis
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responsible for perception and interpretation of sounds, taste, smell, and balance
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Temporal lobe
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conveys sensory impulses to and from the cerebrum and integrates the impulses between the motor cortex and the cerebrum
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Thalamus
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Fatigue, bowel and bladder dysfunction, sexual dysfunction, sensory changes, muscle weakness
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Multiple sclerosis
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Disturbances in consciousness, behavior, sensation and autonomic functioning
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Generalized seizure disorder
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Fever, chills, headache, nuchal rigidity
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Meningitis
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Headache, polyneuritis, unilateral or bilateral facial paralysis, ataxia
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Lyme disease
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Sudden weakness and numbness, confusion, difficulty speaking, loss of balance, paralysis of face, arm, or leg
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Cerebral vascular accident
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Chronic autoimmune neuromuscular disease
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Myasthenia gravis
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Acute polyradiculoneuropathy
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Guillain-Barre syndrome
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Recurrent paroxysmal sharp pain that radiates onto CN V
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Trigeminal neuralgia
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Static and nonprogressive cerebral lesions cause significant motor delay in a child
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Cerebral palsy
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Progressive, degenerative neurologic disorder in older adults
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Parkinson disease
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