2.2 Cs: Neurologic Exam

Front 1

Acute onset of neurological sxs usually has a ___________ cause

Back 1

vascular cause

Front 2

Checking for neurological sxs should include a mental status exam. What are you checking for?

Back 2

Alertness- Level of consciousness

Orientation- where, when, what

Attention- ask to spell backward

Registration/recall- memorize 3 words

Repetition- repeat, testing for aphasia

Naming- name various objects, for aphasia

Content of thoughts- appropriate response

Insight & judgement- ask moral questions

Front 3

List the cranial nerves

Back 3

1- olfactory

2- optic

3- oculomotor

4- trochlear

5- trigeminal (corneal reflex, mastication)

6- abducens

7- facial

8- vestibulocochlear (weber, rinne)

9- glossopharyngeal

10- vagus

11- accessory

12- hypoglossal

Front 4

Homonymous field cut (hemianopsia)--> ________ lesion

*L or R half of each visual field

(if unilateral visual field defect = CN 2 (optic) defect)*

Back 4

Contralateral (opposite) side lesion posterior to optic chiasm

(if lesion on the R side--> will have loss in L hemisphere of each visual field)

Front 5

Bi-temporal field cut (hemianopsia)-->

_______ lesion

*lateral half of each visual fields

Back 5

optic chiasm lesion

or pituitary enlargement compressing optic chiasm

Front 6

Pt presents w/ triad of;

anisocoria (unequal pupils)

ptosis

outward deviation of affected eye

What CN is lesioned?

Back 6

CN 3 lesion

(unopposed lateral rectus--> outward deviation)

Front 7

(LMN/UMN) CN 7 (facial) lesion;

Facial droop on IPSILATERAL side

Upper AND lower facial involvemet

Back 7

LMN CN 7 nucleus or nerve lesion

*Bell's palsy

Front 8

UMN (upper motor neuron) CN 7 lesions involve the corticobulbar tract or CNS.

How do they present?

Back 8

Facial droop on CONTRALATERAL side

Lower facial involvement ONLY

Front 9

Motor spasticity is noted when pts movement is restricted in one direction but easy in others.

When does this occur?

Back 9

cerebral palsy & MS

Front 10

Muscle weakness can be tested w/ ___________

*full strength = 5/5, paralysis = 0/%

Back 10

Pronator drift

*outstretched arm will begin to pronate w time*

(shoulder pathology interferes w this test)

Front 11

___________ , starting distally is usually the first thing affected by sensory neuropathies

*presents w/ (+) Romburg sign (lose balance when eyes are closed)

Back 11

loss of proprioception (have pt clothes eyes & tell whether toe being moved up or down)

(+) Romburg bc proprioception is responsible for maintaining balance when eyes closed*

(pain, temp, etc usually affected later)

Front 12

In _________ lesions & strokes, pts display stereognosis (can't identify object by holding) & neglect (ignore one side of body, think you are touching right when you touch left)

Back 12

Right parietal lesions (stereognosis) & strokes (neglect)

Front 13

Finger to nose (shaking)

Heel to shin

RAM's/RRM's (dysdiadochokinesia, rapid alternating movement)

Rebound

Gait (poor coordination, seem intoxicated)

Test __________ fxn

*Deficits will be ipsilateral to lesions

Back 13

Cerebellum

Front 14

Loss of pain & temp on one side of the face & opposite side of the body is a _________ lesion

Back 14

brainstem lesion

Front 15

Loss of pain & temp on one side of body & loss of weakness &/or vibration on the opposite side body is a __________ lesion

What special reflexes should you check?

Back 15

spinal cord lesion

check Anal wink (pudendal N, S2-S4)

Front 16

Pure motor sxs--> contralateral ________ infarct

*Associated w hypertension & diabetes

Back 16

contralateral small vessel lacunar infarct of internal capsule, pons, basal ganglia

Front 17

Diplopia, ataxia, & dysphagia---->

MUST RULE OUT _________________

*If vertical gaze disturbance very likely!

Back 17

brainstem lesion possible, must rule out!

Front 18

_________ lesions will present w/ hypotonia/ hyporeflexia in the first 24- 48 hrs (before more typical sxs appear)

+ Babinski (big toe comes up & fans out) appear later

Back 18

UMN lesion

Front 19

In a seizure, the eyes look __________ the focus of the seizure

*pupils do NOT react

Back 19

AWAY from the focus

Front 20

In a cortical (hemispheric) infarct, the eyes look _________ the infarct

*spastic gait seen in stroke pts

Back 20

TOWARD the infarct

Front 21

Brainstem infarct, the eyes look _______ infarct

Back 21

AWAY from the infarct

Front 22

Decorticate position (elbows flexed, wrists flexed) is seen w/ deterioration ABOVE the midbrain &

Decerebrate position (elbows extended, wrists flexed) is seen w/ deterioration BELOW the midbrain

Which is usually seen first?

Back 22

Usually decorticate-->

decerebrate-->

flaccid = brainstem involvement = POOR PROGNOSIS

*brain deteriorates cortex--> brainstem

Front 23

Unilateral, fixed, & dilated pupils are a bad sign

what do they suggest?

Back 23

Aneurysm

or

Herniation (in comatose pt, may be d.t inc ICP & push uncus against CN 3)

Front 24

What is the diff btwn the oculocephalic & oculovestibular reflex?

Back 24

oculocephalic- eyes stay fixed on object when head moves

oculovestibular- nystagmus w/ fast component away

Front 25

What drugs make cause ocular motility deficits w/ normal pupils?

block oculovestibular reflex?

pupils non-reactive?

*Pupils are normally large in drug OD, except in opiates (small)

Back 25

ocular motility- Benzos, Barbiturates, Alcohol

block oculovestibular reflex- Gentamycin, succinylcholine, Dilantin, TCA's

non-reactive- Barbiturates, succinylcholine, lidocaine, phenothiazines, methanol, aminoglycosides

Front 26

Roving eye movements w/ eyes closed & eyes deviate slowly toward cold water (oculovestibular reflex) indicates __________

Back 26

TME (toxic metabolic encephalopathy)

^ secondary to hyponatremia or hypoglycemia**

Front 27

In a ____________ lesion, the oculovestibular reflex is NOT intact (no change w/ water)

Back 27

low brainstem lesion

Front 28

In __________, pts appear

Wet (bladder incontinence, first)

Wobbly (ataxia, shuffle feet)

Wacky (memory issues

Back 28

Parkinson/ NPH

*ataxic gait is seen in most dementias**

Front 29

In a __________ lesion, you will see ocular bobbing (oculovestibular reflex) & pinpoint reactive pupils

Back 29

Pons lesion

Front 30

Special reflexes can be checked to localized lesions, & are graded as clonus (4/4), normal (2/4), or absent.

Cremasteric reflex checks for lesions at _____

Bulbocavernous for lesions at _______

Back 30

Cremasteric- genitofemoral N (L1-L2)

Bulbocavernous- S2-S4