Neurology and Skin
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Created by:
mlhendrickson on February 28, 2010
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97 terms
Terms | Definitions |
|---|---|
 Ascending Tracts | Carry sensory impulses to the brain from receptors of skin, muscle and organs |
| Lateral Spinothalamic Tract | Pain and Temperature |
| Posterior Dorsal Column | Touch and Propreoception |
| Innervation of Spinothalamic Tract | DRG to cross central part of gray and white matter to opposite side of Spinal Cord white matter up tract to Thalamus and to the Primary Sensory Cortex |
| Location of Sensory Cortex | Posterior central gyrus of parietal lobe |
| Innervation of Posterior Dorsal Column | DRG and straight up to medulla to the Primary Sensory Cortex |
| Spinothalamic Tract (contralateral or ipsilateral?) | contralateral |
| Posterior Dorsal Column (contralateral or ipsilateral??) | ipsilateral; contralateral in cerebral hemispheres. |
| Test pain and temperature | Sharp and Dull with cotton tip for pain; hold tube with hot water for temperature. |
| Lesion on Spinothalamic Tract | Contralateral loss of pain and temperature below level of lesion |
| Lesion on Dorsal Column Tract | Ipsilateral loss of touch and proprioception below level of lesion |
| If entire cord damaged, what happens below lesion? | No sensation below lesion; full sensation above the lesion |
| If only half the cord damaged, what happens below lesion? | Contralateral loss of pain and temperature below the lesion; Ipsilateral depends on which side... |
| Anterior Horn Cells | Lower Motor Neurons that innervate cervical spine and skeletal muscle |
| Lateral Corticospinal Tract | Upper Motor Neurons related primarily to the Brain and Spinal Cord. |
| UMN lesion | spastic paralysis |
| Motor Cortex location | precentral gyrus of the frontal lobe in each cerebral hemisphere. |
| LMN lesion | Flaccid paralysis |
| Etiology of UMN paralysis | Stroke |
| Etiology of LMN paralysis | Trauma- gunshot or stab wound |
| Reflex Arc | involuntary response to stimulus mediated by the spinal cord; not voluntary |
| Sensory Reflex Pathway | DRG- synapse in SP with motor neurons in anterior root- synapse in SP and back to the same muscle. |
| Biceps SC location | C5 and C6 |
| Triceps SC location | C6 and C7 and C8 |
| Brachiorradialis SC location | C5 and C6 |
| Patellar SC location | L2 and L3 and L4 |
| Achilles SC location | S1 and S2 |
| Normal Reflex Results | Skeletal muscle contracts when they are stretched by the pull of gravity or external manipulation or when their tendons are stretched. |
| Clonus | Set of rhythmic contractions of the same muscle |
| Hyperactive Reflex | exaggerated reflex seen when monosynaptic reflex arc released |
| Hyporeflexia sign of | LMN injury-destruction of anterior horn cell |
| Hyperreflexia sign of | UMN injury- Stroke |
| Stereognosis | Pt feels an object and identifies it |
| Graphesthesia | Pt feels letters or numbers written on their skin and identifies it |
| Alert | Pt. is awake and oriented |
| Lethargic | Pt appears drowsy and may fall asleep if not stimulated |
| Obtunded | Pt is difficult to arouse from sleep like state; Sleeps most of time; confused when awake |
| Stupor | Pt responds only to strong generally painful stimulus; returns to unconscious state when it stops. |
| Coma | Completely unconscious pt - cannot be aroused even by strong painful stimulus |
| Glasgow Coma Scale | Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response. |
| Mild Head Trauma | Glasgow Score 14-15; 3% may deteriorate within 48 hours |
| Moderate Head Trauma | Glasgow Score 9-13; 20% chance of death; 50% chance of long term disability |
| Severe Head Trauma | Score Less than 9; 40% chance of death in 48 hours |
| Decorticate posturing | Hands contracted in; Lesion of cerebral cortex |
| Decerebrate posturing | Hands contracted out; Lesion in brain stem |
| Brocas aphasia | Can comprehend language, but cannot use motor/speech to get the words out; may have paralysis of upper limb on the right |
| Wernike's aphasia | unable to comprehend language; speech is used but with wrong words |
| Charcots Triad | Widening pulse pressure, bradycardia and irregular breathing patterns |
| Layers of Skin | Epidermis, Dermis and Subcutaneous |
| Functions of Skin | Protection, Sensory, Temperature, Wound repair, Absorption and Excretion, Production of Vitamin D |
| Preparation for Skin Assessment | Warm room, good lighting, modesty, use proper equipment, Inspect and Palpate |
| Inspection of Skin | Look for discoloration, masses, lesions, rashes, bruising (ecchymosis) |
| Palpation of Skin | Palpate for Edema, Turgor (elasticity), Moisture, Temperature and Texture |
| Purpuric | Caused by blood flowing out of breaks in vessels |
| Petechiae | tiny puntate hemorrhages- 1-3 mm round; dark red, purple or brown |
| Purpura | Confluent and extensive patch of petechiae and ecchymosis >3 mm flat, red to purple |
| Causes of Purpuric | Thrombocytopenia and scurvy |
| ABCDEs | Test for Melanoma- Asymmetry, Border Irregularity, Color Variation, Diameter greater than 6 mm, Elevation/Enlargement |
| Skin Cancer Risk Factors | History, Change in pigmentation or mole, excessive dry or moist, pruritus, bruising, rash or lesion, medications, hair loss |
| Aphasia | impairment of language modality; Brocas and Wernickes |
| Brain lesion on the right | contralateral left sided spastic paralysis |
| Spinal lesion on the right | ipsilateral right sided spastic paralysis |
| Initial lesion of UMN | spinal shock, pronator weakness followed by spastic paralysis |
| Spinal cord completed transected | Spastic paralysis below the level of the lesion- on both sides |
| Anterior Horn cell lesion on right side | Flaccid paralysis on the right side-ipsilaterally- AT THE LEVEL OF THE LESION ONLY |
| Spinal cord transected also damages Anterior Horn | Spastic paralysis below level of Spinal cord lesion and flaccid paralyis at the level of the anterior horn damaged. |
| Stroke can damage both | motor and sensory |
| Dorsal Column Disease | Syphilis |
| Anterior Horn cell disease | Polio |
| Thumb SC location | C6 |
| Digits 2&3 SC location | C7 |
| Digits 4&5 SC location | C8 |
| Nipple SC location | T4 & T5 |
| Umbilicus SC location | T10 |
| Big Toe SC Location | L4 |
| Middle Toes SC Location | L5 |
| Little Toe SC Location | S1 |
| Dermatome | cutaneous area supplied by the spinal nerve |
| If patient seems arythmic | use reinforcement technique |
| Reinforcement Technique | Ask the pt. to perform an isometric exercise in a muscle group away from the one being tested. |
| Plantar Reflex SC location | L4 to S2 |
| Babinski Reflex sign of | UMN lesion |
| Paralysis of upper limb on right | sign of Brocas aphasia |
| Dementia | progressive deterioration of intellect, behavior and personality due to loss of cortical neurons. |
| If Brain is deprived of oxygen for 3-5 minutes | Irreversible Brain Damage occurs |
| Tract | bundle of fibers which has the same origin and destination and carries similar impulses. |
| Kinesthesia- Position Sense | Hold finger and move up, down, left and right; have patient tell which way you are moving it |
| Position Sense tests the | Posterior Dorsal Column Tract |
| Romberg Test tests the | Posterior Dorsal Column Tract |
| Positive Romberg with eyes open and closed | Cerebellar deficit ataxia |
| Positive Romberg with eyes closed only | Proprioceptive deficit- Sensory ataxia |
| Two point discrimination | the ability to discriminate whether one or two areas of skin are being stimulated |
| Fingertips | 2-8 mm |
| Back | 40-75 mm |
| Dysmetria | Clumsy movements |
| Ataxia | uncoordinated unsteady gait |
| Cerebellum | Coordination Equillibrium and Balance |
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