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PD Neuro Lecture
Terms in this set (89)
What is the purpose of the neurological exam?
Determine if there is a neurological deficit
Localize the site of the problem
Determine the etiology of the problem
Areas of deficit possible determined by the neuro exam
What might cause a neuro deficit?
NL rising of the uvula
NL tongue deviation
NL muscle strength identified as
5/5 in all 4 limbs
__________ is defined as the inability to initiate movement
____________ is defined as the inability to remain motionless
intracranial pressure may be detected by ___________ in the eye
NL Romberg sign
________ impulses that participate in reflex activity
____________ impulses that give rise to conscious sensation
___________ impulses that calibrate body position in space (proprioception)
__________ impulses that help regulate internal autonomic functions like BP, HR and RR
Stimulation of a sensory receptor can occur in
Stimulation of a sensory receptor fires a _____________ nerve fiber
Sensations that sensory fibers register
Sensory fibers registering sensations pass through the ___________ nerves and ___________ roots and enter the spinal cord
After the sensory impulse travels through the posterior (dorsal) root into the spinal cord, it __________ with the ______________ sensory neuron sending impulses to the brain
Interneurons send impulses to the brain via these 2 pathways
Where do corticospinal tracts originate and what type of pathway are they?
the cerebral cortex
Corticospinal tracts are made up of these 2 separate tracts in the spinal cord
These tracts in the spinal cord synapse with alpha motor neurons and interneurons
Lateral Corticospinal tract
These tracts in the spinal cord cross at the cervical level and primarily modulate motor neurons that innervate neck and arm muscles
Anterior Corticospinal tract
What are 3 motor pathways tracts originating in the brain stem?
mediate reflex postural movements in response to visual (+/- auditory) stimuli
postural movements in response to visual (+/- auditory) stimuli
facilitate spinal cord reflexes and muscle tone
Where do spinothalamic fibers cross and where do they go ?
in the spinal cord
pass up to thalamus
____________ are located primarily in the dorsal horn
Lateral spinothalamic tracts conduct __________,_________, and __________
Anterior spinothalamic tracts conduct ______________
Posterior columns convey these 3 different types of sensation
sensory receptors are the muscle spindles and Golgi tendon organs
sensory receptor is the Pacinian corpuscle
sensory receptor is the Meissner corpuscle
Posterior columns synapse in the ___________ and cross to continue to the thalamus
At the thalamic level, the general quality of sensation is perceived but _____________________ are not made
For full perception (of pain, cold, pleasant/unpleasant), a third group of sensory neurons sends impulses from the thalamus to the ____________ of the brain
__________ at different points in the sensory pathways produce different kinds of sensory loss
These help you to identify where a causative lesion might be in the sensory pathway
Patterns of sensory loss AND
Associated motor findings
A lesion in the sensory cortex may not impair the perception of pain, touch, and position, for example, but does impair __________________.
(usually the patient cannot identify it)
Loss of position and vibration sense with preservation of other sensations points to disease of the __________________
loss of all sensations from the waist down, together with paralysis and hyperactive reflexes in the legs, indicates transection of the _______________.
Despite partial damage to the spinal cord, _______ and __________ are often preserved because impulses originating on one side of the body travel up both sides of the cord.
What does TRAP stand for?
Tremor ( rest, pill-rolling)
Rigidity ( lead-pipe, cog-wheel)
Akinesia / bradykinesia
slight or incomplete paralysis
loss or impairment of motor function
enlargement of an organ or part due to an increase in size of its constituent cells
increase in size without true hypertrophy
hypertonicity with increased DTRs
stiffness or inflexibility
loss of tone with diminished DTRs
Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals
Choreiform movements are brief, rapid, jerky, irregular, and unpredictable that may occur at rest or interrupt normal coordinated movements
Athetoid movements are slower and more twisting and writhing than choreiform movements and have a larger amplitude. MC involve the face and distal extremities
Cerebral Palsy can cause this
Movements somewhat similar to athetoid movements, but often involve larger portions of the body, including trunk. Grotesque, twisted postures may result.
Dx criteria for migraine HA
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
C. Headache has at least two of the following characteristics:
1. Unilateral location
2. Pulsating quality
3. Moderate or severe pain intensity
4. Aggravation by or causing avoidance of routine physical activity
(eg, walking or climbing stairs)
D. During headache at least one of the following:
1. Nausea and/or vomiting
2. Photophobia and phonophobia
E. Not attributed to another disorder
content, sequence, logic, coherence, and relevance
ability to focus or concentrate (over time) on one task or activity; "serial 7's
misinterpretations of real external stimuli
subjective sensory perceptions in the absence of stimuli
Screening test for cognitive dysfunction
Mini Mental Status Exam (MMSE)
What does the MMSE assess?
immediate and short-term memory
ability to follow simple verbal and written commands
Depends on the integrity of the dominant hemisphere as well as patient's intelligence
How is attention measured on the MMSE?
Spelling WORLD backwards
Recite the months forwards/ backwards
Serial 7s (or 3s)
Immediate recall, recent & remote memory
What 3 types of memory are assessed on the MMSE?
Higher cerebral function that requires comprehension and judgment
MC used for abstraction assessment on the MMSE
few words (laborius)
impaired inflection & articulation
words are meaningful
rapid & effortless
normal inflection & articulation
sentences lack meaning (incomprehensible)
Neurological changes with aging
Altered mental status
1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.
Glasgow Coma Scale Score of 8 or less
Severe Head Injury-
GCS score of 9 to 12
moderate head injury
An involuntary lifting of a patient's legs in response to an examiners lifting the head. This is often associated with meningeal irritation, such as blood in the mininges (Subarachnoid Haemorrhage) or Acute Meningitis.
inability to completely extend the leg when sitting or lying with the thigh flexed upon the abdomen; when in dorsal decubitus position, the leg can be easily and completely extended.
occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.
Noxious odors stimulate CN1 and __________ nerve
Damage to the optic nerve will also result in a __________ visual defect due to loss of input from the __________ eye. The patient will complain of blindness in that eye.
Damage to the __________ aspect of the optic chiasm may compromise the decussating fibers from both nasal hemiretinas.
The loss of peripheral vision in both eyes is called ______________
Damage to the ________ aspect of the optic chiasm, as may occur in the case of an aneurysm of the internal carotid artery, will affect the fibers of the ipsilateral temporal hemiretina (nasal visual field).
MC isolated facial nerve lesion produces total ipsilateral hemifacial paralysis
cannot raise the eyebrow or close the eyelids on the affected side
Non-fluent, slow, few words & laborious effort
Impaired inflection & articulation
Words are meaningful
Fair to good word comprehension
Impaired naming but pt recognizes objects
Fair to good reading comprehension
Lesion = posterior inferior frontal lobe
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