Health Exam 3. - Neurological

What are the 2 branches of the nervous system?

1. Central Nervous System

2. Peripheral Nervous System

What does the central nervous system include?

Brain and spinal cord

How many pairs of cranial nerves is there?

12 pairs

How many pairs of spinal nerves ?

31 pairs

What are the 2 branches of the peripheral nervous system?

1. Somatic NS

2. Autonomic NS

What 2 branches fall under the autonomic NS?

1. Sympathetic NS

2. Parasympathetic NS

What does the peripheral NS do?

Carries out sensory (AFFERENT) messages to the CNS from sensory receptors

What does the somatic NS do?

Transfer impulses from CNS to skeletal muscles (voluntary)

What does the autonomic NS do?

Relays impulses from CNS to involuntary organs, smooth muscles, cardiac and glands

What NS regulates homeostasis?

Peripheral NS

Where is the parasympathetic NS located?

Anterior in the head and neck and posterior in the sacral region

Sympathetic NS consists of what?

Nerves arising from the spinal cord between the neck and waist region

What do AFFERENT neurons do?

Carry sensory info from receptors to CNS

What do EFFERENT neurons do?

Carry motor info from brain to peripheral nervous system

What happens to neurons in an aging adult?

Atrophy with steady loss of neurons

What happens to nerve conduction in an aging adult?

Velocity of nerve conduction decreases = Slower reactions

What happens to the synapses in an aging adult?

Increased delay at synapse = Diminished sensation of touch, taste, smell, pain

What happens to the motor system in an aging adult?

Slows down movement, strength, and agility decreases

What causes dizziness and loss of balance in an older adult?

Decrease in cerebral blood flow and oxygen consumption

What should perform in a pt with NO significant findings from history?

Screening neurological examination

What do you perform in a pt with neurological concerns?

Complete neurological examination

You perform a neurological recheck exam in what pt?

A pt with neurological deficits who require periodic assessments

What is the sequence for a neurological exam?

1. Mental status

2. Cranial nerves

3. Motor system

4. Sensory system

5. Reflexes

What is cranial nerve 1 (I) name, type and function?

Name - Olfactory

Type - Sensory

Function - Smell

What is cranial nerve 2 (II) name, type and function?

Name - Optic

Type - Sensory

Function - Vision

What is cranial nerve 3 (III) name, type and function?

Name - Oculomotor

Type - Mixed

Function -Motor = Extra ocular movement/ opening of eyelid

Function - parasympathetic - Pupil constriction/ lense shape

What is cranial nerve 4 (IV) name, type and function?

Name- Trochlear

Type - Motor

Function - Down and inward movement of the eye

What is cranial nerve 5 (V) name, type and function?

Name - Trigeminal

Type - Mixed

Function - Motor - Muscle mastication (chewing)

Function - Sensory - sensation of face/scalp/cornea/ mucous membrane of mouth and nose

What is cranial nerve 6 (VI) name, type and function?

Name - Abducens

Type - Motor

Function - Lateral movement of eye

What is cranial nerve 7 (VII) name, type and function?

Name - Facial

Type - Mixed

Function - Motor - facial muscles/ closed eye/ speech/ close mouth

Function - Sensory - Taste buds on anterior 2/3s of tongue

Function - Parasympathetic - Saliva and tears

What is cranial nerve 8 (VIII) name, type and function?

Name - Acoustic

Type - Sensory

Function - Hearing and equilibrium

What is cranial nerve 9 (IX) name, type and function?

Name - Glossopharyngeal

Type - Mixed

Function - Motor- Pharynx (swallowing)

Function - Sensory - Taste buds on 1/3 posterior of tongue

Function - parasympathetic - Parotid gland, carotid reflex

What is cranial nerve 10 (X) name, type and function?

Name - Vagus

Type - Mixed

Function - Motor - pharynx and larynx (talking and swallowing)

Function - Sensory - Sensation of carotid/ carotid sinus/ pharynx/ viscera

Function - Parasympathetic - Carotid reflex

What is cranial nerve 11 (XI) name, type and function?

Name- Spinal accessory

Type - Motor

Function - Movement of trapezius and sternomastoid muscles

What is cranial nerve 12 (XII) name, type and function?

Name - Hypoglossal

Type - Motor

Function - Movement of tongue

What nerves are used to test for Nystagmus?

Nerves III, IV, VI

What does nystagmus in both eyes indicate?

Disease of vestibular system, cerebellum or brainstem

How do you test for cranial nerve V trigeminal MOTOR function?

Asses muscles of mastication by palpating temporal and master muscles as a person clenches teeth

How do you test for cranial nerve V trigeminal SENSORY function?

Close eyes, light touch with cotton on ophthalmic/ maxillary/ mandibular

How do you test for cranial nerve VII facial nerve MOTOR function?

Have pt puff cheeks then press to see if air escapes equally

How do you test for cranial nerve VII facial nerve SENSORY function?

Test taste by applying sugar/salt/lemon to tongue

How do you test for cranial nerve VIII Acoustic nerve?

Whispered test / Tuning fork

How do you test for cranial nerve IX glossopharyngeal and X vagus nerve MOTOR function?

Depress tongue and assess uvula (should rise midline)

Also touch posterior pharyngeal and assess gag reflex

Can the cranial nerve IX glossopharyngeal and X vagus nerve SENSORY be tested?

Mediates taste on posterior 1/3 of tongue, but difficult to test

How do you test for cranial nerve XI spinal accessory nerve?

Examine equality of sternomastoid and trapezius muscles

Check strength by shrugging shoulders upon resistance

How do you test for cranial nerve XII hypoglossal nerve?

Ask person to say light/tight/dynamite (speech is clear and distinct)

Inspecting and palpating motor sys muscles should be:

normal tension in relaxed muscles

Should there be involuntary movements when inspecting and palpating motor system muscles?

Normally none occur. If present, note location, frequency, rate, and amplitude; note movements can be controlled at will

What is a Tic?

involuntary, compulsive, repetitive twitching of a muscle group d/t neurologic cause (tardive dyskinesias, Tourette syndrome)

What is fasciculation?

Rapid, sudden jerk at regular intervals

What is Myoclonic?

Rapid, continuous twitching of resting muscle without movement of limb

Fine

Occurs w/ LMN disease, associated w/ atrophy and weakness

Coarse

Occurs w/ cold exposure or fatigue and is not significant

What is Athetosis?

Sudden, rapid, jerky, irregular, purposeless movement of involving limbs/trunk/face

What is Chorea?

Abnormal involuntary, irregular movement disorder of quick movements of the feet/hands. (Looks like dancing)

What is a tremor?

involuntary contraction of opposing muscle groups, rhythmic

What are the 2 types of Fasciculation?

1. Fine - occurs with LMN disease (atrophy and weakness)

2. Coarse - Occurs with cold exposure or fatigue

What is hunting's disease?

Degeneration of nerve cells in the brain

What is Sydenham chorea?

Neurological disorder that kids get after rheumatic fever or strep

What is cerebral palsy and what is it associated with?

Slow, twisting, continuous movement, resembling a snake or worm. Involved distal more than proximal limbs

Associated with athetosis

What is Dysdiadochokinseaia?

Lack of coordination, slow, clumsy, sloppy ROM

What does dysdiadochokinesia occur with?

Cerebellar disease

What is ataxia?

Uncoordinated or unsteady gait (checked in cerebellar function)

What is Multiple sclerosis (MS)?

Immune mediated disease in which axons undergo inflammation, demyelination, degeneration and sclerosis

What nerves are affected in MS and what does it result in?

Nerves II and III - Results in nystagmus and diplopia

What is Romberg sign and what does it test for?

Ask pt to stand for 20 seconds with eyes closed

What does a positive Romberg test look like?

Loss of balance occurs with cerebellar ataxia

Cerebellar Fxn Tests

Shallow knee bend or hop in place, first on one leg, then the other

Unable to perform a knee bend is?

weakness in quadriceps muscle or hip extensors

What should the eyes be doing during all sensory sys tests?

closed

What is hypoalgesia/analgesia/hyperalgesia?

Decreased pain

Absent pain

Increased pain

What is hypoesthesia, anesthesia, and hyperesthesia?

Decreased touch sensation

Absent touch sensation

Increased touch sensation

What does Anterolateral spinothalamic tract do?

Carries our pain, temperature, crude touch, and pressure from skin to somatosensory area of THALAMUS!

What does dorsal column tract do?

Conveys sensation of fine touch, vibration, two point discrimination, proprioception (body position)

What does loss of vibration sense occur with?

Peripheral neuropathy (diabetes/alcoholism)

Peripheral neuropathy is worse where?

at the feet

What does loss of position sense occur with?

Peripheral neuropathy (DM), multiple sclerosis, spinal cord lesions

What is Streregnosis?

Ability to recognize objects for their forms/size/weight like a coin

What is Astereognosis?

inability to recognize objects by touch

What is graphesthesia?

Ability to read a number traced on skin (tactile discrimination)

Two-point discrimination

Ability to distinguish separation of two simultaneous pinpoints on skin

Extinction

Simultaneously touch both sides of body at same point; normally both sensations are felt

Point location

Touch skin and withdraw stimulus promptly; ask the person to put finger where you touched

What is a deep tendon reflex?

A muscle tendon is tapped and muscle contracts d/t passive strectch of muscles d/t a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle

What is the DTR point scale?

0 - No response

1+ = Diminished

2+ = Normal

3+ = Brisk, but no clinical signifiance

4+ = very brisk, hyperactive

What does grade 4+ in DTR indicate?

Indicates upper motor neuron lesion

What is reinforcement of a DTR?

Reflex fail, try to further relax by switching pt position or increase strength of the hit

What is an alternative technique to help elicit reflexes?

Can also try isometric exercise in a diff muscle group

Testing bicep reflex uses what?

C5 and C6

Testing tricep reflex uses what

C7 and C8

Testing quadriceps uses what?

L2 to L4 (knee)

Testing achilles reflex uses what?

L5 to S2 (ankle jerk)

Hold foot in dorsiflexion

Testing brachioradialis reflex uses what? (wrist)

C5, C6

What is a clonus?

A set of rapid, rhythmic contractions of same muscle, main in arms and hands

What is hyperreflexia?

Exaggerated reflex occurs with upper motor neuron lesions

what is hyporeflexia?

Absence of reflex is a lower motor neuron problem

What does hyporeflexia occur with ?

Interruption of sensory afferents to destruction of motor efferents and anterior horn cells

Plantar reflex tests what?

L4 to S2 (Babinski’s reflex)

What is a normal reflex in a plantar test?

Toes move downward

What is an abnormal response to a plantar reflex?

Toes fan outward and move move upward