Chapter 24: Neurologic System

Central Nervous System

Brain and spinal cord

Peripheral Nervous System

Everything outside the brain and spinal cord

Afferent Neurons

Carry information to CNS

Efferent Neurons

Carry information to muscles

Somatic Nervous System

Controls voluntary muscle movement

Autonomic Nervous System

Controls involuntary functions

Sympathetic Nervous System

Fight or flight response

Parasympathetic Nervous System

Rest and digest response

Brainstem

Central core of the brain, connects cerebrum to spinal cord, consists of midbrain, pons, and medulla, controls life-sustaining, autonomic functions such as breathing, consciousness, BP, HR, and sleep

Cerebral Cortex

Outer layer of brain made up of gray matter, responsible for highest functions including thought, memory, reasoning, sensation, and voluntary movement

Frontal Lobe

Lobe of cerebral cortex responsible for decision-making, movement, and personality

Parietal Lobe

Lobe of cerebral cortex responsible for sensation

Temporal Lobe

Lobe of cerebral cortex responsible for hearing, memory, and language

Occipital Lobe

Lobe of cerebral cortex responsible for vision

Basal Ganglia

Large clusters of gray matter deep within the cerebral hemispheres that initiate and coordinate movement, controls automatic associated movements, helps with procedural learning, and helps with planning motor actions

Thalamus

Found deep in the brain, acts as brain’s main sensory relay station and regulates consciousness, sleep cycles, alertness, and awareness

Hypothalamus

Part of brain that sits just above the brainstem, acts as a major respiratory center and functions in vital regulation, autonomic control, hormonal control, and stress

Cerebellum

Part of brain located at the back, functions in movement coordination, balance, voluntary movements, motor learning, and vision/eye coordination

Spinal Nerves

31 pairs of nerves that relay info between spinal cord and body, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal

Dermatomes

Specific area of the skin supplied by sensory fibers from a single spinal nerve

Screening Exam

Exam for well patients with no significant history

Complete Exam

Exam for patients with neurological concerns or demonstrated signs of dysfunction

Recheck Exam

Periodic assessment for patients with known neurologic deficits

Anterolateral Tract

Spinal tract that senses pain and light touch (spinothalamic)

Posterior Column

Spinal tract that senses vibration, proprioception, and tactile discrimination (dorsal)

Stereognosis

Ability to identify familiar objects placed in hand

Graphesthesia

Ability to identify letter/number traced on palm

Reflex Sites

Biceps, triceps, brachioradialis, patellar, achilles, and plantar

Reflex Grading

Hyperactive (+4), exaggerated (+3), normal (+2), diminished (+1), absent (0)

Pillars of Motor Assessment

Size/symmetry, tone, strength, and coordination/gait

5/5

Normal muscle strength, full ROM against gravity and full resistance

4/5

Good muscle strength, full ROM against gravity, some resistance

3/5

Fair muscle strength, full ROM with gravity, no resistance

2/5

Poor muscle strength, passive movement only

1/5

Trace muscle strength, slight contraction visible, no movement

0/5

Zero muscle strength, no muscle contraction

Romberg Test

Test that evaluates cerebellar function, have patient stand with eyes closed and arms at side, patient should not fall (negative)

Rapid Alternating Movements

Test that evaluates upper extremities coordination, have patient pat both knees while flipping hands

Flaccidity

Decreased muscle tone, muscles feel excessively limp and soft, indicates lower motor neuron dysfunction

Spasticity

Increased muscle tone, muscles demonstrate resistance to passive lengthening, indicates upper motor neuron dysfunction

Rigidity

Constant state of resistance, indicates extrapyramidal tract dysfunction

Tremors

Oscillating movements

Intention Tremors

Tremors that worsen with voluntary movement

Fasciculations

Rapid, continuous twitching of a resting muscle without actual limb movement

Pillars of Neurological Assesment

Level of consciousness, pupillary response, motor function, and vital signs

Stimulation Escalation

Call their name → lightly touch their arm → vigorously shake their shoulder → apply painful stimulus

PERRLA

Pupils are equal, round, reactive to light, and accommodation

Glasgow Coma Scale

Method to measuring comatose state, includes eye opening (4 pts), verbal response (5 pts), and motor response (6 pts)

Stroke

An acute neurological deficit (upper motor neuron lesion) caused by blood deprivation to brain

Ischemic Stroke

Stroke in which a blood clot occludes the cerebral vessel

Hemorrhagic Stroke

Stroke in which a cerebral vessel ruptures and bleeds

Transient Ischemic Attack

Ministroke, symptoms last temporarily (TIA)

Compartment Syndrome

Increased pressure in closed space causing decreased blood flow/tissue damage

5Ps Checklist

Checklist for compartment syndrome symptoms, includes pain, paresthesia, pulselessness, pallor, and pressure

FAST

Stroke assessment, includes face, arms, speech, and time

Anosmia

Decrease/loss of smell bilaterally

Neurogenic Anosmia

Unilateral loss of smell in absence of nasal disease

Ptosis

Drooping

Nystagmus

Back and forth oscillation of the eyes

Dysmetria

Clumsy movement with overshooting the mark

Past Pointing

Constant deviation to one side on finger to nose test

Ataxia

Uncontrolled or unsteady gait

Clonus

Rapid, rhythmic contractions of same muscle

Frog Position

Abnormal position in children in which hips are abducted and almost flat against the table

Opisthotonus

Abnormal position in babies in which the head is arched back, neck is stiff, and legs/arms are extended

Landau Reflex

At 3 months the baby should raise head and arch back when held on stomach, persists until 1.5 years

Rooting Reflex

Infants should search for anything brushed against their cheek near the mouth, disappears around 3-4 months

Palmar Grasp

Infants should grasp your finger with all of their fingers, disappears around 3-4 months

Plantar Grasp

Infants should curl their toes around your thumb, disappears around 8-10 months

Babinski Reflex

Infants toe’s should fan when you brush your finger up their foot, disappears around 24 months

Tonic Neck Reflex

Infants should extend their arm/leg of the way their neck is turned and should flex the other side of the body, appears by 2-3 months and disappears by 4-6 months

Moro Reflex

Infants should look as though they are climbing a tree when startled, disappears by 1-4 months

Nuchal Rigidity

Extreme resistance to any direction of head movement, occurs with inflamed meningitis, test by bringing chin to chest

Alzheimers Warning Signs

Memory loss, problems planning, losing track, confusing time/place, trouble seeing, trouble speaking/writing, losing things, using poor judgement, growing passive, and changing personality

Hemiplagia

Paralysis of one side

Paraplegia

Symmetric paralysis of lower extremities

Quadriplegia

Paralysis in all four extremities

Paresis

Muscle Weakness

Chorea

Sudden, rapid, jerky, purposeless movement of limbs, trunk, or face at irregular intervals, associated with Huntington’s

Athetosis

Slow, twisting, writhing, continuous movement, associated with cerebral palsy

Essential Tremor

Benign intention tremor, common with age