Chapter 16: The Neurological Exam

 **neurological exam**

is a clinical assessment tool used to determine what specific parts of the CNS are affected by damage or disease.

**mental status exam**

which assesses the higher cognitive functions such as memory, orientation, and language.

**cranial nerve exam**

which tests the function of the 12 cranial nerves and, therefore, the central and peripheral structures associated with them.

**gait exam**

 which is often considered a sixth major exam, specifically assesses the motor function of walking and can be considered part of the coordination exam because walking is a coordinated movement.

**Localization of function**

is the concept that circumscribed locations are responsible for specific functions.

**stroke**

The loss of blood flow to part of the brain

**ischemic stroke**

is the loss of blood flow to an area because vessels are blocked or narrowed.

 **transient ischemic attack**

which is similar to a stroke although it does not last as long.

**hemorrhagic stroke**

is bleeding into the brain because of a damaged blood vessel.

**edema**

As blood pools in the nervous tissue and the vasculature is damaged, the blood-brain barrier can break down and allow additional fluid to accumulate in the region

**cerebral cortex**

is the thin layer of gray matter on the outside of the cerebrum.

**anterograde amnesia**

a bilateral lobectomy was performed that alleviated the epilepsy but resulted in the inability for HM to form new memories—a condition called

**retrograde amnesia**

HM was able to recall most events from before his surgery, although there was a partial loss of earlier memories

 **episodic memory**

What he was unable to do was form new memories of what happened to him

**procedural memory**

Episodic memory is autobiographical in nature, such as remembering riding a bicycle as a child around the neighborhood

**Language**

is, arguably, a very human aspect of neurological function.

 **Wernicke’s area**

Adjacent to the auditory association cortex, at the end of the lateral sulcus just anterior to the visual cortex

**aphasia**

Both regions were originally described on the basis of losses of speech and language

**expressive aphasia**

The aphasia associated with Broca’s area

 **receptive aphasia**

The aphasia associated with Wernicke’s area

**Conduction aphasia**

associated with damage to this connection refers to the problem of connecting the understanding of language to the production of speech.

**praxis**

a practical exercise in which the patient performs a task completely on the basis of verbal description\] without any demonstration from the examiner.

**gnosis**

which involves two tasks.

**stereognosis**

involves the naming of objects strictly on the basis of the somatosensory information that comes from manipulating them.

**graphesthesia**

is to recognize numbers or letters written on the palm of the hand with a dull pointer, such as a pen cap.

**anosmia**

Loss of the sense of smell

**Rinne test**

involves using a tuning fork to distinguish between **conductive hearing** and **sensorineural hearing.**

**Weber test**

also uses a tuning fork to differentiate between conductive versus sensorineural hearing loss.

 **intorsion**

The trochlear nerve controls the superior oblique muscle to rotate the eye along its axis in the orbit medially

**paramedian pontine reticular formation (PPRF)**

will initiate a rapid eye movement, or saccade, to bring the eyes to bear on a visual stimulus quickly.

**medial longitudinal fasciculus (MLF**)

These areas are connected to the oculomotor, trochlear, and abducens nuclei by the

**conjugate gaze**

or the movement of the eyes in the same direction, during horizontal movements that require the lateral and medial rectus muscles.

 **internuclear ophthalmoplegia**

The examiner is watching for conjugate movements representing proper function of the related nuclei and the MLF. Failure of one eye to abduct while the other adducts in a horizontal movement

**Diplopia**

is not restricted to failure of the lateral rectus, because any of the extraocular muscles may fail to move one eye in perfect conjugation with the other.

 **convergence**

When the two eyes move to look at something closer to the face, they both adduct,

**accommodation**

The change in focal power of the eye

**accommodation–convergence reflex**

Coordination of the skeletal muscles for convergence and coordination of the smooth muscles of the ciliary body for accommodation

**vestibulo-ocular reflex (VOR)**

coordinates all of the components, both sensory and motor, that make this possible.

 **fauces**

This is followed by inspection, with the aid of a tongue depressor, of the back of the mouth, or the opening of the oral cavity into the pharynx known as the

**Romberg test**

A final subtest of sensory perception that concentrates on the sense of proprioception

**spinocerebellar tract**

This test can indicate deficits in dorsal column pathway proprioception, as well as problems with proprioceptive projections to the cerebellum through the

**hypotonicity or flaccidity**

lack of muscle tone

**pronator drift**

A sign of UMN lesion is a negative result in the subtest for

**deep tendon refle**x

is commonly known as a stretch reflex, and is elicited by a strong tap to a tendon, such as in the knee-jerk reflex.

**superficial reflex**

is elicited through gentle stimulation of the skin and causes contraction of the associated muscles.

 **plantar reflex**

The most common superficial reflex in the neurological exam

**spasticity**

 is an excess contraction in resistance to stretch

 **hyperflexia**

which is when joints are overly flexed

 **paresis**

A lesion on the LMN would result in paralysis, or at least partial loss of voluntary muscle control

 **middle cerebellar peduncle**

are the major physical connection of the cerebellum to the brain stem.

**superior cerebellar peduncle (SCP)**

is the connection of the cerebellum to the midbrain and forebrain.

**inferior cerebellar peduncle (IC**P)

is the connection to the medulla.

**cortico-ponto-cerebellar pathway**

that connects the cerebral cortex with the cerebellum and preferentially targets the lateral regions of the cerebellum.

**vestibulocerebellum**

The flocculonodular lobe

 **cerebrocerebellum**

 the lateral cerebellum

**check reflex**

depends on cerebellar input to keep increased contraction from continuing after the removal of resistance.

**Gait**

can either be considered a separate part of the neurological exam or a subtest of the coordination exam that addresses walking and balance.

**ataxia**

A movement disorder of the cerebellum