Chapter 16: The Neurological Exam

painful stimuli

Mistaking ________ for light touch, or vice versa, may point to errors in ascending projections, such as in a hemisection of the spinal cord that might come from a motor vehicle accident.

nervous tissue

As blood pools in the ________ and the vasculature is damaged, the blood- brain barrier can break down and allow additional fluid to accumulate in the region, which is known as edema.

least partial loss of

A lesion on the LMN would result in paralysis, or at ________ voluntary muscle control, which is known as paresis.

HM

In 1953, a bilateral lobectomy was performed that alleviated the epilepsy but resulted in the inability for ________ to form new memories- a condition called anterograde amnesia.

German neurologist

The ________ and histologist Korbinian Brodmann, who made a careful study of the cytoarchitecture of the cerebrum around the turn of the nineteenth century, described approximately 50 regions of the cortex that differed enough from each other to be considered separate areas.

twelve cranial nerves

The ________ are typically covered in introductory anatomy courses, and memorizing their names is facilitated by numerous mnemonics developed by students over the years of this practice.

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.

placement of the feet

A subtest called station begins with the patient standing in a normal position to check for the ________ and balance.

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 reflex

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 (ICP)

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