Overview of the Central Nervous System and Neurological Exam

What structures make up the central nervous system (CNS)?

Brain and spinal cord.

What is the function of the subarachnoid space and cerebrospinal fluid (CSF)?

Cushion the brain and spinal cord, nourish the CNS, and remove waste.

What are the four lobes of the cerebrum and their primary functions?

Frontal (behavior, intellect), Parietal (sensation), Temporal (hearing, memory), Occipital (vision).

What are the components of the brain stem?

Midbrain, pons, medulla oblongata.

What is the function of the cerebellum?

Coordination and balance.

How many pairs of cranial and spinal nerves are in the PNS?

12 cranial and 31 spinal nerve pairs.

What is the difference between somatic and autonomic nervous systems?

Somatic controls voluntary muscles; autonomic controls involuntary functions.

Which vertebral levels does the sympathetic nervous system arise from?

T1 to L2.

Which nerves are associated with the parasympathetic nervous system?

S1 to S4 and cranial nerves III, VII, IX, X.

What are the components of a complete neurologic exam?

Mental status, cranial nerves, motor system, sensory system, reflexes.

What does the Romberg test assess?

Balance with eyes closed while standing.

What is the purpose of rapid alternating movements (RAM)?

To assess coordination and skilled movements.

Which cranial nerve is responsible for smell?

CN I (Olfactory).

Which cranial nerve controls visual acuity?

CN II (Optic).

Which cranial nerves control eye movement?

CN III (Oculomotor), CN IV (Trochlear), CN VI (Abducens).

What is tested with CN V (Trigeminal)?

Facial sensation and jaw clench.

What does CN VII (Facial) control?

Facial expressions like smiling and puffing cheeks.

Which cranial nerve is tested for hearing and balance?

CN VIII (Vestibulocochlear).

Which cranial nerves are involved in gag reflex and swallowing?

CN IX (Glossopharyngeal) and CN X (Vagus).

What does CN XI (Spinal Accessory) test?

Shoulder shrug strength.

How is CN XII (Hypoglossal) assessed?

By observing tongue movement.

What is stereognosis?

The ability to recognize objects by touch.

What is graphesthesia?

Ability to recognize numbers traced on skin.

What is two-point discrimination?

Ability to distinguish two simultaneous touches.

What is extinction in sensory testing?

Inability to sense bilateral touches at the same point.

What are deep tendon reflexes and examples?

Involuntary muscle contractions like biceps, triceps, patellar, Achilles.

What is the Babinski reflex and what does it indicate in adults?

Extension of big toe; indicates abnormality in adults.

What is clonus?

Rhythmic muscle contractions due to hyperactive reflexes.

How is the deep tendon reflex graded?

0 (no response) to 4+ (very brisk with clonus).

Name three primitive infant reflexes.

Rooting, palmar grasp, Moro.

What are common neurologic changes in older adults?

Decreased senses, intentional tremors, slower gait, reduced vibration sense.

What happens to RAM in older adults?

They are slower and less coordinated.

What is an early sign of sensory loss in older adults?

Reduced vibratory sense in feet.

What are the types of stroke?

Ischemic (clot), Hemorrhagic (bleed), TIA (mini-stroke).

What is the FAST acronym for stroke symptoms?

Face droop, Arm weakness, Speech difficulty, Time to call 911.

What are major risk factors for stroke?

Hypertension, diabetes, smoking, obesity, family history.

What are key stroke prevention strategies?

No smoking, exercise, healthy diet, manage chronic conditions.