Neuro Exam 2: Key Concepts and Clinical Conditions

Rancho Los Amigos Scale

A scale that assesses levels of cognition.

lability

Uncontrolled emotional responses.

cortical blindness

A condition where the optic nerve remains intact but the brain cannot record the image.

dermatome level for umbilicus

T10.

locked-in syndrome

A condition where a patient sustains an injury to the pons and can only move their eyes.

C6 spinal cord injury would effect what muscle

Triceps

T12 spinal cord lesion

A patient could functionally perform sit up.

predictor of functional outcome after SCI

Their available muscle groups following spinal shock resolution.

basilar artery

One major blood supply to the cerebellum

Glasgow coma scale

A scale that looks at motor, verbal and eye responses.

normal intracranial pressure range

5-10 mmHG.

left CVA patient is more

cautious

not closely associated with TBI

Autonomic dysreflexia (OCCURS WITH SCI)

pocketing food

Food that is not properly moved to the back of the throat and swallowed.

purposeful and appropriate on Rancho Los Amigos Scale

Patients are functioning independently but may not be at as high a level as they were before.

transient ischemic attack

A temporary interruption of blood supply to the brain.

Persistent high blood pressure can cause

stroke

Brown - Sequard Syndrome

contralateral pain and temperature loss, & ipsilateral proprioception loss

Brown - Sequard Syndrome

caused by direct penetration by a foreign object resulting in partial damage to one side of the spinal cord

Posterior Cord Syndrome

loss of proprioception, but motor function, pain and light touch remain intact

Central Cord Syndrome

Seen more commonly in the older population (>50)

presents with upper extremities more involved than lower extremities.

Anterior Cord Syndrome

spinal cord injury can be caused by cervical flexion with loss of the anterior spinal artery

Conus Medullaris Syndrome

SCI with residual damage to the base of the spine.

Anterior Cord Syndrome

bilateral loss of motor function, pain, and temperature below the level of the lesion.

ASIA Classification for Spinal Cord Injury

Used to determine the extent of the spinal cord injury post shock.

complete C6 spinal cord injury

will have respiratory involvement

spinal cord injury at C4 ambulating with a walker and isn't wearing braces

injury is incomplete

autonomic dysreflexia

not caused by low blood pressure

incontinence

Uncontrolled

Right CVA

may have contralateral weakness

spinal cord injury losing all motor & sensory function below T4 with no sacral sparing

complete cord lesion

TBI with cerebellar lesion

pt will have some alteration in coordinated movement

main difference between embolus vs thrombus

Embolus: Motion

Thrombus: Stationary

intracerebral hemorrhage

bleed within the brain tissue

Glasgow Coma Scale (GCS) of 5

is still considered comatose

loss of tear production and saliva secretion, loss of stapedius muscle function causing hyperacusis and an ability to smile are all secondary to bilateral temporal bone fractures with swelling causes

disruption to CN VII

The most common cause for embolic CVA involves

the heart

Anterior Cerebral Artery Syndrome is not common

collateral circulation compensates

infratentorial ICH can include the

Cerebellum

Suffers TBI with prior history of TBI

risks a poorer prognosis

non-modifiable risk factor

Age

parietal lobe blood supply

MCA and ACA

cerebral blood flow of 6 ml/100mg/min

results in neuronal death

PCA infarct concern

thalamic syndrome

C8 spinal cord injury become diaphoretic, complains of a severe headache. Fainting is a concern

sit upright, taken vitals, look for the problem

SCI has early onset or greater risk of developing

Osteoporosis

ASIA classification C

incomplete spinal cord injury presenting with motor function preserved below the neurological level with most of those key muscles having a muscle grade < 3

ASIA classification B

incomplete spinal cord injury presenting with intact sensation and no motor function below the neurological level

cauda equina injury bladder involvement

flaccid bladder

syringomyelia

SCI complicaition

spinal shock following a SCI will present with

areflexia.

ASIA A C3 spinal cord injury

will need ventilatory support.

Coup contra coup brain injury

Damage to the brain at the site of impact and directly opposite.

TBI but is alert, oriented with no physical deficits immediately following the injury

closely monitor

stroke involving the occipital lobe

may experience visual deficits.

Paralyzed intercostal muscles from ASIA A C5 SCI will cause

respiratory problems with a decreased inspiratory volume

not a contributor to a hemorrhagic stroke

Thrombocytosis

When treating a pt post CVA, it is important to recognize

an evolving stroke

heterotopic ossification (HO)

Unwanted bone formation around the joints.

right hemispheric stroke problem

difficulty finding their center of gravity.

ASIA D - T10 spinal cord injury

may be able to ambulate.

Female with ASIA B - C8 spinal cord injury

can conceive a child

Segmental breathing is not appropriate in DVT prevention in SCI ASIA A - T4

because it stresses the lower intercostal muscles

dermatome level for nipple area

T4.

ASIA A - L1

able to transfer independently.

closed head injury

brain has not been exposed during the injury.

Conus Medullaris injury

presents with UMN or LMN signs

monitor ICPs and defer treatment

ICP greater than 20mmHg

Glasgow Coma Scale (GCS) best motor response

A score of 6.

GCS: a patient who does not open his eyes and does not respond motorically or verbally under any circumstances

A score of 3.

Hemineglect

Difficulty finding your way back to your room could be caused by

Aphasia

A language disorder that affects a person's ability to communicate or following commands

Baclofen

treats/decreases residual spasticity post CVA

GOS

Used to assist with prognosis of a brain injury

most common artery to infarct in Wallenberg's Syndrome

vertebral artery

Ideomotor apraxia

The person understands the task but can't carry it out correctly

HTP coaches specialty

Neuropsychology.

Not an expected complication with severe TBI

Autonomic dysreflexia (SCI complication)

Infection

diagnosis secondary to a clinical manifestation of increased spasticity

Orthostatic hypotension

may occur when working with bedridden patient

One expected complication when monitoring aneurysm

Vasospasm

Craniotomy for evacuation of a SDH

surgical procedure that may be necessary to avoid brain damage 2/2 a complication of a SAH

Decubitus ulcers, DVT and Pneumonia

conditions that develop due to prolonged immobility.

Will improve when mobilizing a pt with prolonged immobility

Consciousness

Prevent infection

A justification for discontinuing a foley catheter.

Avoid brain tissue damage

A likely justification for placement of a shunt in the brain to the peritoneal cavity or the R atrium

They have emerged from shock

PT goes from diroriented and confused to aware.

Mannitol

Assists with High ICPs

Dilantin

Assist with convulsions.

Compromised blood-brain barrier

A complication of brain injury that is vasculogenic.

Subcortical

A word to describe a lacunar infarct.

R cerebellar stroke presents with signs of discoordination to includeataxia, dysdiadochokinesia, dysmetria on what side

R side

R CVA and presents with homonymous hemianopsia will have

Deficits on left side

Not related to arteriovenous malformation

enlarged capillary network

L hemispheric stroke is most likely to present with

Apraxia

The corticospinal tract

Decorticate posturing indicates damage to this area.

Posture after damage to Brain stem level

Decerebrate posturing

Upper extremities flexed and lower extremities extended

Decorticate posturing

The C8 motor level adds what available movement that was not present at the C7 level

finger flexion

highest level of spinal cord injury that a tenodesis can be available to patients with an ASIA A injury

C5