HA EXAM 2 - neuro w/o cranial nerve

Pupil assessment: what to note

Size, shape, symmetry of both pupils; direct and consensual light reflex

Direct light reflex

Pupil constricts immediately when light is shone into it

Consensual light reflex

The opposite pupil constricts at the same time and to the same degree

Sudden unilateral dilated, nonreactive pupil in a brain-injured person

Ominous - rising ICP/uncal herniation is compressing CN III

Why does herniation dilate the pupil?

CN III runs parallel to the brainstem; ICP pushes brainstem down and presses on CN III

Ptosis

Droopy/falling upper eyelid; can affect one or both eyes

Accommodation

Pupils constrict and eyes converge when shifting focus from far to near

Peripheral nervous system

All nerve fibers outside the brain and spinal cord

Sensory (afferent)

Carries messages TO the CNS from sensory receptors

Motor (efferent)

Carries messages FROM the CNS out to muscles and glands (plus autonomic messages to organs and vessels)

Paresis

Partial paralysis

Paralysis

Total motor loss

Tremor

Involuntary shaking/trembling; may be from anxiety, intention, or at rest

Muscle size: atrophy vs hypertrophy

Shrinking vs enlarging of muscle; may indicate neurological or muscular disease

Muscle strength 0

No visible or palpable contraction

Muscle strength 1

Visible or palpable contraction, no motion

Muscle strength 2

Full ROM with gravity eliminated

Muscle strength 3

Full ROM against gravity

Muscle strength 4

Full ROM against gravity with moderate resistance

Muscle strength 5

Full ROM against gravity with maximal resistance (normal)

Flaccidity

Decreased resistance to movement (hypotonia)

Spasticity and rigidity

Muscle tone abnormalities that may indicate CNS dysfunction

Pronator drift: how to test

Arms extended forward at shoulder height, elbows straight, palms up; hold position

Bilateral downward drift means

Mild upper motor neuron weakness or spinal cord issue

One-sided drift means

Lesion on the contralateral side of the brain

Tics

Sudden, brief, repetitive movements (ex: blinking)

Tremors (involuntary movement)

Rhythmic shaking; common in Parkinson's

Fasciculations

Small muscle twitches seen under the skin (ALS)

Myoclonus

Sudden, quick jerks

Chorea

Irregular, jerky, dance-like movements; Huntington's disease

Paresthesia

Numbness or tingling

Dysphagia

Difficulty swallowing

Dysarthria / dysphasia

Difficulty speaking

Sharp vs dull testing evaluates

Pain perception and sensory nerve function

Light touch testing

Wisp of cotton across multiple dermatomes

Vibration sense testing

Tuning fork on bony prominences; 128 Hz or 256 Hz because lower pitches decay slower

Stereognosis

Identifying a familiar object by touch without looking

Graphesthesia

Recognizing numbers/letters traced on the palm; cortical sensory processing

Neuro red flags needing immediate attention

One-sided weakness/numbness of face, arm, leg; confusion or speech trouble; vision changes; trouble walking/dizziness/balance loss; sudden severe headache without cause

TIA (mini-stroke)

Stroke symptoms that are temporary, often gone within an hour; people often fail to report them

Why do people delay seeking care for stroke?

Symptoms usually do not hurt

F.A.S.T.

Face drooping, Arm weakness, Speech difficulty, Time to call 911