Normal Neuro

This set of flashcards covers key concepts related to neurologic history taking and physical exam techniques, focusing on essential components, risk assessments, examination skills, and diagnoses.

What is another name for the central neuroaxis?

upper motor neuron

What is another name for the peripheral neuroaxis?

lower motor neuron

What are components of the central neuroaxis?

brain (cortex, subcortex, cerebellum, brainstem)

spinal cord

motor neuron

What are components of the peripheral neuroaxis?

motor neuron

peripheral nerve

neuromuscular junction

muscle

What are the goals of taking a neuro history?

localizing the lesion

determining the etiology

What past medical history is important to ask about in a neuro complaint?

migraines

seizures

DM, HTN, HLD, AF

kidney or liver failure

cancer

HIV or STIs

What family history is important to ask about in a neuro complaint?

migraines

stroke

seizures

cancer

What are the components of a neuro exam?

general and mental status

speech and language

cranial nerves

sensory and motor

coordination

gait and balance

deep tendon reflexes

What does “alert” mental status mean?

awake with eyes open

responding to questions

What does “lethargic” mental status mean?

drowsy but will open eyes

responds to questions

What does “obtunded” mental status mean?

opens eyes but responds slowly

confused

What does “stuporous” mental status mean?

arouses from sleep only with painful stimuli

may or may not respond to questions

minimal awareness

What does “comatose” mental status mean?

unrousable with eyes closed

no response to stimuli

How should orientation be evaluated?

person: what is your full name

place: where are we right now

time: what is the date today

situation: what brings you in today, how did you get to this visit

How should attention be evaluated?

state alphabet backwards

spell “WORLD” backward

calculate serial 7s

How should recent memory be evaluated?

give patient 3 words

ask patient to repeat words immediately

ask to recall words in 5 minutes

How should remote memory be evaluated?

ask patient about 3 verifiable past events (last 3 presidents)

What is dysarthria?

slurred or slowed speech

weakness or incoordination

What is aphasia?

impairment of language production or processing

brain dysfunction

What is CN 1? What is its role?

olfactory nerve

sense of smell

Is CN 1 motor, sensory, or both?

sensory

What is CN 2? What is its role?

optic nerve

visual information

Is CN 2 motor, sensory, or both?

sensory

What is papilledema?

bilateral bulging of the optic disc from increased ICP

What is CN 3? What is its role?

oculomotor nerve

eyelid position, pupillary response, extraocular movements

Is CN 3 motor, sensory, or both?

motor

What nerve innervates the superior rectus muscle?

oculomotor

What is the action of the superior rectus muscle?

elevation and abduction

What nerve innervates the lateral rectus muscle?

abducens

What is the action of the lateral rectus muscle?

abduction

What nerve innervates the inferior rectus muscle?

oculomotor

What is the action of the inferior rectus muscle?

depression and abduction

What nerve innervates the superior oblique muscle?

trochlear

What is the action of the superior oblique muscle?

depression and adduction

What nerve innervates the medial rectus muscle?

oculomotor

What is the action of the medial rectus muscle?

adduction

What nerve innervates the inferior oblique muscle?

oculomotor

What is the action of the inferior oblique muscle?

elevation and adduction

What might be seen with CN 3 palsy?

ptosis

inability to adduct affected eye

eye abducted at rest

+/- abnormal pupillary dilation

What is CN 4? What is its role?

trochlear nerve

extraocular movement

Is CN 4 motor, sensory, or both?

motor

What might be seen with CN 4 palsy?

difficulty looking down and in

eye points upward with adduction (superior oblique dysfunction)

+/- head tilt

What is CN 5? What is its role?

trigeminal nerve

facial sensation and temporal/masseter motor function

Is CN 5 motor, sensory, or both?

motor and sensory

What is CN 6? What is its role?

abducens nerve

extraocular movement

Is CN 6 motor, sensory, or both?

motor

What might be seen with CN 6 palsy?

difficulty abducting eye

affected eye unable to look outward

eye adducted at rest

What is CN 7? What is its role?

facial nerve

motor function of facial muscles and taste in anterior 2/3 of tongue

Is CN 7 motor, sensory, or both?

sensory and motor

What might be seen with CN 7 palsy (Bell Palsy)?

unilateral loss of facial muscle control (upper and lower face)

unable to smile, grimace, puff out cheeks

unable to blink or close eye fully

unable to raise eyebrow

How can Bell Palsy be differentiated from a stroke?

strokes usually spare the forehead

is patient can’t move eyebrows, then Bell Palsy

What is CN 8? What is its role?

vestibulocochlear nerve

hearing and balance

Is CN 8 motor, sensory, or both?

sensory

What is CN 9? What is its role?

glossopharyngeal nerve

pharynx movement and sensation of ear canal/pharynx/taste on posterior 1/3 of tongue

Is CN 9 motor, sensory, or both?

sensory and motor

What is CN 10? What is its role?

vagus nerve

movement of pharynx, larynx, and palate

Is CN 10 motor, sensory, or both?

sensory and motor

What is CN 11? What is its role?

spinal accessory nerve

movement of trapezius and SCM

Is CN 11 motor, sensory, or both?

motor

What is CN 12? What is its role?

hypoglossal nerve

movement of the tongue

Is CN 12 motor, sensory, or both?

motor

What dermatome and nerve is being tested at the thumb?

C6

median and radial nerve

What dermatome and nerve is being tested at the pinky?

C8

ulnar nerve

What dermatome is being tested at the lateral forearm?

C8

What dermatome is being tested at the medial forearm?

T1

What dermatome is being tested at the shoulder?

C5

What dermatome is being tested at the lateral dorsal foot or 5th toe?

S1

What dermatome is being tested at the medial dorsal foot or 1st toe?

L5

What dermatome is being tested at the ankle above the medial malleolus?

L4

What dermatome and nerve is being tested at the lateral calf?

S1

peroneal nerve

What nerve is being tested at the lateral thigh?

lateral cutaneous femoral nerve

How is sensory information carried from the body to the brain?

peripheral tissue —> dorsal root ganglia of spinal nerves —> spinal cord —> brain

What is detected by the spinothalamic tract?

pain, temperature, crude touch

What is the role of the corticospinal tract?

most voluntary movement

anterior: proximal muscle control

lateral: distal muscle control

How do signals travel through the corticospinal tract?

upper motor neurons in cerebral cortex —> decussate in medulla or spinal cord —> synapse with lower motor neurons in anterior horn of spinal cord

How do upper motor neurons impact lower motor neurons?

more upper neuron input INHIBITS lower neurons

increased lower motor activity results when upper motor inhibition is REMOVED

How do lower motor neurons impact muscles?

more lower neuron input EXCITES muscles

decreased muscle activity results when lower motor excitation is REMOVED

What is detected by the posterior or dorsal column?

proprioception, vibration, fine touch

Is the sensory system within the spinal cord contralateral or ipsilateral?

ipsilateral

Is the sensory system within the brain contralateral or ipsilateral?

contralateral

Where is the primary somatosensory cortex?

parietal lobe

What are components of the motor exam?

bulk

tone

strength

How should bulk be assessed?

inspect muscles for bulk

assess proximal and distal

assess for symmetry

What is atrophy?

decreased muscle bulk

What is hypertrophy?

increased muscle bulk

How should tone be assessed?

passively move patient limbs

start slow, then rapid

What is normal tone?

even and consistent resistance to movement

What is decreased muscle tone?

flaccid

hypotonic

What is increased muscle tone?

rigidity

spasticity

hypertonic

When might hypotonia be seen?

lower motor neuron or PNS disease

When might hypertonia be seen?

upper motor neuron or CNS disease

What is grade 0 on Ashworth tone scale?

no increase in muscle tone

What is grade 1 on Ashworth tone scale?

slight increase in muscle tone

catch and release or minimal resistance at end of ROM in flexion/extension

What is grade 1+ on Ashworth tone scale?

slight increase in muscle tone

catch, then minimal resistance through less than half of ROM

What is grade 2 on Ashworth tone scale?

more marked increase in muscle tone through most of ROM

affected parts easily moved

What is grade 3 on Ashworth tone scale?

considerable increase in muscle tone passive

passive movement difficult

What is grade 4 on Ashworth tone scale?

affected part rigid in flexion or extension

What is grade 5 motor strength?

active movement against full resistance without evident fatigue

What is grade 4 motor strength?

active movement against gravity and some resistance

What is grade 3 motor strength?

active movement against gravity