Neuro Part 3/Cases PD I

lethargic

drowsy but arousable

obtunded

open eyes, but slow and confused

stuporous

require painful stimuli to arouse

comatose

unarousable

cheyne-stokes

cycles of alternating deep and shallow breathing, followed by a period of no breathing

regarding the glasgow coma score, what score is considered comatose?

8 or less

Stereotypic

painful stimulus evokes a postural response

decorticate

flexor response

decerebrate

extensor response

flaccid

no response, no tone

what cranial nerves for pupillary light reflex?

CN II, III

what cranial nerves for ocular position and movement?

CN III, IV, VI

what cranial nerves for oculocephalic reflex?

CN III, VI, VIII

what cranial nerves for oculovestibular reflex with caloric stimulation?

CN III, IV, VI, VIII

what cranial nerves for corneal reflex?

CN V, VII

what cranial nerves for facial asymmetry and grimace to painful stim?

CN VII

what cranial nerves for gag reflex?

CN IX, X

you are doing a pupillary exam on a comatose patient. if their pupils are asymmetric or have no response to light what would you suspect the cause of the coma?

structural

you are doing a pupillary exam on a comatose patient. if their pupils have a positive response to light what would you suspect the cause of the coma?

metabolic

you are performing the oculocephalic reflex on your patient with suspected brainstem dysfunction. what result would you expect if the patients brainstem is intact? what about if there was a brainstem lesion?

intact – eyes turn to keep looking at the same spot

lesion – eyes move with head

how is the oculovestibular reflex with caloric stimulation performed and what would be the result if the brainstem is intact?

Cold water into EAC; Eyes deviate toward water

cerebral lesions

contralateral body

cerebellar hemispheric lesions

ipsilateral body

brainstem lesions

4 Ds with crossed findings- Diplopia, dysarthria, dysphagia, dizziness

Patient presents with difficulty speaking. They also have mild weakness in the right arm and hand. Where do you think the lesion is?

left cerebral hemisphere

Patient presents with difficulty speaking. They also have mild weakness in the right arm and hand. What other s/s do you think the patient would also have?

May have right arm numbness, have right sided hyper-reflexia and Babinski sign; increased muscle tone (except may not in acute stage)

Patient presents with right sided weakness in the arm and leg. They also admit to diplopia and have left ptosis on exam with the left eye being laterally deviated and inferior.

Where do you think the lesion is?

​​Left midbrain; This is known as "weber syndrome" when it is from a stroke

Ipsilateral CN3 (oculomotor nerve) palsy and Contralateral arm and leg weakness (hemiparesis)

Patient presents with neck pain and left arm paresthesia that goes into the middle finger. They have ipsilateral absent triceps reflex. The biceps and brachioradialis reflexes are intact. Where do you think the lesion is? What other s/s may the patient have?

Neck pain and ipsilateral Shooting pain down arm, paresthesias, numbness in c7 dermatome- middle finger May have Ipsilateral weakness in c7 myotome- elbow extension (triceps) and wrist flexion

C-7 cervical radiculopathy

Patient presents with LBP and pain that radiates down the right leg. It goes from the lateral thigh, crosses at the knee to medial lower leg, to the medial foot. There is numbness and paresthesia in these areas. There is absent right patellar reflex, with an intact achilles reflex.

Where do you think the lesion is? What other s/s may the patient have?

Ipsilateral Weakness in L4 myotome- foot dorsiflexion (tibialis anterior) L 4 Lumbar radiculopathy