Neurologic Exam Week 6

Damage to what regions can cause UMNL?

motor cortex

pyramids

corticospinal tract

What type of lesion causes muscle spasticity?

UMNL

What grade reflexes are caused by UMNL?

3+ / 4+

How much atrophy is present in UMNL?

Little

Damage to what regions can result in LMNL?

Ventral horn

spinal nerve root

peripheral nerve

What grade reflexes are caused by LMNL?

1+ / 0

What is the AKA of a 0 reflex?

Areflexia

T or F: Pathological reflexes only present in the lower extremity?

False (can be present in both upper and lower extremity)

When does the stepping reflex disappear?

2 mo

When does the rooting reflex disappear?

4 mo

What does the palmar grasp reflex disappear?

5-6 mo

When does the Moro reflex disappear?

5-7 mo

When does the tonic neck reflex disappear?

5-7 mo

When does the plantar grasp reflex disappear?

9-12 mo

What direction do you flick the 3rd DIP in Hoffman's test?

Down (Ho-Down)

What is the positive finding of Hoffman's test?

Flexion of the patient's thumb and index finger

What direction do you flick the 3rd DIP in Tromner's test?

Up

What is the positive finding of Tromner's test?

Flexion of the patient's thumb and index finger

What is the name of the test where you use the reflex hammer to stroke the medial distal ulnar region of the hand?

Chaddock's test

What is the positive finding of chaddock's test?

Wrist flexion and finger extension

What does a positive chaddock's test indicate?

Lesion to the pyramidal tract

What is the name of the test where you squeeze the patient's pisiform using your thumb?

Grodon's test

What is the positive finding of gordon's test?

Extension of the fingers

What is the name of the test where the doctor strokes up the lateral aspect of the patient's bottom of their foot?

Babinski's reflex

What is the positive finding of babinski's reflex?

Extension of the big toe

What is the positive finding of almost every single lower extremity pathological reflex test?

Extension of the big toe ("babinski reflex")

Which lower extremity pathological reflex test does not have a positive finding of babinski reflex?

Rossolimo's reflex

What is the name of the test where the doctor strokes the lateral side of the foot?

Chaddock's reflex

What is the name of the test where the doctor squeezes the patient's calf muscle?

Gordon's reflex

What is the name of the test where the doctor uses their knuckles to stroke down the tibial crest?

Oppenheim's reflex

What is the name of the test where the doctor squeezes the achilles tendon?

Shaffer's reflex

What is the name of the test where the doctor pulls down the 2nd or 4th DIP and abruptly releases it?

Gonda's sign

What is the name of the test where the doctor taps the bottom of the foot with the reflex hammer?

Rossolimo's reflex

What is a positive Rossolimo's reflex?

Flexion of the toes

How is clonus tested in the upper extremity?

Pull the patient's wrist into extension

What is a positive sign for clonus?

Patient's wrist will tremble with repetitive pulsating contractions into your hand

What causes the positive sign of clonus?

pathological rapid stretch-contraction reflexes

How is clonus tested in the lower extremity?

Rapidly push the foot into dorsiflexion

T or F: Pathological reflexes are abnormal when present while superficial reflexes are abnormal when absent

True

T or F: Superficial reflex absence can indicate either UMNL or LMNL

True

Which nerves are tested using the abdominal reflex in the upper right quadrant?

Right T7-T10

Which nerves are tested using the abdominal reflex in the upper left quadrant?

Left T7-T10

Which nerves are tested using the abdominal reflex in the lower right quadrant?

Right T11-T12

Which nerves are tested using the abdominal reflex in the lower left quadrant?

Left T11-T12

What is the short cut for the abdominal reflex?

Just stroke each quadrant obliquely towards the umbilicus

What is the normal finding of the abdominal reflex?

Muscles will contract pulling the belly button out towards the stroke

What can cause an absent abdominal reflex?

Anterior corticospinal lesion at the dermatomal level

Excessive adipose tissue

Elderly

What is the name of the test where you stroke the proximal inner thigh with the end of the reflex hammer?

Cremasteric reflex

What is the normal finding of the creamsteric reflex?

Elevation of the testicle on the side tested

What is the name of the reflex where you stroke the plantar foot curling into the big toe?

Plantar reflex

What nerves does the plantar reflex test?

L5 and S1

What is a normal plantar reflex?

Flexion of the toes, absence of the plantar superficial reflex

What is an abnormal plantar reflex?

Babinski sign

What is the test where the doctor strokes the perianal region with a cotton swab?

Anal Wink Reflex

What nerves are tested using the anal wink reflex?

S2-S5

What is the normal finding of the anal wink reflex?

Contraction of the anal sphincter

What is the role of the primary somatosensory cortex?

Awareness of somatic sensations

Touch, pain, temperature

What is the role of the somatosensory association cortex?

processing/analyzing somatic sensations

Memory of sensations

Recognition of sensations

Proprioception

What is the ability to identify objects using touch only?

Stereognosis

What is the ability to identify letters or numbers by touch only?

Graphognosis

What is the ability to sense the position and movement of your body parts?

Statognsosis

What is the ability to accurately localize tactile stimuli without visual input?

Topognosis

What is the ability to determine when you are being touch in two places at once?

Double simultaneous stimulation/"extinction"

How is stereognosis tested?

Place a familiar object into the patient's hand

What does it indicate if a patient can feel an object in their hand, but not recognize it?

somatosensory association cortex lesion

How is Graphognosis tested?

Draw a letter or number of the patient's hand

What does it indicate if a patient can feel you touch their hand, but not recognize the number or letter you draw?

somatosensory association cortex lesion

What is the term for inability to identify a number or letter by touch?

Graphesthesia

What is the AKA of double simultaneous stimulation?

Excitnction

What does it indicate if a patient can only feel stimulus on one side during the double simultaneous stimulation test?

primary somatosensory lesion

What does it indicate if a patient can feel stimulation separately on each side, but not when you touch on both sides at once?

Positive for double simultaneous stimulation extinction

What are less common areas associated with double simultaneous stimulation?

Inferior parietal lobe

Dorsal frontal lobe

Cingulate gyrus

Basal ganglia

thalamus

What does a positive double simultaneous stimulation extinction usually indicate?

right hemispheric stroke

(specifically in the parieto-temporal lesions)