Neurological exam Week 10

What are the components of orientation x3?

Place, person, and time

When would you move on from an informal to a formal evaluation of mental status?

If you sense abnormalities in how alert/oriented/coeherent the patient is

What is the first component of the mental status exam?

History

What is the first test you perform if a patient has history of trauma during the mental exam?

CT

What are the positives of a CT?

Fracutres, subdural hematoma, intracranial bleeding

What do you do with a patient who has a positive CT?

Stabilize in ER

What are the follow-ups for a negative CT?

Check neurological signs

What do you do if a patient has a negative CT and abnormal neurological signs?

Follow up with an MRI

What is the recommendation for someone within 72 hours of concussion?

Avoid triggers (caffeine, loud sounds, alcohol)

What is the recommendation for someone after 72 hours of concussion?

Avoid triggers, but slowly reintroduce external stimuli

What do you do if a concussion patient's symptoms do not improve rapidly over one week?

Refer to concussion rehabilitation specialist

What test do you run if a patient with mental abnormalities has no history of head/neck trauma?

EKG (for heart abnormalities)

What test do you run if a patient with mental status abnormalities has no heart abnormalities?

Lung checks (oxygen/carbon monoxide, carbon dioxide values))

What do you check if a patient with mental status abnormalities has no lung issues?

Check temperature

What is suspected if a patient with mental status abnormalities has a fever?

infection

What test is used to test for infection in a patient with a fever?

Urinalysis

What tests are run if a patient has normal urinalysis with a fever?

Blood labs

What test is run if a patient with a fever has normal bloodwork?

CT scan

What does MMSE stand for?

Folstein mini-mental status exam

What are the components of the orientation portion of the MMSE?

What is the year, season, date, day, moth (0-5 points)

Where are we (state), (country), (town), (hospital), (floor) (0-5)

What are the components of the registration potion of the MMSE?

Name 3 objects: 1 second to say each

Then ask the patient all 3 after you have said them

Give 1 point for each correct answer then repeat them until they learn all 3

What are the components of the attention and calculation portion of the MMSE?

Serial 7s and recall

What is serial 7s?

ask them to count backwards from 100 by 7s

1 point for each correct answer

Stop after 5 answers (0-5)

What is the alternative to serial 7s?

spell "world" backward (0-5)

What are the components of the language portion of the MMSE?

Name a pencil and watch (0-2)

Repeat the following "no ifs, ands, or buts" (0-1)

Follow a 3-stage command: "take a paper and fold it in half, and put it on the floor

Read and obey the following: CLOSE YOUR EYES (0-1)

Write a sentence (0-1)

Copy the design shown (0-1)

What is the continuum of the MMSE?

Alert-drowsy-stupor-coma

What score on the MMSE represents dysfunction?

23/30

What score on the MMSE represents psychosis, delirium, or dementia?

20/30

What is the AKA of acute brain failure?

Delirium

What is the AKA of chronic brain failure?

Dementia

What can make a false positive for the MMSE?

Linguistic difficulties or low education level

Depression or other psychiatric problems

Inattention due to distraction

Where are the language centres located?

Left hemisphere

What is the receptive language center?

Wernicke's area

what is the expressive language center?

Broca's area

What connects Broca's and wernicke's area?

Arcuate fasciculus

What is the term for deficits in language functions (understanding/comprehension/expression)?

Aphasia

What is the term for deficits in speech?

Dysarthria

What lesions may be involved in dysarthria (inability to articulate speech)?

CN V3 (mandibular)

CN VII

CN IX/X

CN XII

Cerebellum

How can CN V3 lesion lead to dysarthria?

It controls jaw movement

How can CN VII lesion lead to dysarthria?

It controls cheek muscles

How can CN IX/X lesion lead to dysarthria?

They control the soft palate

How can CN XII lesion lead to dysarthria?

It controls tongue movement

How can cerebellar lesion lead to dysarthria?

it coordinates all the movements

What are the types of Broca's aphasia?

Expressive aphasia (can't get words out)

Non-fluent aphasia (choppy/unclear speech)

(motor aphasia)

What are the types of Wernicke's aphasia?

Receptive aphasia (can't understand speech)

Fluent aphasia (talking nonsense)

(sensory aphasia)

What is the term for wrong words spoken with a wernicke's aphasia?

Paraphasia

What is the term for new words created by people with wernicke's aphasia?

Neologism

What is the term for a lesion in both Broca's and wernicke's areas?

Global aphasia

What is the term for a lesion of the arcuate fascicles?

Conductive aphasia

What are the symptoms of conductive aphasia?

Loss of repetition, with preservation of comprehension and output

What is the term for a lesion in the middle of the temporal gyrus, inferior and posterior to wernicke's area?

Transcortical sensory aphasia

What is the presentation of transcortical sensory aphasia?

Poor auditory comprehension (similar to wernicke's), but with preserved repetition

(can repeat words, but not understand them)

Which arteries perfuse the language centres of the brain?

MCA / internal carotid artery / anterior circulation

What is the main language function of the right hemisphere?

Tone, cadence, and emphasis on words

Prosody

What is the term for conveying thoughts and emotion through tone of voice?

Prosody

T or F: People with left-sided language deficits are sometimes still able to sing

True (due to preservation of musical activities int eh right hemisphere)

Which hemisphere controls 3 dimensional or spatial perception (conceptually)

Right

What side of the body will a hemishpheric lesion present on?

Contralateral

What is the term for lack of perception on one side?

Hemineglect

T or F: Patients with Broca's aphasia have normal repetition

False (they might not be able to say certain words)