Clinical Skills - Exam 5 (Neuro)

paresthesia

pins and needles

like feet are falling asleep

dysesthesia

pain without reason

TIA

mini stroke with full recovery

CVA

full stroke

lethargic

drowsy but arousable

obtunded

open eyes, but slow and confused

stuporous

require painful stimulation to arouse

comatose

unarousable

dysarthria

defective articulation

aphasia

disorder of speech

hesitancies, gaps, disturbed inflection

aphonia

loss of voice

nerve problems in larynx

dysphonia

less severe impairment in volume, quality, pitch of voice

causes of dysphonia

laryngitis

tumors

unilateral vocal cord paralysis

what is dysarthria

defect in muscular control of speech apparatus

what does dysarthria sound like

words slurred, nasal, or indistinct

central symbolic aspect of language remains

causes of dysarthria

lesion in CNS or PNS

Parkinson's

Cerebellar disease

broca aphasia

slow, non-fluent

meaningful

lesion of posterior inferior frontal lobe

wernicke aphasia

loud and fluent

lacks meaning

lesion of posterior superior temporal lobe

disorientation

problems with memory or attention

cognitive function testing

digit span (repeat #s)

serial 7s (count back from 100 by 7)

spell WORLD backwards

remote memory

birthday, anniversary, SSN

low in late stage dementia

recent memory

events of day, meals, weather

low in dementia, delirium, anxiety, depression

conditions that cannot draw a clock

dementia

visual or motor problems

mental slowness

CN III function

pupil constriction and reaction to light

-opening eye

-most EOMs

CN IV function

down and inward eye movement

extra-ocular superior oblique

CN VI function

lateral eye movement

lateral rectus

CN XI function

motor SCM and trap

if damage is above crossover in medulla problem is...

contralateral side

if damage is below crossover in medulla problem is...

ipsilateral side

3 pathways thru anterior horn cells

pyramidal tract

basal ganglia system

cerebellar system

pyramidal tract function

voluntary movement

delicate, skilled movement

inhibits muscle tone

damage to pyramidal tract results in

weakness

paralysis

poor delicate movement

increased muscle tone

increased DTRs

basal ganglia system function

maintains muscle tone

gross movement

damage to basal ganglia system results in

changed muscle tone

problems w/ posture, gait

bradykinesia

involuntary movements

cerebellar system function

coordination

equilibrium

posture

damage to cerebellar system results in

poor coordination

problems w/ gait, equilibrium

decreased muscle tone

muscle tone

resistance to passive stretch

0/5 muscle strength

no contraction

1/5 muscle strength

visible/palpable muscle contraction w/ no movement

2/5 muscle strength

movement against gravity eliminated

3/5 muscle strength

movement against gravity only

4/5 muscle strength

movement against gravity with some resistance

5/5 muscle strength

movement against gravity with full resistance

cerebellar system in coordination

rhythmic movement and steady posture

vestibular system in coordination

balance and coordination

sensory system in coordination

position sense

spastic muscle tone

increase tone

worse w/ motion extremes

-easy and then hard to move

rigid muscle tone

same difficulty thru ROM

flaccid muscle tone

limp, no strength or tone

paratonia

inability to relax muscle

unrelated to tone

pronator drift

on side w/ lesion

lesion in upper motor neurons

-pronators stronger than supinators

spastic hemiparesis gait

arm immobile and in flexion "posturing"

leg extended and plantar flexed, toes drag, circular motion

cause of spastic hemiparesis

unilateral hemispheric disease

stroke pt

scissor gait

spastic paresis

b/l stiff gait - adductors

short steps, look like walking thru water

steppage gait

foot drop from paralyzed dorsiflexors

-drags foot and lifts it high

-slaps foot down

cause of steppage gait

lower motor neuron disease

neuropathy and polio

sensory ataxia gait

unsteady and wide

loss of position sense

throw feet forward, heel then toe

double tapping sounds

sensory ataxia gait sign

positive romberg with eyes closed

causes of sensory ataxia gait

polyneuropathy or posterior column damage

cerebellar ataxia gait

unsteady, wide base, staggering

difficulty turning

sign of cerebellar ataxia gait

positive Romberg eyes open or closed

causes of cerebellar ataxia gait

cerebellar disease (MS)

parkinsonian gait

fenesterating gait

stooped appearance, falling forward

loss of arm swing, stiff and flexed

short shuffling steps

turns whole body at once

cause of festinating gait in parkinsonian gait

basal ganglia defect

senses of spinothalamic tract

pain (sharp v. dull)

temperature

crude touch

senses of posterior columns

position

vibration

fine touch

senses of sensory cortex

localization

discriminatory

analgesia

absence of pain sensation

hypalgesia

decreased sensitivity to pain

hyperalgesia

increased sensitivity to pain

anesthesia

absence of touch sensation

hypesthesia

decreased sensitivity to touch

hyperesthesia

increased sensitivity to touch

paresthesia

peculiar sensation without stimulation

dysesthesia definition

distorted sensation in response to stimulation

ex: soft feels painful

stereognosis

sensing of familiar objects

graphesthesia

sensing number or letter recognition

point localization

where was the patient touched?

discriminative sensations

extinction

discriminative sensation

stimulate b/l and point to spot

4 DTR

brisk, hyperactive with clonus

CP or MS

clonus

extra beats of a muscle

3 DTR

above average

may or may not be associated w/ disease

2 DTR

average

NORMAL

1 DTR

low normal

0 DTR

absent

bicep nerves

C5 and C6

tricep nerves

C6 and C7

brachioradialis nerves

C5 and C6

quadriceps (patellar) nerves

L2, L3, L4

achillies (ankle) nerves

S1

nerves above umbilicus

T8, T9, T10

nerve below umbilicus

T10, T11, T12

plantar reflex nerves

L5 and S1

Brudzinski's sign

meningeal irritation

positive - hips and knees flex after neck

Kernig's sign

meningeal irritation

positive - pain behind knee when extended

decorticate response to pain

flexor response

arms are like "Cs"

cause of decorticate response to pain

cervical spinal tract

cerebral hemisphere

decerebrate response to pain

extensor

arms like "e's"

cause of decerebrate pain response

problems with midbrain or pons

structural coma pupils

no response

brain bleed