Neurobiology

A good history has the basis of the history of

o   The nature.

o   The onset (When did it begin? acute or chronic?)

o   The extent (How has it progressed? One site, multiple sites?)

o   The duration of the chief complaint and associated complaints.

4 parts of the Evaluation of a patient:

1. History taking

2. Physical examination

3. Neurological examination

4. Laboratory and imaging techniques

A good history has the basis of the history of

o   The nature.

o   The onset (When did it begin? acute or chronic?)

o   The extent (How has it progressed? One site, multiple sites?)

o   The duration of the chief complaint and associated complaints.

4 parts of the Evaluation of a patient:

1. History taking

2. Physical examination

3. Neurological examination

4. Laboratory and imaging techniques

It is necessary to also carry out an____________ approach

integrated medicine

Neurological examination includes

-       Cognitive examination

-       Cranial nerves

-       Motor system examination of the limbs

-       Sensory examination

The general cognitive examination includes details about the individuals orientation in _______________

time, person and place (if not confused or demented)

o   Is this person even awake/alert?

o   Or is this person’s consciousness is depressed? (lethargic, stuporous, or comatose)

We test alertness and wakefulness through the ________

Glasgow Coma Scale

3 behaviours of the glasgow coma scale?

1.     Eye opening response (1-4)

2.     Verbal response (1-5)

3.     Motor response (1-6)

highest points in the glasgow coma scale?

15 = fully awake

Frontal lobe function tests…

Verbal fluency/planning

Ex. number of words generated beginning with a certain letter (e.g. ‘s’) or specific category (e.g. animals) over a 60- or 90- second period.

 

Concentration

Ex. the ability to take in and repeat back immediately a list of objects or a name and address.

Parietal lobe function tests…

-       Dyspraxia: the patient is unable to form, copy or mime gestures and common tasks (e.g. combing hair).

 

-       Visuospatial function: the ability to copy drawings (e.g. interlocking pentagons).

 

-       Language and calculation

Temporal lobe function tests…

-       Anterograde memory: the ability to remember a standard name and address given to the patient 5 minutes after it has been given.

 

-       Language: assessment involves listening to spontaneous speech for content and fluency, naming objects, repeating phrases, following commands, reading and writing.

To test cognitive function, we use the _________

mini-mental state examination

In the mini-mental state examination, a scole of _____ is considered normal cognition

24/30

Cranial nerves
	#	Name	Function (S/M/B)	Assessment
Only	I
One	II
Of	III
The	IV
Two	V
Athletes	VI
Felt	VII
very	VIII
good	IX
Victorious	X
And	XI
Healthy	XII

Cranial nerves
	#	Name	Function (S/M/B)	Assessment
Only	I	Olfactory	Smell (S)	-distinguishing odors w/eyes closed.
One	II	Optic	Vision (S)	-looking into the eye OR identify reading chart -pupilary reflex w/light
Of	III	Oculomotor	Eye movements (M)	-pupilary reflex w/ light -follow the finger movement
The	IV	Trochlear	Eye movements (M)	-follow the finger movement
Two	V	Trigeminal	Sensory/motor – face (B)	-clench jaw
Athletes	VI	Abducens	Eye movements (M)	-follow the finger movement
Felt	VII	Facial	Motor – face, Taste (B)	-smile, puff out cheeks, raise eyebrows
very	VIII	Auditory (Vestibulocochlear)	Hearing/balance (S)	-hearing and following directions
good	IX	Glossopharyngeal	Motor – throat Taste (B)	-stick tongue out and say aw (looking at voice quality, patatal movement, uvula midline)
Victorious	X	Vagus	Motor/sensory – viscera (autonomic) (B)	-stick tongue out and say aw (looking at voice quality, patatal movement, uvula midline)
And	XI	Spinal Accessory	Motor – head and neck (M)	-shrug shoulders, move head to side
Healthy	XII	Hypoglossal	Motor – lower throat (M)	-stick tongue out, move side to side

Examination of the motor system includes what 6 examinations?

Observation: Look for involuntary movements (ex. tremor), wasting, weakness, fasciculation, scars or deformities.

 

Tone: The limb is gently moved, and its stiffness is assessed.

 

Power: movements are assessed and scored according to the Medical Research Council (MRC) rating scale.

Coordination: the ability to coordinate movements in lower limbs (walking) and upper limbs (touch nose)

Reflexes: These are tested by tapping the tendons at certain sites in the upper and lower limbs. Reflexes can be absent, reduced, normal or brisk.

 

Plantar responses: the sole of the foot is gently scratched along its lateral aspect and the toes should fan out and the big toe goes down.

Power is examined using the _________

MRC power rating scale

• based on gravity resistance and external force

The sensory examination includes…

Light touch: cotton wool is gently applied to the skin.

Pinprick: a blunted pin is used.

Temperature: cold and hot tubes or objects are used.

• spinothalamic

Vibration perception threshold (VPT): a tuning fork is applied to the distal interphalangeal joint or big toe. If it is not felt to vibrate, the fork is moved proximally.

• Dorsal column medial lemniscus