Neurological System

The central nervous system consists of…

1. spinal cord

2. brain stem

3. brain

The brain is divided into three major parts:

1. hindbrain

2. midbrain

3. forebrain

The peripheral nervous is made of:

1. autonomic NS

2. somatic NS

The ___________ system is made of the sympathetic and parasympathetic nervous system

autonomic

Limbic system is responsible for…

1. emotions

2. sexual arousal

3. behavioral expression

4. recent memory

Reticular activating system is responsible for…

wakefulness

the temporal lobe is responsible for

memory, Wernike’s system

Hypothalamus controls…

autonomic nervous system and pituitary glands

What are the three layers of the meninges?

1. pia

2. arachnoid

3. dura

___________ _____________ is notable feature of nerve tracts

crossed representation

T/F: spinal nerves are found in the parasympathetic nervous system

False, they are located in the peripheral nervous system

Which nerves are found in the peripheral nervous system?

cranial and spinal nerves

Crainal nerves enter and exit the…

brain

The vagus nerve travels to the…

1. heart

2. respiratory muscles

3. stomach

4. gallbladder

How many pairs of spinal nerves are there?

31

There are ___ spinal cervical nerves

8

There are ___ thoratic cranial nerves

12

There are ____ lumbar cranial nerves

5

There are ___ sacral cranial nerves

5

There are ___ coccygeal cranial nerves

1

"mixed” nerves contain ____ and ______ fibers

sensory, motor

What is dermal segmentation?

cutaneous distribution of various spinal nerves

What is a dermatome?

circumscribed skin that’s supplied mainly from one spinal cord segment through a specific nerve

Oculomotor nerve is responsible for…

eye movement and blinking

trochlear nerve is responsible for…

up and down/back and forth eye movements

vestibular nerve is responsible for…

hearing and balance

hypoglossal nerve is responsible for…

tongue movement

accessory nerve is responsible for…

neck and shoulder movement

trigeminal nerve is responsible for…

facial sensnations, jaw movements, taste

abducens nerve is responsible for…

eye movements

facial nerve is responsible for…

expression and sense of taste

glossopharyngeal is responsible for…

taste and swelling

vagus nerve is responsible for..

heart rate and digestion

How many cranial nerves are there?

C1-7

How many thoratic nerves are there?

T1-11

How many lumbar nerves are there?

L1-5

How many sacrum nerves are there?

S1-5

What are the sensory pathways?

anterolateral tract and posterior columns

What is the anterolateral tract responsible for?

sensations of pain, temperature, itch, and crude touch

What are the posterior columns responsible for?

proprioception, vibration, stereognosis

What is stereognosis?

the mental perception of the senses, usually in reference to the ability to perceive the form of solid objects by touch.

The motor pathways are..

1. corticospinal/pyramidal tract

2. extrapyramidal tract

What is the corticospinal/pyramidal tract used for?

very skilled and purposeful movements

What is the extrapyramidal tract used for?

primitive motor movements AKA muscle toning and autonomic movements

if a nerve is severed, what may happen?

sensations may be sent to the dermatome above or below

Which dermatomes innervate the thumb middle finger and fifth finger?

C6 C7 C8

Which dermatomes innervate the axilla?

T1

Which dermatomes innervate the nipple?

T4

Which dermatomes innervate the umbilicus?

T10

Which dermatomes innervate the groin?

L1

Which dermatomes innervate the knee?

L4

How is movement directed in infants?

primitive reflex

Babies go through __________, which allows them to localize stimuli and develop sensory/motor

myelinization

A delay in the synapse may cause _______________ in aging adults

slow reaction time

What causes diminished senses in aging adults?

increased delay at the synapses

What may cause dizziness and loss of balance in aging adults?

decrease in cerebral blood flow and oxygen

A stroke is considered a…

cerebral vascular accident

What is the difference between an ischemic stroke and a hemorrhagic stroke?

ischemic occurs when a blood clot blocks blood flow to arteries in the brain

hemorrhagic occurs when a blood vessle bursts in the brain

What may happen during an ischemic stroke?

death of brain tissue

What should you ask during a neuro health history?

changes in senses that could indicate cranial nerve damage

What should you ask a patient regarding seizures?

1. course and duration

2. motor activity in body

3. postictal phase

4. precipitating factors

5. medical therapy

What is the postictal phase?

the period immediately following a seizure, lasting from minutes to days, during which the brain recovers from the electrical activity disruption.

What neurological findings require further questioning?

tremors seizures incoordination difficulty swelling/speaking

What should you ask for during a pediatric neuro exam?

1. maternal/fetal problems during pregnancy/delivery

2. gestational status

3. birth weight

4. apgar score

What is an apgar score?

scale to assess newborn health post birth based on appearance, pulse, grimace (reflex irritability), activity (muscle tone), and respiration

What should you ask for in an aging adult neuro exam?

1. dizziness

2. memory

3. tremors

4. sudden vision loss

What are you looking for in a mental status assessment?

A appearance

B behavior

C cognition

T thought processes

Why might a full mental status exam be needed?

• initial screening suggests anxiety or depression

• sudden behavior changes

• brain lesions

• aphasia

• mental illness

What is aphasia?

impairment of language ability secondary to brain damage

What does the glasgow coma scale test for?

scores eye opening response, motor response, and verbal response

A person that is somnolent would be…

not fully alert and sleepy if not stimulated, decreased spontaneous movement

A person that is obtunded would be…

difficult to arouse and confused on arousal, difficult to keep awake

What is an MMSE?

mini mental state examination, checks for orientation

What is a mini cog test?

tests for cognitive impairment in aging adults

How do you perform a mini-cog test?

recall three words said and draw a complete round clock

What is Cauda equina syndrome (CES)?

nerve roots at the lower end of the spinal cord (the cauda equina) are compressed

s/s of CES

• Severe low back pain and sciatica

• Leg weakness or numbness

• Bowel and bladder dysfunction

• Loss of sensation in the saddle area

• Sexual dysfunction

what can cause CES?

• Herniated disc

• Spinal stenosis (narrowing of the spinal canal)

• Tumor

• Infection

• Spinal injury to lumbar nerves

What kind of reflex is the knee jerk?

stretch reflex (triggered by stretching of the muscle)

What is a delusion?

firm fixed and false idea that is irrational and cannot be changed even with evidence

What is a halluctiation?

sensory perceptions that are not present

What is an illusion?

misperception of an existing stimulus

A score of ___ on the generalized anxiety disorder scale (GAD-7) indicates anxiety

3+

What is anhedonia?

lack of interest

How can you test for cerebellar function?

1. The Romberg test

2. checking for pronator drift

3. balance test

4. observing gait

5. tandem walking (walking in straight line heel to toe)

what does the Romberg test for and how is it performed?

stand with feet together, initially with eyes open, then with eyes closed. It evaluates static balance (ability to maintain balance using visual and proprioceptive input)

what might a positive romberg test indicate?

peripheral neuropathy or sensory ataxia

what is ataxia?

dysfunction on gait, posture, and patterns of movement due to cerebellar dysfunction or sensory loss

Abnormal posturing is categorized into ____________ and ____________ types

neurological and musculoskeletal

Neurological posturing include…

Decorticate Posturing and Decerebrate Posturing

Decorticate posturing is characterized by…

arms flexed and bent inward, fist clenches

Decerebrate posturing is characterized by…

limbs pointing out

Musculoskeletal posturing includes…

1. lordosis

2. kyphosis

3. scoliosis

4. flat back

5. forward head posture

Brudzinski’s sign and Kernig’s sign are both indicative of what?

meningitis or infection

What does a postive Kernig’s sign look like?

resistance to extension of the leg while the hip is flexed

What does a postive Brudzinski sign look like?

With one hand under neck and other hand on person's chest, sharply flex chin on chest and watch hips and knees. Resistance and pain in neck, with flexion of hips and knees

How would you perform a heel to shin test?

run the sole of one foot up and down the shin of the opposite leg

how would you perform a rapid alternating movement test?

pat knees with both hands the lift up, turn hands, and pat knees with back of hands; ask the person to do it faster

How do you perform finger to finger test?

ask person to touch thumb to each finger on same hand then reverse directions

What tests would you use to determine coordination and skilled movements?

1. heel to shin test

2. finger to nose test

3. rapid alternating movements (RAM) test

4. finger to finger test