PD E2- Neuro

What is the inability to initiate movement?

Akinesia

What is the inability to remain motionless?

Akathisia

What is a slight or incomplete paralysis (weakness)?

Paresis

What is a loss or impairment of motor function (paralysis)?

Plegia

What is loss or impairment of one side of the body?

Hemiplegia/hemiparesis

What is loss or impairment of the legs and lower body?

Paraplegia/paraperesis

What is loss of impairment of all four limbs?

Quadriplegia/quadriparesis

What is the progressive degeneration and shrinkage of muscle and/or nerve tissue?

Atrophy

What is the enlargement of an organ or part due to an increase in size of its constituent cells?

Hypertrophy

What is an increase in size without true hypertrophy?

Pseudohypertrophy

What is hypertonicity w/ inc DTRs?

Spasticity

What is stiffness or inflexibility?

Rigidity

What is loss of tone w/ diminished DTRs?

Flaccidity

What are extrapyramidal abnormal movements, as seen in Parkinsons?

Tremor- rest, pill rolling

Rigidity- lead pipe, cogwheel

Akinesia/bradykinesia

Postural instability

What are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals that can be caused by Tourette’s syndrome or drugs (phenothiazines, amphetamines)?

Tics

What are unpredictable, brief, rapid, jerky, irregular movements that occur at rest or interrupt normal coordinated movements and seldom repeat themselves, and are associated with Sydenham’s chorea and Huntington’s?

Chorea

What body parts are often involved in Chorea?

face, head, lower arms, hands

What are slower movements that are more twisting and writhing and have a larger amplitude; often associated with spasticity and cerebral palsy?

Athetosis

What body parts does athetosis most commonly involve?

face & distal extremities

What are movements similar to athetoid but involve larger portions of the body (trunk) that can result in grotesque twisted posture and can be caused by spasmodic torticollis, primary torsion dystonia, and phenothiazines?

Dystonia

What abnormal thought process involves indirection and delay in reaching a point because of unnecessary detail?

Circumstantial

What is it called when a person shifts from one unrelated subject to another?

Loose associations

What is it called when thought process is almost continuous flow of accelerated speech with abrupt topic changes?

Flight of ideas

What is incomprehensible speech because of illogic, lack of meaningful connections, abrupt topic changes, or disordered word use/grammar?

Incoherence

What is fabrication of facts of events to fill in gaps in impaired memory?

Confabulation

What is the persistent repetition of words or ideas?

Perseveration

What is the repetition of words or phrases of others?

Echolalia

What are invented or distorted words?

Neologisms

What is the sudden interruption in mid sentence or before completion of an idea?

Blocking

What is it called when a person chooses a word based on sound instead of meaning?

Clanging

What are recurrent, uncontrollable thoughts, images, or impulses that a persons considers unacceptable or strange?

Obsessions

What are repetitive acts that a person feels driven to perform to prevent or produce some unrealistic future state of affairs?

Compulsions

What are false, fixed, personal beliefs that are not shared by other members of the person’s culture?

Delusions

What are persistent, irrational fears accompanied by a compelling desire to avoid the stimulus?

Phobias

What are apprehensions, fears, or tensions that may be free-floating or focused?

Anxieties

What is a sense that things in the environment are strange, unreal, or remote?

Feelings of unreality

What is a sense that oneself is different, changes, or unreal & identity is lost?

Feelings of depersonalization

What is a marked reduction in mental and physical activity requiring a vigorous stimuli to provoke a response?

Stuporous

What level of consciousness is characterized by drowsiness/somnolence, clouded consciousness, and slow thought, movement, and speech?

Obtunded

What level of consciousness is completely unconscious, can’t be aroused by painful stimuli, absence of voluntary movement, +/- reflexes?

Comatose

What is the acute confusion state that is potentially reversible and usually occurs over a period of days to weeks?

Delirium

What is the confusion/disorientation state that is slow & insidious in onset, progresses slowly over Mos-yrs, and is NOT reversible?

Dementia

Delirium or Dementia?

• acute onset

• fluctuating pattern

• orientation usually impaired

• attention impaired or fluctuating

• impaired memory

• lasts hrs-days

Delirium

Delirium or Dementia?

• insidious onset

• progressive

• normal or impaired orientation

• normal attention

• impaired memory

• duration - mos-yrs

Dementia

What can cause delirium?

Drugs, ethanol

Electrolyte imbalance

Low PO2 (hypoxia)

Injury to brain

Relapsing fever (malaria)

Infection

Uremia

Metabolic (liver damage)

What are causes of dementia?

Drugs and toxins

Endocrine

Metabolic and mechanical

Epilepsy

Nutrition and nervous system

Tumor and trauma

Infection

Arterial compromise

What are misinterpretations of real external stimuli?

Illusions

What are subjective sensory perceptions in the absence of stimuli?

Hallucinations

What test screens for cognitive dysfunction and assesses orientation, attention, immediate and short term memory, language/speech, and ability to follow simple verbal and written commands?

Mini Mental Status Exam (MMSE)

How do you test for attention in MMSE?

depends on integrity of dominant hemisphere and intelligence;

ex: spell WORLD backwards, recite months forwards/backwards, digit span, serial 7s or 3s

How is memory tested for in MMSEs?

Immediate recall- name 3 objects & pt immediately repeat

Recent- ask pt to recall after 5 mins

Remote- as well known events in the past that is verifiable

How is thought content and perceptions assessed in MMSE?

Thought process (logic, relevance, organization, coherence)

Thought content (delusions, obsessions, compulsions, phobias)

Perceptions (hallucinations)

Insight

What part of the MMSE requires higher cerebral function where you would ask the patient to interpret a simple problem?

Judgement

What part of the MMSE asses higher cerebral function that requires comprehension and judgement and proverbs are commonly used, asking pts to interpret sayings such as “people who live in glass houses should not throw stones”?

Abstraction

What is being assessed in the speech portion of MMSE?

Quantity (spontaneity), rate (fast vs slow), rhythm (hesitant), volume, articulation and fluency (recite no ifs, ands, or buts)

What is difficulty producing or understanding language?

Aphasia

Where would the lesion be if a patient has aphasia?

Dominant cerebral hemisphere (Broca’s or Wernicke’s)

What is difficulty in articulation?

Dysarthria

Where would the lesion be if a pt presents with dysarthria?

tongue and palate

What is difficulty in phonation?

Dysphonia

Where would the lesion be if a pt presents with dysphonia?

palate and vocal cords

What is difficulty comprehending or speaking?

Dysphasia

What does dysphasia indicate?

Cerebral dysfunction

What is the critical score in the Glasgow Coma Scale?

8

What does a Glasgow Coma scale score of 9-11 indicate?

Not in a coma; moderate severity

What does a Glasgow coma score of ≥12 indicate?

Not in a coma, minor injury

What does a Glasgow coma scale score pt ≤8 indicate?

90% of pts are in a coma

if persists at 6 hrs → 50% die

What is defined as not opening eyes, not obeying commands, and not uttering understandable words?

Coma

What 3 responses are measured in the Glasgow Coma Scale?

best motor response (max score 6), best verbal response (max score 5), eye opening (max score 4)

Pupillary light reaction _____ in a metabolic coma.

reamins intact

What is one of the most important signs to distinguish structural from metabolic causes of a coma?

Presence/absence of light reaction

Pupillary light reaction is ______ in structural comas?

absent

What assesses brainstem function in a comatose patient by holding open upper eyelids, turning pt’s head quickly from one side then the other, looking at eye movement?

Oculocephalic reflex (“doll’s eyes)

How does a comatose patient with an intact brainstem respond to the Oculocephalic reflex (Doll’s eye reflex)?

As the head is turned, the eye move towards the opposite side

What assesses brainstem in a comatose patient by elevating the pt’s head 30° & instilling ice water followed by warm water into the ear canal, looking for nystagmus?

(*performed after oculocephalic reflex fails)

Oculovestibular reflex (Calorics)

What is the normal response the Oculovestibular reflex (Caloric), indicating an intact cortex and brainstem?

Rapid side to side eye movements (nystagmus) initially

Cold water: eyes quickly move away from cold water then slowly back toward

Warm water: eyes move toward warm water then slowly move away

What response to Oculovestibular reflex (Caloric) indicates no cortical response with an intact brainstem?

No nystagmus

Eyes turn slowly toward cold water

What response to the Oculovestibular reflex (Caloric) indicates no cortical response and no brainstem response?

No eye movement seen

What drugs can damage the vestibular nerve, causing an abnormal response to the oculovestibular reflex?

antimalarial drugs, certain abx, diuretics, and salicylates

What conditions are you ruling out by performing the oculovestibular reflex?

Acoustic neuroma, BPPV, labyrinthitis, meniere’s

What is a normal response to painful stimulus?

Avoidant - push stimulus away or withdraw

What is the stereotypic response to painful stimuli in a comatose patient?

Abnormal postural responses of trunk and extremities (decorticate or decerebrate)

Which posturing?

• abnormal flexor response

• rigidity, flexion of arms, clenched fists, extended legs

  • arms bent inward toward body w/ sits and fingers bent and held on chest

• destructive lesion of corticospinal tracts

Decorticate

What posturing?

• abnormal extensor reflex

• rigid extension of arms and legs, downward pointing of toes and backward aching of head

• caused by deterioration of structures of nervous system, particularly upper brain stem

  • lesion in diencephalon, midbrain, pons

  • metabolic disorders

Decerebrate

How do you test muscle tone in a comatose patient?

grasp forearm near wrist, raise vertical, lower off bed and watch how it drops (normal = arm drops slowly)

support flexed knees, extend one leg at time at the knee and let fall or flex both legs so that the heels rest on bed and release them (normal - slowly return to extension)

Monocular visual disturbance is associated with a lesion _____ to the optic chiasm.

Anterior

Binocular visual disturbance is associated with a lesion _____ to the optic chiasm.

Posterior or at

If visual problems improve with glasses, what kind of issue is it?

Refractive error

What medication can produce a blue hue in the eye?

Viagra

What medication can produce a yellow or green hue in the eye?

Digitalis

What condition is associated with “rainbows” or “halos” in their vision?

Acute glaucoma

What condition is associated with wavy vision?

Migraine

What condition is associated with a “drawn curtain” over vision?

Retinal detachment

What is the standard clinical test for BPPV?

Dix Hallpike

What are involuntary eye movements, usually triggered by inner ear stimulation, that begin as a slow pursuit movement followed by a fast, rapid resetting phase?

Nystagmus

What condition is associated with nystagmus that is provoked with the head turned to 1 side?

BPPV

What is the treatment for BPPV?

Epley

What are precautions that should be taken when performing the Epley maneuver?

avoid driving 24 hrs, avoid strenuous activities, and stop procedure if severe N/V

What is the most important diagnostic clue for differentiating a primary vs secondary headache?

Steady, B/L, non throbbing pain that is worse in the AM, may awaken patient at night, and is worse w/ valsalva

What condition?

• U/L pain in orbital, frontal, or temporal region

• often accompanied by conjunctival injection, lacrimation, rhinorrhea, congestion, ptosis, and sweating

• lasts 15min-3 hrs; occurs frequently for wks-mos before remission

Cluster HA