Week 10: Nervous System HA

A series of vocabulary-style flashcards covering cranial nerve functions, headache types, neurological red flags, specialized physical exam signs, and clinical grading scales.

Cranial Nerve I (Olfactory)

Responsible for the sense of smell; it is not routinely tested.

Cranial Nerve II (Optic)

Responsible for vision.

Cranial Nerve III (Oculomotor)

Responsible for pupillary constriction, eyelid elevation (opening the eye), and most extraocular movements.

Cranial Nerve IV (Trochlear)

Responsible for downward, internal rotation of the eye.

Cranial Nerve V (Trigeminal)

Motor: temporal and masseter muscles (jaw clenching), lateral pterygoids (lateral jaw movement). Sensory: facial sensation.

Cranial Nerve VI (Abducens)

Responsible for lateral deviation of the eye.

Cranial Nerve VII (Facial)

Motor: facial movements/expressions, closing the eye, and closing the mouth. Sensory: taste substances on the anterior $\frac{2}{3}$ of the tongue and sensation from the ear.

Cranial Nerve VIII (Vestibulocochlear)

Acoustic nerve responsible for hearing (cochlear division) and balance (vestibular division).

Cranial Nerve IX (Glossopharyngeal)

Motor: pharynx. Sensory: pharynx and larynx.

Cranial Nerve X (Vagus)

Motor: palate, pharynx, and larynx. Sensory: pharynx and larynx.

Cranial Nerve XI (Spinal Accessory)

Motor: sternocleidomastoid and trapezius.

Cranial Nerve XII (Hypoglossal)

Motor: tongue.

Tension Headache

Duration of $30$ minutes to $7$ days; presents as bilateral, pressing/nonpulsatile pain. Only $1$ or less symptoms of nausea, photophobia, or phonophobia.

Migraine with Aura

Duration of $4-72$ hours; presents as unilateral, pulsating/throbbing, moderate to severe intensity. Features one or more: nausea/vomiting, photophobia, or phonophobia.

Migraine without Aura

A migraine-type headache where no aura symptom lasts longer than $1$ hour. Aura may include visual disturbances, vertigo, tingling, or numbness.

Cluster Headache

Duration of $15$ minutes to $3$ hours; occurs in groups, often behind one eye. Associated with ipsilateral eye lacrimation, conjunctival injection, ptosis, and nasal stuffiness.

Thunderclap Headache

A headache warning sign characterized by sudden onset; described as the "worst headache of my life."

Kernig Sign

Evaluated by flexing the supine patient's hip and knee and then attempting to straighten the leg; pain or resistance in the hamstrings is a positive sign.

Brudzinski Sign

Tested by flexing the patient's neck; involuntary hip and knee flexion indicates a positive sign.

Giant Cell Arteritis Complication

The most serious complication is temporary or permanent blindness.

Stereognosis

The ability to identify a familiar object (e.g., key or coin) when placed in the hand.

Graphesthesia

The ability to identify a number drawn on the palm with a blunt object.

Rapid Alternating Movements

Tests such as arm striking, finger tapping, and foot tapping used to evaluate cerebellar function.

Deep Tendon Reflex (DTR) Grade $4+$

Very brisk, with clonus.

Deep Tendon Reflex (DTR) Grade $2+$

Average, normal reflex.

Deep Tendon Reflex (DTR) Grade $1+$

Diminished reflex; may require reinforcement using the jendrassik maneuver.

Muscle Strength Grade $0$

No muscular contraction noted.

Muscle Strength Grade $2$

Active movement with gravity eliminated (planar movement).

Muscle Strength Grade $3$

Active movement against gravity.

Muscle Strength Grade $5$

Active movement against full resistance (normal).

Positive Romberg Sign

Increased sway when the patient closes their eyes while standing with feet together; suggests sensory ataxia.