NPTE 2026 Neuro Quick Recall

Normal Resting Membrain potential of brain

Positive on the outside, -70mV on the inside

A-Fibers

Large diameter, myelination nerve fibers with faster conduction

beta Motor fiber purpose

Touch & Pressure

Delta Fiber Purpose

Sharp, fast, localized pain temp and crude touch

Normal Tug Score

<10 s

Inc fall risk Tug Score

> 20 s

RLA level 1

No response - patient does not respond to external stimuli and appears asleep

RLA level II

Generalized response: Generalized & non specific response to stimuli. Limited Response

RLA Level III

Localized Response: responds specifically & inconsistently with delays but may follow simple commands for action

RLA Level IV

Confused, Agitated response: Bizarre, incoherent, inappropriate behaviors with no short term recall and bad attention

RLA Level V

Confused, inappropriate, non agitated: random, fragmented & non-purposeful responses to unstructured stimuli. Impaired memory and selective attention, follows simple commands regularly. No retention of new info

RLA Level VI

Confused & Appropriate: context appropriate, goal directed responses but depends on external stimuli for direction. Carry over for relearned NOT new tasks w continued limits in STM

RLA VII

Automatic, appropriate responses: Appropriate in familiar environments and can perform ADL with carryover for new skills slowly. Initiates social interactions but judgement is impaired

RLA VIII

patient is oriented and responds to environment but abstract reasoning is impaired compared to PLOF

Active Seizure Safety

remain with patient and ensure safe environment, prevent aspiration by staying in side lying

H & Y stage 1

unilateral involvement, minimal disability

H & Y Stage 2

B/L or Midline involvement but NO balance impacts

H&Y Stage 3

Balance impaired & some activity limitations

H&Y Stage 4

All symptoms present and severe - ambulation only with assistance

H&Y stage 5

Bed Bound

CN Origins (CE-MI-PONS-MEDU)

Cerebrum - I & II

Midbrain - II & IV

Pons - V, VI, VII, VIII

Medulla - IX, X, XI, XII

CN for Tongue Sensation

Ant 2/3: V - sensation VII- taste

Post 1/3 - IX

Which side does the tongue deviate to if CN XII is damaged

IP Side

‘Lick Your Lesion’

Signs of Autonomic Dysreflexia

HTN, Bradicardia, bad HA, severe anxiety, blurred vision

What to do if suspected autonomic dysreflexia

Upright posture, loosen tight clothing, look @ cath

ASIA Level A

COMPLETE - no motor OR sensory preserved in S4-5

AISA Level B

Incomplete - sensory but no motor preserved below neurological level & includes S4-5

AISA Level C

Incomplete: Motor function is preserved below neurological level & most key muscles have MMT <3

AISA Level D

Incomplete: Motor function preserved below neurological level and most major mm groups MMT >3

AISA Level E

Motor and sensory preserved

Lesion Level for Quad SCI

C1-8

Spinal Level for Para SCI

T1-L1

Number 1 cause for SCI

MVA

Central Cord Syndrome

BL loss of P! And Temp (spinothalamic tracts), motor function (ventral horn) mostly in UE

Preserved Prop

Brown Sequard Syndrome

IP loss of vibration, pressure & prop (dorsal column), corticospinal tracts w/ loss of motor function and spastic paralysis below lesion level

CL loss of spinothalamic tract w loss of P! And temp below but BL loss AT lesion level

Anterior Cord Syndrome

Loss of lateral corticospinal tracts w/ BL loss of motor function & spastic paralysis below lesion level, Loss of spinothalamic tracts BL P! And temp loss

Dorsal column preserved: prop, kinesthesia & vibratory sense

posterior cord syndrome

BL loss of Dorsal columns - prop, vibration, pressure, 2-point discrimination

Preserved motor function pain and light touch

Dorsal Column Medial Lemniscal tracts (DCML)

Light touch, prop, vibration and tactile discrimination

DCML UE Location

Fasciculus Cuneatus - Lateral

DCML LE Location & name

Fasciculus Gracilis - medially

Anterior arterial Spinothalamic Tract (ALST)

Fast Pain and Temperature (lateral)

Crude Touch (anterior)

Spinocerebellar Tracts

Proprioception info from GTO, mm spindles

Spinoreticular Tracts

Ascending & sensory: Deep and chronic P! Via diffuse polysynaptic paths

lateral Corticospinal tract

Fractionated, distal voluntary movement

Vestibulospinal Tracts

Medial- BL C & T projections: Reflexive head and neck movements, VOR Antigravity

Lateral: IP Projections facilitates extension and inhibits flexion in trunk (L & T)

Rubrospinal Tracts

Wrist and finger extension, arises from red nucleus

Reticulospinal Tracts

Anticipatory Postural Adj & modifies P! Signals

Tectospinal Tracts

From superior colliculus and assists in head turning

Steregnosis Test

Ability to ID familiar objects by touch

Barognosis

Ability to differentiate weight

Tinnetti/POMA

Wholistic Balance test including turning 360, sternal nudge, turning, gait initiation

Scores for Tinetti/POMA

Highest 28

19-24 mod fall risk

<19 High fall risk

DGI - Dynamic Gait Index

Examines gait, head turns, pivot, obstacles and stairs

Which one is more advanced FGA or DGI

FGA because it included eyes closed and backwards walking

DGI score breakdown

Total is 24

22-24 is safe in ambulation

<19 is predictive of falls

Most Common Stroke

MCA

ACA Stroke S/S

CL LE>UE hemiparesis & hemisensory loss

Apraxia , UI, Frontal Lobe Changes

MCA Stroke S/S

CL UE & face >LE hemiplegia and hemisensory loss

CL Neglect or inattention (R Sided)

Aphasia- Broca’s our Wernikes

Lenticulostriate Stroke

Deep MCA in Internal Capsule is equal severity face, UE & LE on the CL side

Broca’s Aphasia (B.E.N)

Broken, expressive, non fluent

Aware of issue

Frontal lobe

Wernicke’s Aphasia

Temporal Lobe - unable to understand

Word Salad

Fluent

A stroke on which side of the brain leads to aphasia

left

Left = language

Homonymous Hemianopsia

Loss of ½ of visual field because of supply to optic radiations

PCA stroke

not Common

CL Sensory loss

Involuntary movements

Thalamic pain syndrome

Homonymous hemianopsia (CL to lesion) bc of loss to 1st degree visual cortex

Lacunae Stroke

Pure Motor w/ CL hemiplegia

No aphasia

PICA Stoke/ Wallenberg’s

most common brain stem stroke

Ataxia, nystagmus

Dec P! And temp in IP face and CL body, IP horners

Dysphasia