DIRECTIONS AND LOCATIONS

outer edge of the iris

Area where a cotton swab is touched to check the corneal reflex

proximally and distally

Directions in which extremities are tested for deep pressure sensitivity

Distal and proximal

Two general screening patterns for testing somatic sensations, along with side to side

Side to side (R vs L)

One of two general screening patterns for testing somatic sensations, comparing homologous areas

medial

Direction associated with the Gracile tract (tract of Goll), relating to the feet on the ground ('Gitna')

lateral

Direction associated with the Cuneate tract ('burdaChUNEATE'), relating to the border ('burda'-ch)

up/down/straight

Possible alternatives for the patient's report when testing position sense to reduce chance guessing

distally

Direction in which position sense is noted to be normal if it is also normal proximally

proximally

Direction in which testing should proceed if position sense is found abnormal at the digits

feet together

Starting position for the patient when performing the Romberg sign test

lateral side of the sole

Area stroked when eliciting the Plantar Reflex

right and left sides

Sides that reflexes should be compared between when doing the examination

lateral

Direction of the fast component of gaze-evoked nystagmus in relation to the side of the lesion

outstretched

Position of the arms when performing the wrist-tapping test for cerebellar function

down the shin

Direction in which the patient is instructed to run their heel during the heel-to-shin test

opposite knee

Location where the patient is instructed to place one heel at the start of the heel-to-shin test

rostrocaudal

Orderly fashion in which general inspection of the patient is recommended to proceed

asymmetry

Finding to check for during general inspection of the patient, indicating a difference between sides

right and left sides

Sides that muscle bulk, body symmetry, and joint alignment are compared between

Proximal vs Distal

Comparison for muscle strength testing that helps differentiate muscle from nerve diseases

proximal

Location where muscle diseases usually present with weakness

distal

Location where nerve diseases usually present with weakness

Upper vs Lower Extremity

Comparison for muscle strength testing that can provide clues about myotome involvement

Left vs Right

Comparison for muscle strength testing that could indicate the side of the lesion

Laterality

Characteristic that could indicate the side of the lesion in muscle strength testing

shortest position

Position from which muscles are strongest according to the Length-strength principle

longest position

Position from which muscles have little or no strength according to the Length-strength principle

ipsilateral

Projection pattern of the spinocerebellar tract mentioned as unique compared to decussating sensory tracts

from receptors to their respective cortical areas

General directional flow described for various sensory pathways

right side of the body

Side experiencing weakness in a clinical example of lesion localization

Left cortex–precentral gyrus and postcentral gyrus

Plausible localization site in the cortex for weakness on the right side of the body

ascend

Direction second-order neurons take in the anterolateral column after crossing

contralateral side

Side to which second-order neurons in the anterolateral pathway cross through the anterior white commissure

ipsilaterally

Direction axons of first-order neurons in the anterolateral pathway ascend or descend segments via Lissauer's tract before synapsing

dorsal horn

Location in the spinal cord where first-order neurons of the anterolateral pathway synapse with second-order neurons

anterior white commissure

Structure through which second-order neurons of the anterolateral pathway cross to the contralateral side

anterolateral column

Location where second-order neurons of the anterolateral pathway ascend after crossing

ventroposterolateral (VPL) nucleus of the thalamus

Nucleus in the thalamus where second-order neurons of the anterolateral pathway terminate

primary somatosensory cortex

Destination of third-order neurons from the thalamus in the anterolateral pathway

from the thalamus to the primary somatosensory cortex

Directional projection of third-order neurons in the anterolateral pathway

from the tongue and epiglottis

Origin of taste information traveling via the Gustatory Pathway

to the nucleus solitarius, then to the thalamus and gustatory cortex

Destinations of taste information traveling via the Gustatory Pathway

from Scarpa’s ganglion to vestibular nuclei

Direction signals travel in the Vestibular Pathway from vestibular hair cells

Ventroposteromedial Nucleus

Nucleus in the thalamus concerned with facial input to the anterolateral pathway

Ventroposterolateral Nucleus

Nucleus in the thalamus concerned with inputs from the body to the anterolateral pathway

Inferior glossopharyngeal ganglion

Ganglion through which the glossopharyngeal nerve passes taste sensation

bilateral

Description of auditory information transmission

lateral olfactory stria

Part of the olfactory tract responsible for conscious appreciation of smell

leading signals to the lower motor

Direction described for the most direct motor pathways

in the same eye

Location of pupil constriction in the direct light reflex when light is shone

in the opposite eye

Location of pupil constriction in the consensual light reflex when light is shone in one eye

to the right

Direction a patient kept falling in a clinical case example

left side of her mouth elevated

Side and movement of the mouth in a clinical case example

right side of her mouth drooped

Side and movement of the mouth in a clinical case example

right great toe dorsiflexed

Side, location, and movement observed when scratching the surface of the foot in a clinical case example

left foot, the toes curled downward

Side, location, and movement observed when performing the plantar reflex test on the left foot in a clinical case example

right internal capsule

Structure likely containing the lesion in a clinical case example presenting with right-sided weakness, responsible for projecting contralaterally

contralateral spinal cord and to the brainstem

Destinations of corticospinal and corticobulbar fibers from the right internal capsule

contralateral side

Side experiencing motor deficits resulting from lesions of corticospinal and corticobulbar tracts

Localization

Identification of the site of the nervous system that has been affected

Anatomic diagnosis

Diagnosis based on localization

proximal symmetric weakness without sensory loss

Characteristic presentation of lesions localized to the muscle

symmetric weakness with sensory loss

Presentation of peripheral nerve and nerve root lesions (according to a false statement, they are NOT always symmetrical)

Multifocal

Anatomic distribution typical of conditions like multiple sclerosis or metastatic tumors

Focal

Anatomic distribution when a lesion is localized to an area in the central nervous system

Disseminated

Anatomic distribution where the lesion is scattered as if seeds were spread on the ground

System

Anatomic distribution describing lesions affecting a group of neurons or neuronal network

localized to an area in the CNS

Description of focal anatomic distribution

proximal and asymmetric

Description of peripheral nerve neuropathies (stated as often, but a false statement says they are not)

Location, extension, and radiation

Aspects describing the pattern of a patient's symptoms

muscle, neuromuscular junction, peripheral nerve, nerve root, spinal cord, brainstem, cerebellum, subcortical brain (white matter), and cortical brain (grey matter)

Specific sites in the nervous system where lesions can be localized

probable site (anatomic diagnosis)

Aspect indicated by history taking, critical for neurologic diagnosis

Localization

Factor determining differential diagnosis when combined with time course

Facial weakness

Part of the neurologic examination that can be assessed during history taking

Extremity weakness/involuntary movements

Part of the neurologic examination that can be assessed during history taking, especially if obvious

Apply light pain

Step in eliciting responses for GCS after using voice/commands and gentle stimulation

Apply deep pain

Step in eliciting responses for GCS after applying light pain

Check orientation (date, place, person)

Task performed using voice, command, or name-calling

Localization of damage

Concept illustrated by a figure showing manifestations in a patient

Medial temporal lobes, hippocampal fornix-mamillary body circuit, basal forebrain

Neural structures that subserve recent memory and orientation

Left angular gyrus

Neural structure that subserves calculation

Frontal lobes

Neural structures that subserve insight, judgment, and planning

backwards

Direction for reciting months or spelling "WORLD" or "KARNE" as a test of attention

backwards

Direction for naming PH presidents as a test of remote memory

unrelated

Description of items the patient is asked to remember for immediate and recent memory testing

Contralateral parietal

Lesion location that causes Stereognosis (inability to identify objects by touch)

in their hand

Location where objects are placed for the patient to identify by touch during Stereognosis testing

on the other hand

Side where Stereognosis testing should be repeated

Inferomedial temporo-occipital region

Lesion location that causes Prosopagnosia (inability to identify faces)

L angular gyrus / posterior parasylvian area

Lesion location that causes Gerstmann Syndrome, including R-L disorientation and finger agnosia

R-L Disorientation

A component of Gerstmann Syndrome

left ear / right eye / L hand

Examples of body parts used to verify R/L disorientation

right or left hand

Side where a digit is randomly touched when testing Finger Agnosia

R Parietal

Primary lesion location that causes Hemi Inattention or Neglect

symmetrical figure

Type of figure the patient is asked to draw when testing for Hemi Inattention

bisect a line in the middle

Task the patient is asked to perform when testing for Hemi Inattention

left side

Side where neglect is shown in an example figure

R posterior parietal

More specific lesion location that causes Hemispatial neglect (cannot visualize half of the visual field)

double simultaneous cutaneous stimuli

Type of stimuli used to test for sensory inattention

one or simultaneously both cheeks

Location where light pressure is applied randomly with finger tips or cotton wisps to test for sensory inattention