Neuro Basics & Examination

FF Week 2

Frontal lobe

Function:

• CEO: on top of everything

• C: controls planning, programming, movement

• E: emotion, behavior, personality

• O: olfaction (sense of smell)

Broca’s aphasia when affected

Temporal lobe

Function:

• Hearing and language comprehension

Wernicke’s aphasia when affected

Broca’s aphasia

BEN has Broca’s

• Broken speech (difficulty speaking, words don’t come out)

• Expressive aphasia

• Non-fluent aphasia

Frontal lobe

Use yes/no questions during treatment sessions

Wernicke’s aphasia

Unable to understand

Receptive aphasia

Fluent aphasia

Word salad (speak fluently, words don’t make sense)

Temporal lobe

Use gestures/demonstrations during treatment sessions

Aphasia nugget

Left hemisphere is usually called the dominant hemisphere

Broca’s and Wernicke’s aphasia are more often seen with Left hemisphere lesions

Parietal lobe

Gives perceptual information

With lesion:

• Perceptual disorders e.g. unilateral neglect

• Sensory loss

Occipital lobe

Gives visual information

With lesion:

• Visual loss

Cranial nerve pneumonics

I: Olfactory: On: Some

II: Optic: On: Say

III: Oculomotor: On: Money

IV: Trochlear: They: Matters

V: Trigeminal: Traveled: But

VI: Abducens: And: My

VII: Facial: Found: Brother

VIII: Vestibulocochlear: Voldemort: Says

IX: Glossopharyngeal: Guarding: Big

X: Vagus: Very: Brains

XI: Spinal Accessory: Secret: Matter

XII: Hypoglossal: Horcruxes: Most

“S” = sensory; “M” = motor; “B” = both

Cranial nerve location

CE MI PONS MEDU

• Cerebrum

• Midbrain

• Pons

• Medulla

Number of letters = number of cranial nerves in that location

CE: CN I & II

MI: CN III & IV

PONS: CN V, VI, VII, & VIII

MEDU: CN IX, X, XI, & XII

Cranial nerve I (1)

Olfactory (On, Some)

Sensory Function: sense of smell

When affected: anosmia - loss of sense of smell

Test: identify familiar odors with eyes closed

Cranial nerve II (2)

Optic (On, Say)

Sensory Function: vision - color, acuity (clarity), peripheral vision, Pupillary Light Reflex

When affected: blindness, myopia - short sighted (can see close objects), presbyopia - far sighted (can see far objects)

Test: test visual fields

Pupillary light reflex

Protective reflex

Sensory/afferent: sensing light - CN II

Motor/efferent: constriction - CN III

Cranial nerve III (3)

Oculomotor (On, Money)

Motor

Motor Functions:

• Movement of eyeball: up, down, in, & up/in (innervates all eye movement muscles besides superior oblique and lateral rectus - SO4 & LR 6)

  • If affected: lateral strabismus - abnormal resting eye position; eye at rest points out

• Opens eyelids

  • If affected: ptosis - drooping of eyelids

• Constricts pupils

  • If affected: dilation of pupils

Test: upward, downward, and medial gaze

Cranial nerve IV (4)

Trochlear (They, Matters)

Motor Function: eye movement (SO4) - down/in (looks at nose; nose has 4 letters for CN 4)

Test: downward and in gaze

Cranial nerve VI (6)

Abducens (And, My)

Motor Function: eye movement (LR6) - out

Test: lateral gaze

Cranial nerve V (5)

Trigeminal (Traveled, But)

Sensory Functions:

• Sensation to face

• Afferent/sensory component of Corneal Touch Reflex

• Sensation to anterior 2/3 of tongue: temperature, texture, etc.

Motor Functions:

• Chewing (tri-CHEW-minal)

• Dampens sounds (hyperacusis if affected)

Jaw jerk reflex: a quick, involuntary upward closing of the jaw when the chin is tapped

• Normal response: absent/slight

• Abnormal responses:

  • Exaggerated/brisk (often with clonus) - indicates UMN lesion

  • Absent - LMN lesion or CN 5 lesion

Test: sensation of face, muscles of mastication, corneal reflex, and jaw reflex

Cranial nerve VII (7)

Facial (Found, Brother)

Sensory Function:

• Taste to anterior 2/3 of the tongue: spicy, sour, bitter, etc.

Motor Functions:

• Movement of face (besides opening eyelids and chewing)

• Efferent/motor component of Corneal Touch Reflex

• Dampens sounds (hyperacusis if affected)

• Lacrimation (crying)

• Salivation

Test: muscles of facial expression, taste to anterior 2/3 of tongue - identify familiar tastes, close eyes tight, smile with teeth, puff cheeks

Cranial nerve nugget

Happy hour opens at 3 and closes at 7

CN 3 - opens eyelids

CN 7 - closes eyelids

Cranial nerve VIII (8)

Vestibulocochlear (Voldemort, Says)

Sensory Functions:

• Balance

• Hearing (conductive vs sensorineural hearing loss)

Test: hearing tests, balance and coordination tests: finger to nose

Diagnosing hearing loss

Conductive vs Sensorineural hearing loss

Step 1 - Rinne’s Test: determines type (conductive vs sensorineural)

• Start by place tuning fork on bone behind the ear (Rinne behind the pinne; pinna is outer portion of ear) once they can no longer hear, switch to placing it lateral to outer ear

• Normal: AC > BC

• Sensorineural loss: AC > BC

• Conduction loss: BC > AC

• AC = air conduction

• BC = bone conduction

• Testing to see if patient hears air conduction or bone conduction as louder

Step 2 - Weber’s Test: determines side (L vs R)

• Place tuning fork in the middle of the top of the patient’s head

• Normal: heard equal on both sides

• Sensorineural loss: heard louder in normal ear

• Conduction loss: heard louder in affected ear

• CANS for Weber’s test

  • (CA): Conductive is louder in Affected ear

  • (NS): Sensorineural is louder in Normal ear

*May be easier to remember how sensorineural loss will present with Weber’s test, and then just know that conductive loss will be opposite

Cranial nerve IX (9)

Glossopharyngeal (Guarding, Big)

Motor Functions:

• Swallowing control

• Salivation

Sensory Functions:

• Sensation and taste to posterior 1/3 of tongue

  • “P” kinda looks like “9” (cranial nerve 9 = Posterior tongue)

• Gag reflex - afferent pathway

Test: taste and sensation to posterior 1/3 of tongue, ability to swallow, gag reflex (afferent)

Cranial nerve X (10)

Vagus (Very, Brains)

Motor Functions:

• Speech and swallowing

• Gag reflex - efferent pathway

• Deviation of uvula

  • “Punching bag” like structure, if you punch from the right (lesion) it deviates to the left

Sensory Functions:

• Sensation from organs like the heart and lungs

• Main nerve for parasympathetic influence - “rest & digest”

Test: gag reflex (efferent), say “ahh”, rise of uvula when stroked

Cranial nerve XII (12)

Hypoglossal (Horcruxes, Most)

Motor Function:

• Moves tongue

  • Lesion moves tongue to same side of lesion

  • “Lick your lesion”

Test: tongue protrusion - if injured, will deviate towards side of lesion

Cranial nerve XI (11)

Spinal Accessory (Secret/Ancient, Matter)

Motor Function:

• Innervates sternocleidomastoid and trapezius muscles

Test: resisted shoulder shrug