Chapter 16: The Neurological Exam

Vocabulary and key clinical concepts from Chapter 16 regarding the neurological exam, strokes, and cortical functions.

Neurological Exam

A rapid assessment of neurological functions used by healthcare professionals to evaluate the mental status exam, cranial nerve exam, sensory exam, motor exam, and coordination exam (including the gait exam).

Cerebrovascular Accident (CVA)

Commonly known as a stroke, it is the loss of blood flow to part of the brain; neurons start to deteriorate within $1$ or $2\,\text{minutes}$ and permanent damage may result within a few hours.

Ischemic Stroke

A type of stroke caused by a loss of blood flow due to a drop in blood volume (hypovolemia) or a vessel being blocked or narrowed by an embolus or thickening of the vessel wall.

Transient Ischemic Attacks (TIA)

Often called "mini-strokes," these are strokes in which the symptoms resolve within $24\,\text{hours}$.

Hemorrhagic Stroke

Bleeding into the brain due to a damaged blood vessel, where accumulated blood fills the cranial vault and presses against brain tissue.

Edema

The accumulation of fluid in a region of the brain that occurs as the blood-brain barrier breaks down following a hemorrhagic stroke.

Meningitis

A bacterial or viral infection of the meninges, which can be cranial or spinal and is detected by a spinal tap and analysis of CSF.

Primary Cortical Areas

Regions of the cerebral cortex where sensory information is initially processed or where motor commands emerge to go to the brain stem or spinal cord.

Association Areas

Regions adjacent to primary cortical areas that further process modality-specific input.

Multimodal Integration Areas

Regions where modality-specific regions meet to process multiple modalities together or different modalities based on similar functions, such as spatial processing.

Episodic Memories

Autobiographical memories of specific events.

Procedural Memories

Memories related to remembering how to do something.

Anterograde Amnesia

The inability to form new memories after a neurological event.

Retrograde Amnesia

The inability to recall old memories formed before a neurological event.

Expressive Aphasia

A condition associated with damage to Broca's area where speech production is compromised.

Receptive Aphasia

A condition associated with damage to Wernicke's area characterized by a loss of understanding of language content.

Conduction Aphasia

A condition where a patient cannot faithfully repeat spoken language.

Sensorium

The parts of the brain involved in the reception and interpretation of sensory stimuli.

Praxis

A subtest where a patient performs a task completely on the basis of a verbal description without demonstration from the examiner.

Gnosis

A type of sensory testing that includes stereognosis (identifying an object by feel) and graphesthesia (recognizing numbers or letters drawn on the palm).

Stereognosis

A subtest of gnosis where a patient identifies an object, such as a coin, by feeling it with their eyes closed.

Graphesthesia

A subtest of gnosis where the patient recognizes numbers or letters drawn on their palm.

Saccades

Rapid, conjugate movements of the eyes used to survey a complicated visual stimulus or follow a moving stimulus.

Accessory Nerve (XI)

The cranial nerve that controls the trapezius and sternocleidomastoid muscles; tested by shrugging shoulders or flexing the neck against resistance.

Hypotonicity

Also known as flaccidity, it is a state in which there is no muscle tone detected during passive movement.

Check Reflex

A coordination test where the patient flexes their arm at the elbow and the examiner suddenly releases it to check the cerebellar response to stop the contraction after resistance is removed.

Finger to Nose Test

A coordination test where the patient alternates between touching the examiner's moving finger and their own nose.