NMS I - Exam 1 (VBI, CB, DC, ect.)

If a pt has head and neck pain, what should be evaluated

think vascular = VBI (stenosis)

Cerebral vascular ischemia

heachaches, diplopia, drop attacks, dysarthria, dysphagia

Absolute contraindications

VBI

major artery aneurysm

acute arthropathies and acute freactures

malignancies

myelopathy or cauda equina symptoms

Relative contraindications

hypermobility

demineralization of bone

benign bone tumors

bleeding disorders

radiculopathy w/progressive neurological signs

Stethoscope for bruits

diaphragm = high sounds

bell = low sounds

Barre-Lieou

causes compression of vertebral arteries to try to elicit symptoms

If any of the VBI tests (VBA functional maneuver, Barre-Lieou, DeKleyn’s) are positive what three further imaging should be done

1) MR angiogram of head

2) MR angiogram of neck

3) MRI of head

The body will fall ____ the side of the cerebellar lesion

towards

Six cardinal fields of gaze revealed nystagmus in right eye when looking to the righ

cerebellar lesion on right involving flocculonodular lobe

Cerebellar tracts are _________ and produce ipsilateral findings

double crossed

Where does cerebellar tracts cross

1st - superior cerebellar peduncle in midbrain

2nd - corticospinal and rubrospinal tracts (pyramidal decussation)

Cerebellar lobe functions - Hemispheres

appendicular coordination (UE + LE)

• finger to finger, finger to nose, finger to nose to finger, heel to shin

Cerebellar lobe functions - Vermis

gait and axial coordination (walking and trunk)

• tandem gait, hopping on one leg, squatting on one leg

Cerebellar lobe functions - Flocculonodular/Vestibulocerebellum

connections with vestibular nuclei (eye and gross balance)

• vestibular function and connections w/labyrinth

Pt falls with only eyes closed = DC deficit below lesion

sensory ataxia

• classic findings of Tabes dorsalis or B12 deficiency (MC)

• syringomyelia

What poisons vermis producing a widened gait

alcohol

Hypermetria vs Hypometria (finger to nose, finger to finger)

hypermetria = over shooting

hypometria = undershooting

What abnormality can be found in finger to nose to finger (eyes open ONLY)

dyssynergia (incoordinate movement)

What two things can be found in heel to shin

dyssynergia

dysmetria (inaccuracy in measuring distance)

Abnormality found in RAM (diadochonkinesia)

dysdiadochonkinesia = cerebellar dysfunction

Abnormality from Holmes Rebound test (eyes open and closed)

loss of check reflex

What part of the cerebellum is being evaluated during tandem gait

vermis

Posterior cord syndrome (infarction of posterior spinal artery)

loss of vibration, proprioception, reflexes below level of lesion

**Note: pain, temperature, muscle strength are spared

Anterior spinothalamic tract carries what sensation

light touch

Lateral spinothalamic tract carries what sensation

sharp pain and temperature

Cuneatus tract (UE) and Gracilis (LE) of dorsal columns carry what sensation

vibratory sensation, proprioceptive info, 2pt touch discrimination

Posterior cervical disc herniation affects _____ part of the spinal cord first

anterior

• effects anterior and lateral spinothalamic tracts

Discriminating local touch name

topesthesia

Deep pain and topesthesia is initiated by

corpuscles of Meissner

Sensation is carried by primary large diameter heavily myelinated fibers through

posterior/dorsal spinal cord district

Your static and motion palpation exam findings reveal that your pt experiences pain BEFORE end range with your passive ROM

pt has an acute condition

Your static and motion palpation exam findings reveal that your pt experiences pain AS end range is reached with your passive ROM

pt has a subacute condition

Your static and motion palpation exam findings reveal that your pt experiences pain AFTER end range with your passive ROM

pt has a chronic condition

Resisted muscle testing of right triceps muscle reveals that is painful and strong

pt has a minor sTrain (Tendon)

2pt touch discrimination normal values

Finger tips = 2-4mm

Dorsum of fingers = 4-6mm

Palm = 8-12mm

Dorsum of hand = 20-30mm

Nosognosis

ability for pt to know that they are ill (pt will deny there is a problem)

Medial side of ring finger is innervated by

ulnar C8

Lateral side of ring finger is innervated by

median C8

Nerve root Irritation (NRI)

hyper’s (inc sympathetics)

instrumentation break AWAY from involved side (vasoconstriction/hypothermia)

Nerve root compression (NRC)

hypo’s (dec sympathetics)

instrumentation break TOWARDS involved side (vasodilation/hyperthermia)

NRC means the nerve is

dying

Sensory/Motor/DTRs exams exhibit abnormal or decreased findings with NRC, what sensations are lost 1st

1) autonomics

2) light touch

3) sharp pain and temp

4) vibratory sensation

Sensory/Motor/DTRs exams exhibit abnormal or decreased findings with NRC, what sensations are regained 1st

1) vibratory sensation

2) proprioception

3) pain and temp

4) light touch

Paresthesia (abnormal sensation like tingling/burning) + instrumentation break AWAY from involved side

NR irritation

Anesthesia (absent sensation) + instrumentation break TOWARDS involved side

NR compression

SOL in Cervicals (L)

IVF = same as disc level (C5 IVF)

Disc = below NR level (C5 disc)

NR = C6

SOL in Thoracics (I)

VF = same as disc level (T7 IVF)

Disc = same as NR level (T7 disc)

NR = T7