Abnormal Neuro

Practice flashcards derived from the neurology history and physical exam lecture notes, covering key topics, definitions, and examination techniques.

What is a MMSE?

more formal evaluation of a patient’s mental status and cognitive abilities

What score is a normal MMSE result?

30-26

What score is a mild MMSE result?

25-20

What score is a moderate MMSE result?

19-10

What score is a severe MMSE result?

9-0

What is dysarthria?

incoordination or weakness of speech muscles

inefficient muscle control of the mouth, lips, tongue, or pharynx

What are characteristics of dysarthria?

abnormal volume (hypophonia)

abnormal rhythm

abnormal tempo of speech

What are subsets of dysarthria?

flaccid (lazy mouth)

spastic

ataxic

hypokinetic

hyperkinetic

mixed

What are causes of dysarthria?

parkinsonism

stoke

bell’s palsy

myasthenia gravis

ALS

MS

How is dysarthria evaluated?

reading of the grandfather passage

What are components of the language screening?

spoken language comprehension

reading comprehension

naming

repetition

narrative picture description

writing

What is aphasia?

disorder of expressing or understanding speech

What is expressive aphasia?

Broca's aphasia

slow, broken non-fluent language

preserved comprehension

impaired repetition and naming

patient usually aware

What usually causes expressive aphasia?

lesion in the inferior frontal lobe

What is receptive aphasia?

Wernicke's aphasia

unintelligible and malformed words

impaired repetition and naming

impairment of comprehension

patient usually unaware

What usually causes receptive aphasia?

lesion in the posterior temporal lobe

What is mixed/global aphasia?

mixture of expressive and receptive aphasia

very little information exchanged or mute

What is hypoesthesia?

reduction in sensation

What is anesthesia?

absence of sensation

What is parasthesia?

pins and needles

What is dysthesias?

distorted sensations

What etiologies are associated with cerebral cortex sensory abnormalities?

stroke

tumor

abscess

TBI

MS lesion

What sensory changes are associated with damage to the cerebral cortex?

contralateral sensory loss in face and limbs (brainstem may have crossed findings)

What etiologies are associated with spinal cord sensory abnormalities?

myelopathy

trauma

tumor

MS lesion

abscess

What sensory changes are associated with damage to the spinal cord?

dermatomal sensory deficit below level of lesion

ipsilateral to lesion or bilateral if central/complete

What etiologies are associated with spinal serve root sensory abnormalities?

compression

post-op

trauma

What sensory changes are associated with damage to the spinal nerve root?

unilateral dermatomal sensory loss

What etiologies are associated with peripheral mononeuropathy sensory abnormalities?

carpal tunnel

meralgia paresthetics

What sensory changes are associated with peripheral mononeuropathy?

sensory loss or pain in pattern of cutaneous innervation

What etiologies are associated with peripheral polyneuropathy sensory abnormalities?

diabetes

alcohol use disorder

vitamin deficiency

guillain barre

What sensory changes are associated with peripheral polyneuropathy?

distal>proximal (stocking glove)

LE before UE

What is the indication for temperature sensory testing?

sensation to light touch or pain is abnormal

What is the indication for sensory level testing?

sensory impairment, concern the cause is spinal cord dysfunction

What is a positive sensory level test?

clear sensory level where sensation is diminished or absent below a certain point

What is cortical sensory testing?

assesses higher cortical sensory processing pathways

integrates touch and position sense

recognition of texture/shape and ability to detect 2 points

What is the indication for cortical sensory testing?

screening sensory exam is normal or shows slight impairment

PLUS concerned about cortical (parietal) abnormality

What is assessed by cortical sensory testing?

stereognosis

graphesthesia

2 point discrimination

point localization

double simultaneous extinction/neglect

What is stereognosis?

ability to recognize objects

What is graphesthesia?

number identification

ability to recognize writing on skin

What is 2 point discrimination?

ability to distinguish 2 separate points of contact

What is normal 2 point discrimination?

finger: <5mm

toe: <8mm

What is extension/neglect?

failure to attend to, respond to, or orient toward stimuli (with intact sensory pathways)

cortical finding, contralateral to lesion

usually localizes to right/non-dominant hemisphere (left sided impairment)

When should sensory double simultaneous stimulation be done?

after you have ensured both sides of the body have intact sensation

When should visual double simultaneous stimulation be done?

after you have ensured all visual fields are intact

What is a tremor?

rhythmic, involuntary, oscillatory movements

What is a rest tremor?

tremor at rest

low frequency, fine tremor

pill rolling

What conditions commonly have a rest tremor?

parkinsonism or Parkinson’s

What is a postural tremor?

tremor when affected body part is actively trying to maintain posture

What conditions commonly have a postural tremor?

benign essential tremor

hyperthyroidism

anxiety

Parkinson’s re-emergence

What is an intention tremor?

absent at rest and appears during movement

worse as the limb approaches a target

What conditions commonly have an intention tremor?

cerebellar injury (stroke, alcohol, hereditary)

MS

What is dyskinesia?

involuntary, erratic, repetitive movements

common in mouth, lips, and face

associated with medication use

What is dystonia?

sustained or intermittent muscle contraction

causes twisting, often patterned, can be painful

may improve with sensory trick

What are examples of dystonia?

blepharospasm

writers cramp

spasmodic torticollis

What is chorea?

continuous, random, unpredictable, irregular

flowing movements of the body, dance-like

appears restless

What condition is commonly associated with chorea?

Huntington’s

What is athetosis?

slower, twisting motions of extremities or face

What condition is commonly associated with athetosis?

cerebral palsy

What is a tic?

sudden, rapid, recurrent, non-rhythmic, stereotypes motor movement or vocalization

regular intervals

semi-voluntary movements, preceded by premonitory urge

What condition is commonly associated with tics?

tourette’s

What are fasciculations?

visible, involuntary twitching of individual muscle fibers

small movements

often idiopathic

What condition is commonly associated with fasciculations?

ALS

nerve damage

What is myoclonus?

sudden, brief, shock-like jerk

rhythmic or non-rhythmic

individual muscles or groups

What conditions are commonly associated with myoclonus?

benign sleep starts

medication side effects

organ dysfunction

epilepsy

What is negative myoclonus?

flapping tremor (asterixis)

patient holds hands out in front of them at shoulder level with wrists extended

due to involuntary muscle relaxations

What condition is commonly associated with negative myoclonus?

severe liver disease

What is the cause of positive myoclonus?

involuntary muscle contractions

What is fatigability?

assessment of fatigable weakness

What conditions can be assessed via fatigability?

myasthenia gravis

lambert eaton myasthenic syndrome

When should fatigability be tested for?

patient has proximal weakness on initial exam or concerned about NMJ disorders

What is the diagnosis if there is increased weakness after fatigability testing?

myasthenia gravis

What is the diagnosis if there is improved strength after fatigability testing?

lambert eaton myasthenic syndrome

When should ocular fatigability be performed?

patient has ptosis on initial exam

concerned about NMJ disorder

What is the diagnosis if there is worsening ptosis after ocular fatigability testing?

myasthenia gravis

What is assessed by the ice pack test?

myasthenia gravis in patients presenting with ptosis

What is the diagnosis if there is improving ptosis after the ice pack test?

myasthenia gravis

What is the pathophysiology of the ice pack test?

cold from ice pack slows activity of acetylcholinesterase —> increases amount of ACh —> improved ability of ACh to bind to receptors

What is dysdiadochokinesia?

slow, irregular, clumsy movements (cerebellar issue)

What is parkinsonism?

slow, low amplitude, breakdown movements (basal ganglia issue)

What factors should be assessed with rapid alternating movements?

speed, amplitude, rhythm, smoothness of movements

What is ankle clonus?

sign of hyper-reflexia

abnormal, rapid, involuntary rhythmic muscle contraction and relaxation brought on by stretching a tendon

When should ankle clonus testing be done?

hyperreflexia on initial exam

concern for upper motor neuron or CNS lesion

What is the planter reflex (Babinski)?

primitive reflex that is present at birth

should disappear by 6 months to 2 years

What is the interpretation of plantar reflex if there is plantar flexion?

normal test in adults

no evidence of upper motor neuron or CNS pathology

What is the interpretation of plantar reflex if there is plantar extension or flaring out of toes?

positive test in adults

indicates upper motor neuron or CNS pathology

What are abdominal reflexes?

cutaneous reflexes elicited above and below the umbilicus

correspond to T8-T10 (upper) and T10-T12 (lower)

should be present and symmetric

What is the interpretation if there is a unilateral absence of abdominal reflexes?

spinal cord pathology

What is the cremasteric reflex?

cutaneous reflex corresponding to L1-L2 (genitofemoral nerve)

stimulation leads to ipsilateral cremaster contraction

What nerve innervates the cremaster muscle?

genitofemoral nerve (L1-L2)

What is a spastic hemiplegic gait?

spasticity of the upper and lower extremity on the same side

affected LE extended (ankle plantarflexion and inversion)

affected leg swung outward (circumduction) and body leans toward contralateral side

A spastic hemiplegic gait is commonly seen with what pathology?

CNS lesion (stroke)

What is a spastic diplegic/paraplegic (scissor) gait?

bilateral, symmetric LE spasticity > UE

stiff and slow gait (walking through water)

steps short, thighs may cross, toes point inward, walk on toes

A spastic diplegic/paraplegic gait is commonly seen with what pathology?

cerebral palsy

cervical myelopathy

What is a steppage gait?

excessive hip and knee flexion to lift the foot higher

difficulty with dorsiflexion

cannot heel walk

A steppage gait is commonly seen with what pathology?

foot drop (radiculopathy)

peripheral neuropathy

What is a parkinsonian gait?

stooped posture

slow to start, difficult to stop

short and shuffling steps

decreased arm swing (unilateral)

festination

What is festination?

tiny rapid steps to try and maintain center of gravity

turning

seen in parkinsonian gait

What is a cerebellar ataxic gait?

staggering, unsteady gait with wide base

patients will have already had a positive Romberg

A cerebellar ataxic gait is commonly seen with what pathology?

cerebellar dysfunction (stroke, tumor)

What is a sensory ataxic gait?

unsteady and wide base gait

feet thrown forward and slap down onto ground (to get sensory input)

watch ground and staggering worse with eyes closed

positive Romberg, worse with eyes closed