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Neuro Physical Exam

Language expression Inferior frontal lobe, anterior motor strip, dominant hemisphere
Impaired memory Bilateral mesial temporal lobe lesions or bilateral medial thalamic lesions
Impaired attentiveness Diffuse mild cortical dysfunction, right parietal lesion
Homonymous hemianopsia Lesion to the contralateral visual pathway posterior to optic chiasm
Ptotic lid + larger pupil (poorly responsive to light) Third nerve lesion
Ptotic lid + smaller pupil (responsive to light) Horner's syndrome
Diplopia keys (2) 1. Diplopia worsens in the gaze direction of the action of the paretic muscle 2. The outer image is always the false image
Corneal reflex CN V-VII polysynaptic reflex
Most common cause of progressive unilateral hearing loss Acoustic neuroma
Slowed speech Spastic (upper motor neuron) process
Irregular speech rates Ataxic (cerebellar) process
Deltoid muscle C5 > C6, axillary nerve
Triceps muscle C7 > C6 & C8, radial nerve
Interossei muscles C8 & T1, ulnar nerve (also requires C7 & C8 radial nerve finer extensors to have normal strength)
Iliopsoas muscle L2 & L3 > L4, femoral nerve
Dorsiflexor muscles L4 & L5, peroneal nerve
Biceps reflex C5 > C6, musculocutaneous nerve
Triceps reflex C7 > C6 & C8, radial nerve
Quadriceps reflex L2, L3 & L4, femoral nerve
Achilles reflex S1 > S2, tibial nerve
Slowing of rapid alternating movements Upper motor lesions
Positive Babinski response Injury to the corticospinal tract
Triple flexion: 1. Extension of the great toe & dorsiflexion of the ankle 2. Flexion of the knee 3. Hip flexion The BIG BABINSKI, signifies major upper motor neuron injuries
Dysmetria Ipsilateral cerebellar (hemispheres) dysfunction
Fiber type: Vibration, joint position sense, light touch Large myelinated fibers
Fiber type: Pain and temperature Small myelinated and small unmyelinated fibers
Tract type: Pain and temperature Spinothalamic tract
Tract type: Vibration and joint position sense Posterior columns
Joint position sense, stereognosis, graphesthesia, touch localization, two-point discrimination Cortical sensations; the contralateral parietal cortex is essential for their perception
Spastic gait muscle imbalances Increased plantar flexor, knee extensor and hip extensor tone with inability to flex hip, knee and ankle (stiff leg with toes dragging and some circumduction)
Parkinsonian gait characteristics 1. Flexion of the neck, trunk and arms 2. Short steps 3. Poor arm swing 4. Difficulty turning
Ataxic gait characteristics Inability to perform tandem gait is the first manifestation then irregularity of stride rate and length with imprecise foot placement and leg control
Created by: megankirch