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DU PA Neuro Ana/appr
DU PA Neuro Anatomy Review/Approach to the Neuro Patient
| Question | Answer |
|---|---|
| symptom of "light headed" may be indicative of | cardiac insufficiency |
| symptom of "off balance" may be indicative of | cerebellar or posterior column disfunction |
| small lesions in high traffic areas such as the brain or spinal cord may lead to | widespread neurologic disfunction |
| pain is usually due to a lesion of the | peripheral nervous system |
| aphasia is usually due to a lesion of the | central nervous system |
| degenerative diseases progress | gradually |
| vascular diseases progress | rapidly |
| location: limb clumsiness | ipsilateral cerebellar hemisphere |
| location: unsteadiness of gait or posture | midline cerebellar structures |
| location: slowness of voluntary movement | substantia nigra and striatum |
| location: involuntary movement | striatum, thalamus, subthalamus |
| location: unilateral weakness or sensory complaints | contralateral cerebral hemisphere |
| location: language disfunction | left hemisphere (frontal and temporal) |
| location: spatial disorientation | right hemisphere (parietal and occipital) |
| location: anosognosia (lack of insight into deficit) | right hemisphere (parietal) |
| location: hemivisual loss | contralateral hemisphere (occipital, temporal, and parietal) |
| location: flattening of affect or social disinhibition | bihemispheric (frontal and limbic) |
| location: alteration of consciousness | bihemispheric (diffuse) |
| location: alteration of memory | bihemispheric (hippocampus, fornix, amygdala, and mammillary bodies) |
| location: double vision | midbrain and pons |
| location: vertigo | pons and medulla |
| location: alteration of consciousness | midbrain, pons, medulla (reticular formation) |
| location: weakness and spasticity (ipsilateral) and anesthesia (contralateral) below a specific level | corticospinal and spinothalamic tracts |
| location: unsteadiness of gait | posterior columns |
| location: bilateral (can be asymmetric) weakness and sensory complaints in multiple contiguous radicular distributions | central cord |
| location: weakness and wasting with muscle twitching (fasciculation) but no sensory complaints | anterior horn of spinal cord (diffuse or segmental) |
| location: weakness and sensory loss confined to a known radicular distribution (pain, a common feature, may spread) | cervical, thoracic, lumbar, and sacral |
| example: autosomal dominant | Huntington's disease |
| example: autosomal recessive | Friedreich's ataxia |
| example: sex-linked recessive | Duchenne's muscular dystrophy |
| example: sporadic genentic | Down syndrome |
| example: intrinsic neoplastic | glioblastoma |
| example: extrinsic neoplastic | metastatic melanoma |
| example: paraneoplastic | cerebellar dengeneration |
| example: stroke | thrombotic, embolic, lacunar, hemorrhagic |
| example: structural | arteriovenous malformation |
| example: inflammatory | cranial arteritis |
| example: bacterial | Meningococcal meningitis |
| example: viral | herpes encephalitis |
| example: protozoal | toxoplasmosis |
| example: fungal | cryptococcal meningitis |
| example: helminthic | cysticercosis |
| example: prion | Creutzfeldt-Jakob disease |
| example: central degenerative | Parkinson's disease |
| example: central and peripheral degenerative | amyotrophic lateral sclerosis |
| example: autoimmune, central demylinating | multiple sclerosis |
| example: autoimmune, peripheral demyelinating | Guillain-Barre syndrome |
| example: autoimmune, neuromuscular junction | myasthenia gravis |
| example: endogenous, toxic/metabolic | uremic encephalopathy |
| example: exogenous, toxic/metabolic | alcoholic neuropathy |
| example: psychogenic | hysterical paraparesis |
| __ is most often used to investigate seizures, and is also used to evaluate brain death | electroencephalography |
| __ are commonly used in the evaluation of probable multiple sclerosis | visual-evoked potential studies |
| Alertness or state of awareness of the environment | level of consciousness |
| the ability to focus or concentrate over time on one task or activity | attention |
| recent or short term memory covers __ | minutes, hours, or days |
| remote or long-term memory refers to intervals of | years |
| awareness of personal identity, place, and time; requires both memory and attention | orientation |
| sensory awareness of objects in the environment and their interrelationships (external stimuli), also refers to internal stimuli such as dreams or hallucinations | perceptions |
| the logic, coherence, and relevance of the patient's thought as it leads to selected goals; how people think | thought processes |
| what the patient thinks about, including level of insight and judgement | thougth content |
| awareness that symptoms or disturbed behaviors are normal or abnormal | insight |
| process of comparing and evaluating alternatives when deciding on a course of action, reflects values that may or may not be based on reality and social conventions or norms | judgment |
| an observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor | affect |
| a more sustained emotion that may color a person's view of the world | mood |
| mood is to affect as climate is to __ | weather |
| a complex symbolic system for expressing, receiving, and comprehending words | language |
| assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions | higher cognitive functions |
| toward the CNS | afferent |
| away from CNS | efferent |
| superior or toward the cranium | rostral |
| inferior or toward the sacrum | caudal |
| anterior or front of body | ventral |
| posterior or back of body | dorsal |
| thick outer layer of meninges | dura mater |
| thin middle layer of meninges | thin middle layer |
| delicate, highly vascular layer of meninges | pia mater |
| usually caused by a rupture of the middle meningeal artery associated with trauma | epidural hematoma |
| usually due to a rupture in the veins that drain into the dural sinuses | subdural hematoma |
| most often associated with head trauma | subdural hematoma |
| may take 24 hours to 2 weeks to fully develop | subdural hematoma |
| presents with a "thunderclap" and the "worst headache of my life" | subarachnoid hemorrhage |
| nourishes neuronal tissue, removes metabolic wast, extends into subarachnoid space surrounding cranial nerves and spinal cord | CSF |
| main passageway for ascending and descending fiber tracts in the brain. Almost all neural traffic to and from the cerebral cortex passes through it | internal capsule |
| when this area is destroyed, no dopamine flows to the basal ganglia. This leads to parkinson's disease | substantia nigra |
| the cerebellum has an __ effect on movement | ipsilateral |
| if the __ is damaged there is no paralysis, just slow, clumsy, tremulous, uncoordinated movements | cerebellum |
| relay station of the brain. Contains the thalamus, and hypothalamus | diencephalon |
| all sensory tracts from the body synapse in the thalamus before being directed to the cortex except __ | olfactory |
| controls autonomic functions, regulates homeostasis, coordinates neural and endocrine functions | hypothalamus |
| emotional behavior and memory, bridge between the autonomic and voluntary responses to change in the environment | limbic system |
| involved in signaling stimuli related to reward, fear, motivation. Emotional learning | limbic system |
| required for the formation of long-term memories | hippocampus |
| contributes to cognitive processing including attention | cingulate gyrus |
| part of the brainstem, plays a central role in bodily and behavioral alertness. Crucial for maintaining the state of consciousness | reticular activating system |
| A clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma | concussion |
| inability to use language, loss of access to the symbols that we use to represent concepts | aphasi |
| few words written or spoken. Less difficulty comprehending. | Broca's aphasia |
| able to produce written and spoken words. More deficient in comprehension. | Wernicke's aphasia |
| gray matter destruction from chronic alcohol use. | Korsakoff's psychosis |
| pain or pressure registered in non-nervous tissue structures such as meninges or arteries | headahce |
| spinal cord ends at | L1-L2 |
| for a lumbar puncture the needle is inserted between the __ vertebrae (the level of the iliac crest) to avoid spinal nerves | L4-L5 |
| disorder in which two sides of the vertebral arches fail to fuse during development, results in an open vertebral canal | spina bifida |
| dermatomal area of groin is innervated by | L1 |
| dermatomal area of shoulder is innervated by | C4 |
| dermatomal area of nipple line is innervated by | T4 |
| dermatomal area of umbilicus is innervated by | T10 |
| myotome of shoulder | C5-6 |
| myotome of elbow | C6-7 |
| myotome of hand | C8-T1 |
| myotome of hip flexion | L1-2 |
| myotome of knee extension | L3-4 |
| myotome of knee flexion | L5-S2 |
| myotome of plantar flexion | S1-2 |
| hoarse voice with lung CA can be due to a __ palsy caused by pressure from the tumor | recurrent laryngeal nerve |
| Voluntary muscle activity-impulses originate in the precentral gyrus in large cell bodies called __ | pyramidal cells |
| intrinsic hand flexors and extensors | ulnar nerve |
| deltoid | axillary nerve |
| biceps | musculocutaneous nerve |
| triceps, wrist and hand extensors | radial nerve |
| most forearm flexors/pronators | median nerve |
| adductor muscles of thigh | obturator nerve |
| iliopsoas, quadriceps | femoral nerve |
| tibialis anterior, peroneal | peroneal nerve |
| gastrocnemius, posterior tibialis | tibial nerve |
| spastic, no atrophy, no fasciculations or fibrillations, hypertonic reflexes, babinski may be present | Upper motor neuron paralysis |
| flaccid, atrophy, fibrillation and fasciculations may be present, hypotonic reflexes, babinski absent | Lower motor neuron paralysis |
| coarse muscle twitching | fasciculations |
| fine barely visible twitch of a single muscle fiber | fibrillations |
| if absent, indicates damage to sensory function, internuclear connection, or motor function | reflexes |
| tests the integrity of nerve pathways | reflexes |
| mediates arm abduction at the shoulder | C5 |
| mediate flexion at the elbow and the biceps reflex | C5 and C6 |
| mediates wrist extension | C6 |
| mediates elbow extension and the triceps reflex | C7 |
| mediates leg extension at the knee and the patellar tendon | L4 |
| mediates dorsiflexion at the ankle | L5 |
| mediates plantar flexion at the ankle and the achilles tendon reflex | S1 |
| meaningless unintentional movement occuring unexpectedly (chorea, athetosis, hemiballismus, tremors at rest) signify __ | basal ganlia dysfunction |
| awkwardness with intentional movement (hypotonia, decreased DTR, aesthenia, dysmetria, intention tremor, ataxia, speech disorders) indicates __ | cerebellar disorder |
| sudden jerky, purposless movements | chorea |
| slow writhing movements of fingers and wrist primarily | athetosis |
| sudden wild, flailing movement of one arm | hemiballismus |
| decreased skeletal muscle tone | hypotonia |
| muscles are mildly fatigued and tire more easily | aesthenia |
| inability to gauge distance, power, or speed of movement | dysmetria |
| impaired ability to stop one action and start another | dysdiadocokinesis |
| senses pain-temperature. nerves enter spinal cord and cross over almost immediately. Lesion results in a loss of sensation contralaterally below the level of the lesion | lateral spinothalamic tract |
| senses light touch and pressure. nerves enter spinal cord and crosses over almost immediately. Lesions result in a loss of sensation contralaterally below the level of the lesion | anterior spinothalamic tract |
| senses conscious proprioception, stereognosis and vibration. Nerves enter spinal cord and initially travels up the same side. Cross over at junction of spinal cord and brainstem. | posterior/dorsal columns |
| CN: smell | olfactory (I) |
| CN: vision | optic (II) |
| CN: all eye muscles except those supplied by IV and VI | oculomotor (III) |
| CN: superior oblique muscle | trochlear (IV) |
| CN: external rectus muscle | abducent (VI) |
| CN: sensory:face, sinuses, teeth, etc.motor: muscles of mastication | trigeminal (V) |
| CN: muscles of the face | facial (VII) |
| CN: inner ear | vestibuloccochlear (VIII) |
| CN: motor: pharyngeal musculature, sensory: posterior part of tongue, tonsil, pharynx | glossopharyngeal (IX) |
| CN: motor: hear, lungs, bronchi, gastrointestinal tractsensory: heart, lungs, bronchi, trachea, larynx, pharynx, gastrointestinal tract, external ear | vagus (X) |
| CN: muscles of the tongue | hypoglossal (XXI) |
| CN: sternocleidomastoid and trapezius muscles | accessory (XI) |
| CN involved with diplopia | CN's II, IV, VI |
| CN involved with decreased facial sensation | CN V |
| CN involved with decreased strenght/drooping of the face | CN VII |
| CN involved with deafness and dizziness | CN VIII |
| CN involved with dysarthria and dysphagia | CN's IX, X, XII |
| CN involved with decreased strength in neck and shoulder | CN XI |
| pronator drift assesses | subtle corticospinal lesion |
| light touch assesses | posterior columns |
| pain assesses | spinothalamic tract |
| joint position sense assesses | posterior column |
| vibration assesses | posterior column |
| graphesthesia assesses | cortical sensory |
| double simultaneous stimulation assesses | cortical sensory |
| two point discrimination assesses | posterior columns, cortical sensory |
| deep tendon reflexes __ in upper motor neuron involvment | increased |
| deep tendon reflexes __ in lower motor neuron involvement | decreased |
Created by:
bwyche
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