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Neurology Chapter 1


Frontal Lobe Thinking/Personality Center (Personality change after trauma). Two cortexes - sensory & motor.
Sensory Cortex Frontal Lobe - Post central gyrus
Motor Cortex Frontal lobe - Precentral gyrus (thicker)
Parietal Lobe Receptive speech (hearing)
Temporal Lobe Expressive speech (talking) - contralateral to the dominante side
Occipital Lobe Vision Center
Cerebellum Execution of Smooth Movements. Supplied by superior, anterior inferior and posterior inferior cerebellar arteries.
Basal Ganglia Controls nonpurposal (unintentional) movement (ex. Parkinson's - Pill rolling)
Brainstem Mid brain, Pons & medulla (continuous with the spinal cord)
Meninges Pia, Arachnoid & Dura
CSF Made in the choroid plexus in the lateral ventricles (Subarachnoid Space) -> 3rd ventricle (anterior to brain stem) -> 4th ventricle -> medial foramina magendie & two lateral foramin luschka. Reabsorbed by the arachnoid granulations then to dural sinuses.
Hydrocephalizaion caused by Damaged arachnoid granulations
Blood thinner herbs Ginko, Garlic & ginsing. Together they are more potent than coumadin.
Licorice Root Increase blood pressure
Recommended hours of sleep per night 8-10
Gloscow Coma Scale Motor Response: 1-6Eye Opening: 1-4Verbal: 1-5
Orientation questions - inorder Time, Place, Person
Spelling questions - in order World (5) - Hand (4) - Cat (3)
Papiledema (Opthamoscopic Exam) Loss of venous pulsation
Hypoglossal lesion Tongue deviates toward lesion
Strength Grade 5 - Full force4 - Less force3 - Against gravity2 - Lateral Movement1 - No movement
Biceps reflex C5** & C6
Brachioradialis reflex C5 & C6**
Triceps Reflex C7** & C8
Patellar Reflex L3** & L4
Achilles Reflex S1** & S2
Babinskis S1 or above UMN lesion
Meningeal Irritation S&S Posterior HA, Fever & altered mental status
Coordination Testing (Basal Ganglia & Cerebellum) Finger-Nose, Heel-Shin, Rapid alternating movements & balance.
Basal Ganglia VS. Cerebellum BG - Tremor @ rest that disappears with movement.
Peripheral Nerve Lesions Dermatome or myotome distribution. Radicular Pain. LMN signs.
CNS Lesions General deficits within an extremity. Loss of sensation. UMN signs.
Spinal Cord Lesions UMN & Dermatome defect or Dissociation of sensation modalities
When to use lumbar punture for Dx. Meningitis, encephalitis, meningeal cancer, GBS (Guillain-Barré Syndrome ), acute demyelinating disorders, bengin intracranial hypertension, seizure, storke, polyneuropathy, subarachnoid hemorrhage (must CT scan prior to r/o brain herniation)
Post Lumbar puncture Patient lies supine for 6 hours to minimize HA & postential CSF leak
CT Pros & Cons Pro - cheap, fast, good blood localization & decrease in claustrophobia.Cons- Poor visualization of posterior fossa, cervical structures, and acute changes
MRI Pros & Cons Pros - Visualizes posterior fossa, cervical structures, soft tissues and acute changes well.Cons - Expensive, long, small area, patients cant be on ventilation or have metal implants.
CT myelogram Dye w/in subarachnoid space. Visualization around spinal cord.
EMG (Evoked potential studies) Localizes lesion. Elucidates etiology of nerve damage (metabolic, polyneuropathy, radiculopathy, myelopathy or compressive.
EEG Localizes defect. Can be used to determine brain death or coma.
Tracts 4 sensory & 1 motor
Sensory Tracts Spinothalamic, Posterior Column, Spinal Cerebellar
Spinothalamic Tract Pain, temperature & light touch. Enters spinal cord & decussates (crossover) 1 or 2 levels up from entry location. Terminates in sensory cortex.
Posterior Column Conscious stereognosis (3-D object discrimination), proprioception & light touch.Enters spinal cord and travels to medulla. Decussates at medulla and follows medial limbicus to sensory cortex.
Spinal Cerebellar Tract Unconscious proprioception. Always stays ipsilateral to the sensory cortex. Patient leans toward the side of the cerebellar lesion.
Motor Tract UMN (everything before spinal junction)-> crosses medulla -> corticospinal tract -> alpha interneuron -> LMN
UMN Dz. S&S Hyoerreflexic. Spastic (tough to move). No atrophy to muscles. No vesiculation (twitch). Positive babinskis sign.
Babinskis sign Toes fan & ankle, knee, hip dorsiflex & patient withdraws.
LMN Dz. S&S Hyporeflexic. Flaccid. Atrophy. Vesiculation (Twitches). Normal (negative) babinskis.
Created by: 147401391
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