Cranial nerves, parts of brain, neuro exam, patho;HA (NEUROLOGIC) QL
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| neurologic functions | physiological functions, ADLs, function in society; indepent status
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| CNS | brain, spinal cord
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| PNS | cranial nerve / spinal nerve
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| cerebrum lobes | frontal, parietal, occipital, temporal (speech, sensation, vision, hearing)
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| frontal lobe | "SPEECH"; voluntary movement, emotions, intellect, conscious activities
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| frontspeak | j
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| parietal lobe | "SENSATION"; temperature, pain, tactile, shape/object discrimination
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| paired-senses | k
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| occipital lobe | "VISUAL"; recieves & interprets visual stimuli from retina
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| occipital (oh see!) | k
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| temporal lobe | "HEARING; SMELL"; recives auditory impulses from cochlear nerve; interprets smell from olfactory
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| temporary hearing and smell | f
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| CNS: diencephalon | thalamus, hypothalamus, epithalamus
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| thalamus | "traffic control tower"; all motor AND sensory signals processed
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| hypothalamus | autonomic control center; regulating involuntary activities
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| hypothalamus regulates: | BP, HR, force of heart contraction, digestion, RR /depth, temp, food intake (satiety), water balance, sleep cycle, pain, pleasure, fear
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| epithalamus | mood, sleep control, CSF fluid formation
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| cerebellum | muscle coordination,smooth movement, tone, equilibrium (balance)
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| CNS: lower brain area | brainstem: midbrain, pons, medulla oblongata
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| brainstem regulates | BP, RR, Resp. depth, Resp. rhythm, coughing, sneezing, hiccuping, swallowing, and vomiting
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| spinal cord | extension of brain stem; transmits impulses to brain; simple reflex activity
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| spinal cord protection: | meninges, CSF, vertebrae
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| CN originating in brain: | 1,2 (anterior); 3,7 (brainstem)
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| cranial nerves | olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocular, glossopharyngeal, vagus, spinal accessory, hypoglossal
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| some say money matters but my brother says big brains matter more | sensory, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor
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| olfactory | smell (unilateral/bilateral anosmia)
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| optic | vision (optic atrophy, papilledema, amblyopia, field defect)
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| oculomotor | extrinsic eye movement (diplopia, ptosis of lid, dilated pupil, inability to focus close objects)
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| trochlear | eye muscle movement (convergent strabismus, diplopia)
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| trigeminal | TOUCH ON FACE; opthalmic: (scalp, upper eyelid, nose, cornea, lacrimal gland); maxillary & mandibular (lower eyelid, nasal cavity, upper teeth / lip;;;; tongue, lower teeth, skin of chin, lower lip); MOTOR: teeth clenching; mandibular movement (tic, loss
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| abducens | extrinsic eye movement (strabismus, diplopia)
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| facial | taste; facial movements (smiling, closing eyes, frowning); tear production; salivary stimulation (Bell's palsy, inability to distinguish taste)
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| vestibulocochlear | vestibular (balance, coordination); cochlear (hearing); (tinnitus, vertigo, deafness)
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| glossopharyngeal | gag/swallow reflexes; taste (posterior 3rd of tongue); (loss of gag reflex, taste, swallowing)
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| vagus | muscles of throat, mouth (swallowing, talking); (loss of voice, impaired voice, unable to swallow)
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| spinal accessory | moves trapezius, SCM muscles, larynx, pharynx, soft palate (difficulty shrugging shoulders, unable to turn head R/L)
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| hypoglossal | moves tongue (swallowing, movement of food (during chewing), speech); (difficulty speech, swallowing, protruding tongue)
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| spinal nerves | all have sensory & motor properties
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| dermatome | area of body that each spinal nerve innervates
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| neuro exam | head to toe; distal to proximal
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| slow, deliberate movement | frontal
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| slurred speech | parietal
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| smiling | facial
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| hearing | vestibulocochlear
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| voluntary skeletal muscle movement | frontal
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| neuro techniques | inspection, palpation, sensory / motor func. tests, percussion (relex hammer)
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| neuro exam assesses: | mental status, CN function, motor function, sensory function, simple reflex
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| Broca's aphasia | (expressive aphasia); know what to say but can't get words out; FRONTAL LESION
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| Wernicke's aphasia | (receptive aphasia); difficulty forming cohesive sentences; can say words but sound like nonsense; TEMPORAL/PARIETAL LESION
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| degrees of consciousness | lethargy, obtunded, stupor, coma
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| LETHARGY | client opens eyes, answers questions, and falls back to sleep(common: light sleep)
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| OBTUNDED | opens eyes to LOUD voice, responds slowly w/ confusion, unaware of environment. (common: deep sleep, narcotic use)
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| STUPOR | awakens to painful stimuli, but quickly returns to unresponsive sleep. (common: drug overdose, general anesthesia).
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| COMA | least responsive; graded on the GLASCOW COMA SCALE w/ best eye opening response, best motor response, best verbal response. 3 = deep unresponsive , coma; (common: brain trauma/disease).
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| glasgow coma scale | 15 highest possible score—all of us now should be at 14 or higher. 3 = deep unresponsive , coma. (Brain trauma/disease being one of most common).
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| short-term memory | current data
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| long-term memory | easy past history; ABNORMAL: inability to recall: (cerebral cortex damage, Alzheimer's disease)
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| memory that declines w/ aging | short-term
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| problem solving | addition/subtraction; ABNORMAL: organic brain disease, nervousness, lack of education
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| abstract thinking | similar / different about objects?; common sayings; ABNORMAL: organic brain damage, mental deficiencies, language/education difference
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| mood / emotional state | ABNORMAL: depression, neuro problems (parkinson's); emotional disturbances, psychiatric issues (schizo, bipolar)
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| thought processes / judgement / decision-making | ABNORMAL: psychiatric disease, emotional dist., neuro disorder (Alzheimer),
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| olfactory | (S); identify smell; ABNORMAL: cold; CN I dysfunction, genetic, zinc deficiency Unilateral problem? Brain tumor?
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| optic | test near/far/color vision; opthalmoscope ID optic disc; ABNORMAL: CN 2 dysfunction; chronic disease like HTN, DM. Tumors, Intracranial Hemorrhage.
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| CN 3,4,6 (eye muscle movement) | (M); follow finger 6 card. points of gaze (hor, vert, diag); shine light to observe constrict; both eyelids lifted (ptosis)
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| CN 3 | eye muscle movement, pupillary const., eyelid lifting
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| ptosis | eyelid drooping (CN 3)
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| trigeminal | (S + M); SENSORY: perceive TOUCH ON FACE by blink reflex, cotton ball; MOTOR: clench / move temporalis, masseter muscles
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| facial | (S+M): SENSORY: test taste on anterior 2/3 tongue w/ food samples; MOTOR: manipulate muscles of face (smile, close eyes tightly); identify "blink" (corneal) reflex; tear,saliva production (onion)
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| vestibuloscochlear | (S): hearing (whisper test); vestibular (Romberg test); + Romberg = unable to maintain balance
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| glossopharyngeal | (S+M): SENSORY: gag reflex (tongue depressor), taste (posterior 3rd); MOTOR: say "AHH" (uvula rises midline symmetrically at soft palate); swallow
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| vagus | (S+M): SENSORY: normal digestive response; MOTOR: vocal cord function (hoarseness = CN X lesion); swallowing (tongue depressor)
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| spinal accessory | (M): manipulate SCM, trapezius muscles (shrug shoulders, rotate neck w & w/o resistance)
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| hypoglossal | (M): tongue movement (R+L, U+D, smooth, easy movements); tongue strength (equal resistance both sides)
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| cerebellum, posterior spinal tract neurons test | smooth, coordinated movement (gait, balance, walk heel to toe); client unable to walk (shin to heel test: slide heel one foot along shin of other = motion should be smooth / heel should NOT fall off shin
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| upper extremity coordination (finger-nose) | finger to nose test; ABNORMAL: cerebellar disease (overshoot and miss nose)
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| upper extremity coordination (rapid alternating movements of hands test) | RAMHT test: supinate/pronate hands (movement equal b/w hands; smooth)
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| parietal lobe / (sensory) spinal tract / peripheral spinal nerves | *test most distal areas first; TOUCH tests (touch over all extremeties while eyes closed); dull/shap; hot/cold; vibration (tuning fork)
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| other sensory function tests: | stereognosis (closes eyes, IDs object); graphesthesia (closes eyes, IDs number)
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| Two-Point Discrimination test | sensory func.; gradually move qtips apart; peripheral nerves, parietal cortex intactness;
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| Sense of Joint Movement Test (Sense of positions) | closes eyes, tells whether moving toe/finger up, down, etc.; ABNORMAL: parietal cortex, sensory spinal tract, or peripheral nerve damage (tracts are not intact or otherwise damaged in some way)
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| reflex tests? | spinal nerve / cord
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| reflex hammer | 0 = Absent reflex; 1+ = Hypoactive reflex 2+ = Normal reflex.
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| 3+ = Brisk (above normal BUT NOT indicative of disease). |
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| 4+ = Hyperactive,hyperreflexive= ABNORMAL:Increased CNS excitability: assoc w/ Clonus—rapid succession of muscular contraction and relaxation when foot dorsiflexed. |
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| Clonus | hyperreflexive; rapid succession of muscular contraction/relaxation when foot dorsiflexed
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| other reflex tests | biceps reflex: strike tendon w/ hammer = biceps contract; triceps reflex (same), patellar reflex, ankle reflex (elicits plantarflex); plantar reflex,
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| Babinski's reflex (plantar) | ABNORMAL: toes fan out, extend (normal < 2yo)
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| Abdominal reflexes | stroke w/ handle side of hammer along abdomen (ab muscles contract)
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| Neuro check (abb.) | Level of Consciousness
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| Pupillary constriction (direct/consensual). |
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| Strength and movement of extremities (hand grips, range of motion). |
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| Sensation in extremities |
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| Vital Signs |
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| common neuro abnormalities: | motor function, gait, and movement.
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| dysfunction of cranial nerves. |
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| seizures |
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| spinal cord injury. |
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| infections. |
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| degenerative disorders. |
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| fasciculation | twitch = motor neuron disease
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| tic | habit; psychogenic; involuntary spasmodic muscle movement; common: face, neck, shoulders
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| tremor | rhythmic, alternating involuntary movement (contraction of opposing muscle groups); Parkinson's, MS, uremia, alcohol intoxication
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| seizures / epilepsy | rapid, excessive firing of synapses in the brain
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| -clonus, tonic-clonic seizures severely attacking entire body for minutes to a brief, simple staring state lasting less than a second. |
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| -brain injury at birth, high fever in childhood, trauma, infections, HTN syndrome, stroke, environmental toxins, drug O.D., withdrawal from alcohol, sedatives. |
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| --EPILEPSY: chronic seizure disorder |
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| spinal cord injuries | --(cervical, thoracic, lumbar, sacral areas); higher the level of injury of spinal cord = more neurological deficiencies. Cervical injury most severe leading to quadriplegia or death.
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| --Causes: Accidents (MVA), sports, diving, gunshots, stab wounds |
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| most sever spinal injury | cervical
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| neuro infections | Meningitis: inflammation and bacterial/ viral infection of meninges or membranes of brain + spinal cord; high fever, nuchal (neck) rigidity, inability to flex neck greater than 45 degrees without pain, severe headache. When neck flexed, hips and knees fle
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| encephalitis | neuro infection spread into brain tissue (often deadly or with permanent brain damage); high fever, nuchal (neck) rigidity, inability to flex neck greater than 45 degrees without pain, severe headache. When neck flexed, hips and knees flex (Brudzinski's s
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| Brudzinski's sign | when neck flexed, hips and knees flex (encephalitis, meningitis)
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| lyme disease | deer-borne tick disease; (flu-like symptoms, followed by arthritis symptoms (joint stiffness) and papular erythemic rash at bite site) Simple antibiotic tx—but without can lead to permanent and severe neurological complications
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| Alzheimer's Disease | degenerative neuro disease: progressive deterioration of cerebral cortex functioning (common over 65 yo; can begin in middle adult years); loss of memory (noticeable by self and others), shorter attention span, then confusion and disorientation, hallucina
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| MS | degenerative neuro disease: deterioration of the myelin sheath or protective coating protecting the nerve tracts in the brain and spinal cord; first signs: 20 - 40 yo - numbness, tingling of one side of the body; progressive but ranges in severity; may le
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| Parkinson's Disease | Attacks "white matter" nerve cell bodies of the brain responsible for initiating and stopping smooth flowing voluntary movements.
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| ;uncontrolled voluntary movements (fasciculations and tremors of hands when write or eat, shuffle feet when walking, bob head when moving or rotating, speak with tremor in voice); moves very slowly; "mask face." ;respond to you, but slowly. You MUST be pa |
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| Etiology unknown—perhaps toxins. Can also be genetic. |
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| dev. cons: geriatric | Changes in neurologic function (steady, slow decline) already begin at 40 .
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| Senses change (All deteriorate over time—smell, taste, vision, hearing, touch). |
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| Gait slows. Posture more flexed, not as erect. Takes longer to perform tasks. |
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| Decreased reaction time. Be patient and don't talk for them!! Recent memory in particular more difficult to recall. |
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| Deep tendon reflexes diminish. Coordination there but slowed. |
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| Tire faster. If need to complete full neurological exam—give rest breaks |
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| psychosocial | Inability to control movements—So Frustrating!!!
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| Changes in speech and elimination patterns (want to communicate but find it difficult or impossible). |
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| Inability to carry out certain activities of daily living/others seem to take forever and more tiring. |
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| Diminished self-esteem—I just can't do as much any more. |
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| Social isolation—U.S. culture values youth |
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| cultural / environmental | Genetics: Alzheimer's, Multiple Sclerosis, Parkinson's.
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| Environmental toxins: neurological disorders like Parkinson's, neuro deficits, neoplasms (cancerous tumors). |
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| Alzheimer's: more common in blacks |
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| HP 2010: Alzheimer's & head trauma | s
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| HP 2010: alzheimer's | Increase numbers of persons seen in primary healthcare who receive mental health assessment, particularly middle, older adults with family history of Alzheimer's; increase the numbers of adults w/ mental disorders who receive treatment. More adult daycare
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| HP 2010: head trauma | Reduce hospitalization for nonfatal head injuries (safety courses; equipment free or low cost).
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| Reduce deaths caused by motor vehicle crashes (safety courses). |
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| Increase the use of safety belts (random police checks). |
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| Increase the use of helmets by cyclists (law requirement in motorcycles; should we enforce it with bicycles?) |
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| Reduce deaths by falls (home safety programs for older clients). |
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