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30 Cards in this Set
- Front
- Back
Acute onset of neurological sxs usually has a ___________ cause |
vascular cause |
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Checking for neurological sxs should include a mental status exam. What are you checking for? |
Alertness- Level of consciousness Orientation- where, when, what Attention- ask to spell backward Registration/recall- memorize 3 words Repetition- repeat, testing for aphasia Naming- name various objects, for aphasia Content of thoughts- appropriate response Insight & judgement- ask moral questions |
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List the cranial nerves |
1- olfactory 2- optic 3- oculomotor 4- trochlear 5- trigeminal (corneal reflex, mastication) 6- abducens 7- facial 8- vestibulocochlear (weber, rinne) 9- glossopharyngeal 10- vagus 11- accessory 12- hypoglossal |
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Homonymous field cut (hemianopsia)--> ________ lesion *L or R half of each visual field (if unilateral visual field defect = CN 2 (optic) defect)* |
Contralateral (opposite) side lesion posterior to optic chiasm (if lesion on the R side--> will have loss in L hemisphere of each visual field) |
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Bi-temporal field cut (hemianopsia)--> _______ lesion *lateral half of each visual fields |
optic chiasm lesion or pituitary enlargement compressing optic chiasm |
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Pt presents w/ triad of; anisocoria (unequal pupils) ptosis outward deviation of affected eye What CN is lesioned? |
CN 3 lesion (unopposed lateral rectus--> outward deviation) |
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(LMN/UMN) CN 7 (facial) lesion; Facial droop on IPSILATERAL side Upper AND lower facial involvemet |
LMN CN 7 nucleus or nerve lesion *Bell's palsy |
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UMN (upper motor neuron) CN 7 lesions involve the corticobulbar tract or CNS. How do they present? |
Facial droop on CONTRALATERAL side Lower facial involvement ONLY |
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Motor spasticity is noted when pts movement is restricted in one direction but easy in others. When does this occur? |
cerebral palsy & MS |
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Muscle weakness can be tested w/ ___________ *full strength = 5/5, paralysis = 0/% |
Pronator drift *outstretched arm will begin to pronate w time* (shoulder pathology interferes w this test) |
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___________ , starting distally is usually the first thing affected by sensory neuropathies *presents w/ (+) Romburg sign (lose balance when eyes are closed) |
loss of proprioception (have pt clothes eyes & tell whether toe being moved up or down) (+) Romburg bc proprioception is responsible for maintaining balance when eyes closed* (pain, temp, etc usually affected later) |
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In _________ lesions & strokes, pts display stereognosis (can't identify object by holding) & neglect (ignore one side of body, think you are touching right when you touch left) |
Right parietal lesions (stereognosis) & strokes (neglect) |
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Finger to nose (shaking) Heel to shin RAM's/RRM's (dysdiadochokinesia, rapid alternating movement) Rebound Gait (poor coordination, seem intoxicated) Test __________ fxn *Deficits will be ipsilateral to lesions |
Cerebellum |
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Loss of pain & temp on one side of the face & opposite side of the body is a _________ lesion |
brainstem lesion |
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Loss of pain & temp on one side of body & loss of weakness &/or vibration on the opposite side body is a __________ lesion What special reflexes should you check? |
spinal cord lesion check Anal wink (pudendal N, S2-S4) |
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Pure motor sxs--> contralateral ________ infarct *Associated w hypertension & diabetes |
contralateral small vessel lacunar infarct of internal capsule, pons, basal ganglia |
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Diplopia, ataxia, & dysphagia----> MUST RULE OUT _________________ *If vertical gaze disturbance very likely! |
brainstem lesion possible, must rule out! |
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_________ lesions will present w/ hypotonia/ hyporeflexia in the first 24- 48 hrs (before more typical sxs appear) + Babinski (big toe comes up & fans out) appear later |
UMN lesion |
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In a seizure, the eyes look __________ the focus of the seizure *pupils do NOT react |
AWAY from the focus |
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In a cortical (hemispheric) infarct, the eyes look _________ the infarct *spastic gait seen in stroke pts |
TOWARD the infarct |
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Brainstem infarct, the eyes look _______ infarct |
AWAY from the infarct |
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Decorticate position (elbows flexed, wrists flexed) is seen w/ deterioration ABOVE the midbrain & Decerebrate position (elbows extended, wrists flexed) is seen w/ deterioration BELOW the midbrain Which is usually seen first? |
Usually decorticate--> decerebrate--> flaccid = brainstem involvement = POOR PROGNOSIS *brain deteriorates cortex--> brainstem |
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Unilateral, fixed, & dilated pupils are a bad sign what do they suggest? |
Aneurysm or Herniation (in comatose pt, may be d.t inc ICP & push uncus against CN 3) |
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What is the diff btwn the oculocephalic & oculovestibular reflex? |
oculocephalic- eyes stay fixed on object when head moves oculovestibular- nystagmus w/ fast component away |
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What drugs make cause ocular motility deficits w/ normal pupils? block oculovestibular reflex? pupils non-reactive? *Pupils are normally large in drug OD, except in opiates (small) |
ocular motility- Benzos, Barbiturates, Alcohol block oculovestibular reflex- Gentamycin, succinylcholine, Dilantin, TCA's non-reactive- Barbiturates, succinylcholine, lidocaine, phenothiazines, methanol, aminoglycosides |
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Roving eye movements w/ eyes closed & eyes deviate slowly toward cold water (oculovestibular reflex) indicates __________ |
TME (toxic metabolic encephalopathy) ^ secondary to hyponatremia or hypoglycemia** |
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In a ____________ lesion, the oculovestibular reflex is NOT intact (no change w/ water) |
low brainstem lesion |
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In __________, pts appear Wet (bladder incontinence, first) Wobbly (ataxia, shuffle feet) Wacky (memory issues |
Parkinson/ NPH *ataxic gait is seen in most dementias** |
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In a __________ lesion, you will see ocular bobbing (oculovestibular reflex) & pinpoint reactive pupils |
Pons lesion |
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Special reflexes can be checked to localized lesions, & are graded as clonus (4/4), normal (2/4), or absent. Cremasteric reflex checks for lesions at _____ Bulbocavernous for lesions at _______ |
Cremasteric- genitofemoral N (L1-L2) Bulbocavernous- S2-S4 |