1. Dysarthria vs. Aphasia
    • slurred speech (able to produce speech)
    • vs impaired ability to produce or comprehend language
  2. Apraxia
    inability to carry out leaned motor tasks
  3. Hemianopia (visual field cut)
    blindness in half of the visual field
  4. organization of information flow in the brain
    cortex (4 lobes) --> internal capsule --> thalamus --> basal ganglia --> brainstem --> PNS
  5. neurological exam (steps)
    • 1. mental status
    • 2. Cranial nerves
    • 3. Motor
    • 4. Sensory
    • 5. Reflexes
    • 6. Cordination
    • 7. Gait
  6. 1. Mental status exam: types of exam
    • -Set tone for the remainder of exam
    • -Level of consciousness
    • -Orientation
    • -Attention and Concentration
    • -Memory
    • -Naming
    • -Language
  7. Mental status exam: level of consciousness
    alert, lethargic, stuporous, comatose
  8. Mental Status exam: orientation
    place, person, date and situation
  9. Mental status exam: Attention & concentration
    digit spans (7), serial 7's and spell WORLD backward
  10. Mental status exam: memory
    immediate recall, recent memory, long-term memory and cueing
  11. Mental status exam: Language
    fluency, repetition, comprehension
  12. Cranial Nerve exam CN I
    • generally dont test
    • Dont use noxious odors (interfere w/ SA of CN V)
  13. Cranial nerve exam - CN II
    • Visual Acuity
    • Fundoscopic exam
    • Visual Fields
    • Pupillary rxn to light
  14. Cranial nerve exam - CN III, IV, VI
    • All eye movement - III
    • Toward midline - IV
    • Away from midline - VI
  15. Cranial nerve exam - CN V
    • Check light touch and pinprick for facial sensation (V1,V2,V3)
    • Corneal reflex (w/CN VII - dab cotton swab to the eye)
    • Masseter contraction
    • Jaw Jerk
  16. Cranial nerve exam - CN VII
    • Facial Movement
    • Eye Closure
    • Taste
    • Bell's Palsy vs. Stroke (wrinkling of the
    • forehead)
  17. Cranial nerve exam - CN VIII
    hearing and balance
  18. Cranial nerve exam - CN IX, X
    • Gag reflex
    • Palatal elevation (say AH - uvula will deviate away from the affected side)
    • Clarity of Speech
  19. Cranial nerve exam - CN XI
    • shoulder shrug (trapezius)
    • Turn head against resistance (SCM)
  20. Cranial nerve exam - CN XII
    • tongue power
    • tongue deviation (to the affected side)
  21. Motor Exam
    Bulk, Tone and Power
  22. Motor exam - Bulk
    • Relatively preserved in central lesion
    • Loss more rapidly in Peripheral lesion
  23. Motor exam - Tone (rigidity, Spasticity, Cogwheeling, Paratonia)
    • -Rigidity: inc tone throughout range of motion
    • -Spasticity: Initial velocity and Force-dependent "catches during passive movement of extremity
    • -Cogwheeling: ratchet-like catches throughout range of motion
    • Paratonia: resistance to passive movement in all reaction, seems somewhat willful
  24. Motor exam - grade
    • Strength/Power
    • Pronator drift
    • Graded 0-5

    5 – movement against full resistance

    4 – movement against some resistance

    3 – movement against plane of gravity, but no resistance

    2 – movement only in plane

    1 – only contraction detectable

    0 – no movement
  25. Sensory exam: pathway involve
    Light touch, pinprick, temperature, vibration, proprioception

    2 pathways:

    • Dorsal Column Medial Lemniscus (DCML):
    • transmits light touch, vibration, proprioception. Crosses in brainstem.

    • Anterolateral System: transmits pinprick
    • and temperature.  Crosses in spinal cord.
  26. Reflex exam
    Graded 0, 1+, 2+, 3+, 4+ by convention

    0: no reflex

    1+: requires reinforcement

    2+: normal

    3+: spread to adjacent muscle groups

    4+: clonus
  27. Coordination exam: type of exam
    Testing cerebellum

    Finger to nose

    Rapid alternating movements

    Fine finger movements

    Heel to shin
  28. Gait exam

    Toe walk, heel walk, tandem

    Arm swing, stride length, posture, turning

    Romberg :pt stands with feet together eyes closed.  Look for sway. If pt falls sign of DCML dysfunction.
  29. Localization (components)
    Cortex (the lobes)

    Sub-cortex (basal ganglia, internal capsule, thalamus)


    Spinal cord


    Peripheral Nerve

    Neuromuscular Junction

  30. Cortex localization
    Aphasia: impaired ability to produce or comprehend language

    Apraxia: inability to carry out learned motor tasks

    Hemianopia/Visual Field Cut: blindness in half of the visual field

    Neglect: inattention to one side of the universe
  31. Subcortex localization
    No cortical signs, the patient looks relatively good.

    Pure motor

    Pure sensory

  32. Brainstem localization
    Cranial nerve deficits

    Crossed signs
  33. Spinal Cord localization
    Sensory level

    Bladder and bowel

    Brown Sequard Syndrome
  34. Plexus/ peripheral nerve localization
    Map out dermatomes (one dermatome -->peripheral ; a region with multiple dermatome --> plexus)
  35. Neuromuscular Junction localization
    Myasthenia gravis: eyelid weakness (ptosis), eye movement weakness, respiratory weakness, swallowing and speaking difficulty, generalized weakness.  Fatiguable.
  36. Muscle localization
    Tenderness to palpation

    Elevated CK on serum testing

    Difficulty rising out of chair, brushing hair, going up stairs.
  37. Neurological red flags (meningitis)
    • Meningeal Signs
    •     --Kernig’s sign: flex thigh on abdomen with knee in flexed position. Extend knee
    • – positive if elicits pain or resistance.
    •     --Brudzinski’s Sign: flexion of the neck leads to flexion of the hips and/or knees
  38. Neurological Red Flags - Headache
    Worst headache of pt’s life, particularly if rapid onset (thunderclap headache)

    New-onset headache in pt over 50

    Headache and seizures

    New onset headache in pt with history of cancer or HIV

    Headache worse in morning, with exertion, or valsalva.

    Position dependent headaches

    Any abnormality in neurological exam
  39. Neurological Red Flags (besides meningitis and headache)
    Alteration of consciousness

    Vertical nystagmus

    Cranial Nerve Abnormalities

    Pulsatile tinnitus
  40. bonus
Card Set
Summer 13' System 4