Neurologic System Flashcards

• Personality
• Behavior
• Emotions
• Intellectual function

Primary center for sensation

Primary visual Receptor

Primary Auditory reception center

Language comprehension

Mediates motor speech

• Olfactory
• Sensory
• Smell

• Optic
• Sensory
• Vision

• Oculomotor
• Both
• Motor: most extraoculomotor muscle movement, opening of eyelids
• Parasympathetic: Pupil constriction, lens shape

• Trochlear
• Motor
• Down and inward movement of eye

• Trigeminal
• Both
• Motor: Muscles of mastication
• Sensory: Sensation of face and scalp, cornea, mucous membranes of mouth and nose

• Abducens
• Motor
• Lateral movement of eye

• Facial
• Both
• Motor: Facial muscles, close eye, labial speech, close mouth
• Sensory: Taste(sweet, salty, sour, bitter) on anterior 2/3 of tongue

• Acoustic
• Sensory
• Hearing and equilibrium

• Glossopharyngeal
• Both
• Motor: Pharynx (phonation and swallowing)
• Sensory: Taste on posterior 1/3 of tongue, pharynx (gag reflex)

• Vagus
• Both
• Motor: Pharynx and Larynx (talking and swallowing)
• Sensory: General sensation from carotid body, carotid sinus, pharynx, viscera

• Spinal
• Motor
• Movement of trapezius and sternomastoid muscles

• Hypoglossal
• Motor
• Movement of tongue

• "Thinking brain"
• Deals with thought, memory, reasoning, sensation, and voluntary movement

Controls the automatic associated movements of the body (ex. arm swinging while walking)

Main relay station for nervous system

• Major control center that has many vital functions
• Regulates temp, HR, and BP control
• Sleep center
• Anterior/Post. pituitary gland regulator
• Coordinates ANS activity and emotional status

• "Doing brain"
• Concerned with motor coordination of voluntary movements, equilibrium, and muscle tone
• DOES NOT initiate movement but coordinates and smooths movements

• Midbrain
• Pons
• Medulla

• Merges into thalamus and hypothalamus
• Contains many motor neurons and tracts

Contains ascending and descending fiber tracts

• Connects brain and spinal cord
• Contains autonomic centers (Respiration, heart, GI)
• Pyramidal Decussation occurs

Crossing of the motor fibers

• Contains fiber tracts that connect brain to spinal nerves
• Mediates reflexes

• Sensory Pathway
• Transmits pain, temperature, and crude/light touch

• Sensory Pathway
• Conduct sensations of position (proprioception), vibration, and finely located touch (stereognosis)

• Motor Pathway
• Permits very skilled and purposeful movements

• Motor Pathway
• Permits gross automatic movements such as walking

• Motor Pathway
• Coordinates movement, maintains equilibrium, and helps maintain posture

• Located completely in the CNS
• Examples are cpticospinal, corticobulbar, and extrapyramidal tracts
• Ex. of UMN diseases: CVA, cerbral palsy , and MS

• Located in the PNS
• ANY MOVEMENT must be translated into action by lower motor neuron fibers
• Ecamples are cranial and spinal nerves
• Ex. of LMN diseases: Spinal cord lesions, Poliomyelitis, and amyotrophic lateral sclerosis

12 pairs of cranial nerves, 31 pairs of spinal nerves, and all their branches

Sensory

Motor

• afferent messages
• sensory receptors

• efferent messages
• muscles and glands

• Sensory are Afferent
• Motor are Efferent

Ex. Patellar

• Corneal Reflex
• Abdominal Reflex

Pupillary response to light and accomodation

• Abnormal
• Ex. Plantar Reflex

• Named for the region of the spine they exit: 8 cervical, 12 Thoracic, 5 lumbar, 5 sacral, 1 coccygeal
• Contain both sensory and motor fibers

• Innervate smooth(involuntary) muscles, cardiac muscle, and glands
• Mediate unconscious activity

Innervate skeletal (voluntary) muscles

Partial or Incomplete paralysis

Inability to control ROM of muscles

Abnormal sensation, such as burning, numbness, or tingling

Loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation

Difficulty forming words

Difficulty with language comprehension or expression

Have pt occlude one nostril and identify the smell and repeat on the other side with a different smell

• Decrease or loss of smell
• Occurs with tobacco smoking, allergic rhinitis, and cocaine use

Unilateral loss of smell with absence of nasal disease

• Test visual acuity and visual fields by confrontation
• Use opthalmoscope to examine ocular fundus

• Palpable fissures equal in width
• PERRLA
• Six cardinal positions of gaze

• Vestibular system
• Cerebellum
• Brain stem

• Myasthenia gravis (CN 3)
• Horner's Syndrome

Causes sudden, unilateral, dilated and nonreactive pupil

• Pt close eyes and touch cotton whisp to forehead, cheeks, and chin
• Palpate TMJ as person clenches teeth (muscles should be equally strong bi-lat) and try to separate jaws by pushing down on chin while pt clenches jaw

• Pt should correctly identify taste
• Have pt frown, close eyes tightly (examiner tries to pry open), lift eyebrows, smile, and puff cheeks

Test ability to hear normal conversation, whispered voice test ("baseball"), Weber/Rinne tests

• Pt should correctly identify taste
• Check for uvula and soft palate to rise midline and tonsils to move medially; illicit gag reflex

• Have pt rotate head and shrug shoulders against resistance
• *Turn head side to side to show off your earrings ("accessories")*

• Ask pt to say "light, tight, dynamite" and note that lingual speech sounds are clear and distinct
• Ask pt to stick out tongue; note that tongue protrudes midline with no tremors

Ask pt to walk heel-to-toe in a straight line

• Opposition (thumb to fingers)
• Finger-to-finger (pt to examiner)
• Finger to nose (eyes closed)
• Heel-to-shin

• Sharp and Dull ends of tongue blade
• Have pt identify whether it's sharp or dull with eyes closed

• Apply cotton whisp to skin on arms, forearms, hands, chest, thighs, and legs at random
• Have pt say "Now" when touched
• EYES CLOSED

• Place tuning fork on bony surface of fingers and great toe
• Ask pt to say when vibrations start and stop
• EYES CLOSED

• Move finger or big toe up or down and ask pt to tell you which way it moved
• EYES CLOSED

Posistion/Motion Sense

• Put familiar object in pt hand and have them identify it
• EYES CLOSED

Object Recognition

• Draw number on pt palm and ask them to identify it
• EYES CLOSED

Number Recognition

• Pt in flat-lying supine position
• Raise leg straight or flex thigh on abdomen, then extend knee
• Resistance to straightening or pain is positive

Meningeal irritation

• Have pt slex chin to chest
• Watch hips and knees
• Resistance and pain in neck, with flexion of hip and knees is positive

Meningeal irritation

• Acute: Trauma, spinal cord injury, brain attack, poliomyelitis, polyneuritis, Bell's Palsy
• Chronic: Muscular dystrophy, diabetic neuropathy, multiple sclerosis,
• Episodic: Myasthenia gravis

Spastic or flaccid paralysis of one side (right or left) of body and extremities

Symmetric paralysis of both lower extremities

Paralysis in all four extremities

• Rapid, continuous twitching of resting muscle or part of muscle, without movement og limb, that can be seen or palpated
• Can be fine or coarse

• Rapid, sudden jerk or a short series of jerks at fairly regular intervals.
• Severe with gran mal seizures

• Coarse and slow (3 to 6 per second)
• Partly or completely disappears with voluntary movement

• Rate Varies
• Worse with voluntary movement
• Occurs with cerebellar disease and multiple sclerosis

• Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
• Occurs at irregular intervals
• Common with Sydenham's chorea and Huntington's disease

• Slow, twisting, writhing, continuous movement, resembling a snake or worm
• Occurs with cerebral palsy
• "Athetoid" hand: some fingers are flexed and some are extended

p. 706

• Upper extremities: Flexion of arm, wrist, and fingers; adduction of arm (ex. tight against thorax)
• Lower extremities: Extension, internal rotation, plantar flexion
• Indicates hemispheric lesion of cerebral cortex

• Complete loss of muscle tone and paralysis of all four extremities
• Indicates copletely nonfunctional brain stem

• Upper Extermities: Stiffly extended, adducted, internal rotation, palms pronated
• Lower extremities: Stiffly extended, plantar flexion
• Teeth clenched; hyperextended back
• Indicates lesion in brain stem at midbrain or upper pons

• Prolonged arching of the back, with head and heels bent backwards
• Indicates meningeal irritation