question

CNS : *Cerebral Cortex Lesion* : Motor Findings

answer

- chronic contralateral corticospinal-type weakness and spasticity - flexion is stronger than extension in the arm - plantar flexion is stronger than dorsiflexion in the foot, and the leg is externally rotated at thehip

question

CNS : *Cerebral Cortex Lesion* : Sensory Findings

answer

Contralateral sensory loss in the limbs and trunk on the same side as the motor deficits

question

CNS : *Cerebral Cortex Lesion* : DTRs

answer

increased DTRs

question

CNS : *Cerebral Cortex Lesion* : example of cause

answer

cortical stroke

question

CNS : *Brainstem Lesion* : Motor Findings

answer

weakness and spasticity plus cranial nerve deficits such as diplopia and dysarthria

question

CNS : *Brainstem Lesion* : Sensory Findings

answer

variable; no typical sensory findings

question

CNS : *Brainstem Lesion* : DTRs

answer

increased DTRs

question

CNS : *Brainstem Lesion* : Example of Cause

answer

brainstem stroke, acoustic neuroma

question

CNS : *Spinal Cord Lesion* : Motor Findings

answer

weakness and spasticity affecting both sides causing paraplegia or quadriplegia depending on the level of injury

question

CNS : *Spinal Cord Lesion* : Sensory Findings

answer

dermatomal sensory deficit on the trunk bilaterally at the level of the lesion and sensory loss from tract damage below the level of the lesion

question

CNS : *Spinal Cord Lesion* : Deep Tendon Reflexes

answer

increased DTR

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CNS : *Spinal Cord Lesion* : examples of causes

answer

trauma, causing cord compression

question

CNS : *Subcortical Gray Matter* : Basal Ganglia Lesion : Motor Findings

answer

slowness of movement (bradykinesia), rigidity, and tremor

question

CNS : *Subcortical Gray Matter* : Basal Ganglia Lesion : Sensory Findings

answer

sensation not affected

question

CNS : *Subcortical Gray Matter* : Basal Ganglia Lesion : Deep Tendon Reflexes

answer

DTR normal or low

question

CNS : *Cerebellar Lesion* : Motor Findings

answer

hypotonia, ataxia, and other abnormal movements, including nystagmus, dysdiadochokinesis, and dysmetria

question

CNS : *Cerebellar Lesion* : Sensory Findings

answer

sensation not affected

question

CNS : *Subcortical Gray Matter* : Basal Ganglia Lesion : Examples of Causes

answer

parkinsonism

question

CNS : *Cerebellar Lesion* : Deep Tendon Reflexes

answer

DTR normal or decreased

question

CNS : *Cerebellar Lesion* : examples of causes

answer

cerebellar stroke, brain tumor

question

PNS : *Anterior Horn Cell Lesion* : Motor Findings

answer

weakness and atrophy in a segmental or focal pattern; fasiculations

question

PNS : *Anterior Horn Cell Lesion* : Sensory Findings

answer

sensation intact

question

PNS : *Anterior Horn Cell Lesion* : Deep Tendon Reflexes

answer

DTR decreased

question

PNS : *Anterior Horn Cell Lesion* : Examples of Causes

answer

polio, amyotrophic lateral sclerosis

question

PNS : *Spinal Roots and Nerves Lesions* : Motor Findings

answer

weakness and atrophy in a root-innervated pattern; sometimes with fasiculations

question

PNS : *Spinal Roots and Nerves Lesions* : Sensory Findings

answer

corresponding dermatomal sensory deficits

question

PNS : *Spinal Roots and Nerves Lesions* : Deep Tendon Reflexes

answer

decreased DTRs

question

PNS : *Spinal Roots and Nerves Lesions* : Examples of Causes

answer

herniated cervical or lumbar disc

question

PNS : *Peripheral Nerve - Mononeuropathy* : Motor Findings

answer

weakness and atrophy in a peripheral nerve distribution; sometimes with fasiculations

question

PNS : *Peripheral Nerve - Mononeuropathy* : Sensory Findings

answer

sensory loss in the pattern of that nerve

question

PNS : *Peripheral Nerve - Mononeuropathy* : Deep Tendon Reflexes

answer

decreased DTR

question

PNS : *Peripheral Nerve - Mononeuropathy* : examples of causes

answer

trauma

question

PNS : *Peripheral Nerve - Polyneuropathy* : Motor Findings

answer

weakness and atrophy more distal than proximal; sometimes with fasiculations

question

PNS : *Peripheral Nerve - Polyneuropathy* : Sensory Findings

answer

sensory deficits, commonly in stocking-glove distribution

question

PNS : *Peripheral Nerve - Polyneuropathy* : Deep Tendon Reflexes

answer

decreased deep tendon reflexes

question

PNS : *Peripheral Nerve - Polyneuropathy* : Examples of Causes

answer

peripheral polyneuropathy of alcoholism, diabetes

question

PNS : *Neuromuscular Junction Lesion* : Motor Findings

answer

fatigability more than weakness

question

PNS : *Neuromuscular Junction Lesion* : Sensory Findings

answer

sensation intact

question

PNS : *Neuromuscular Junction Lesion * : Deep Tendon Reflexes

answer

normal DTRs

question

PNS : *Neuromuscular Junction Lesion* : Examples of Causes

answer

Myasthenia Gravis

question

PNS : *Muscle Lesion* : Motor Findings

answer

weakness usually more proximal than distal; fasiculations rare

question

PNS : *Muscle Lesion* : Deep Tendon Reflexes

answer

normal or decreased DTRs

question

PNS : *Muscle Lesion* : Examples of Causes

answer

muscular dystrophy

question

Anterior Cerebral Artery

answer

pink part

question

Anterior Choroidal Artery

answer

yellow part

question

Middle Cerebral Artery

answer

green part

question

Posterior cerebral artery

answer

purple part

question

Prefrontal area

answer

yellow part

question

Premotor area

answer

light blue part

question

Primary Motor Cortex

answer

light purple area

question

Motor speech (Broca's) area

answer

dark purple area

question

Primary Somatic Sensory Cortex

answer

Dark Green area

question

Somatic Sensory Association Area

answer

Middle green area

question

Taste area

answer

yellowish green area

question

Primary Auditory Cortex

answer

light pinkish area

question

Auditory Association Area

answer

Violet area

question

Sensory Speech (Wernicke's area)

answer

orange area

question

Reading comprehension area

answer

teal area

question

Visual association area

answer

middle pink area

question

Visual cortex

answer

red area

question

Vasodepressor or Vaovagal Syncope

answer

- sudden peripheral vasodilation esp in skeletal muscles without compensatory risk in cardiac output; heart rate then blood pressure fall; often slow onset, slow offset - brought on by a strong emotion such as fear or pain - predisposing factors : fatigue, hunger, a hot humid environment are - prodromal manifestations : restlessness, weakness, pallor, nausea, salivation, sweating, yawning - prompt return of consciousness when lying down but pallor weakness nausea and slight confusion may persist for a time

question

Orthostatic (Postural) Hypotension

answer

- Inadequate vasocontrictor reflexes in both arterioles and veins, with resultant venous pooling, decreasing cardiac outpat, and low blood pressure - brought on by standing up - parkinsons, shy-drager syndrome, lewy body disease diabetes, amyloidosis, antihypertensive vasodilator drugs; prolonged bed rest are predisposing factors - associated with light headdedness and palpitations on standing up - improvement with lying down

question

Cough Syncope

answer

- neurally mediated, possible vagal stimulation - brought on by severe paroxysm of coughing - chronic bronchitis in a muscular man is a predisposing factor - no prodromal manifestations except for cough - prompt return to normal

question

Micturation Syncope

answer

- vasovagal stimulation - brought on by emptying the bladder after getting out of bed to void - predisposing factors include nocturia - prompt return to normal

question

Arrhythmias

answer

- decreased cardiac output from cardiac ischemia, ventricular arrhythmias, prolonged QT syndrome, persistent bradycardia, infrafasicular block; often sudden onset; sudden offset - precipitating factors include sudden change in rhythm - predisposing factors include heart disease, aging decrease tolerance of abnormal rhythms - prompt return to normal prolonged cerbral hypoperfusion cardiac arrest

question

Aortic Stenosis and Hypertrophic Cardiomyopathy

answer

- vascular resistance falls with exercise, but cardiac output cannot rise due to outflow obstruction - precipitating factors include exercise - predisposing factors include cardiac disorders - usually prompt return to normal

question

Myocardial Infarction

answer

- sudden arrhythmia or decreased cardiac output - predisposing factors include coronary artery disease - prodromal manifestation is ischemic chest pain

question

Massive Pulmonary Embolism

answer

- sudden hypoxia or decreased cardiac output - variable precipitating factors including prolonged bed rest and clotting disorders - DVT, bedrest, hypercoagulable states (SLE; cancer), protein S or C deficiency, antithrombin III deficiency, estrogen therapy - dyspnea, pleuritic chest pain are prodromal manifestations - recovery is related to time to diagnosis and treatment

question

Hypocapnia due to Hyperventilation

answer

- constriction of cerebral blood vessels secondary to hypocapnia induced by hyperventilation - precipitating factors : anxiety and panic disorders - predisposing factors : anxiety - dyspnea, palpitations, chest discomfort, numbness and tingling of the hands and around the mouth lasting for several minutes, consciousness is often maintained - slow improvement as hyperventilation ceases

question

Hypoglycemia

answer

- insufficient glucose to maintain cerebral metabolism; secretion of epinephrine contributes to symptoms; true syncope is uncommon - variable precipitating factors including fasting - insulin therapy and a variety of metabolic disorders are predisposing factors - sweating, tremor, palpitations, hunger, headache, confusion, abnormal behavior, coma are prodromal

question

Hysterical Fainting from Conversion Reaction

answer

- brought on through stressful situation - hysterical personality traits are predisposing factors

question

Jacksonian Seizures

answer

- tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side - normal consciousness

question

Other motor focal seizures

answer

- turning of the head and eyes to one side, or tonic and clonic movements of an arm or leg without the Jacksonian spread - normal consciousness

question

Focal Seizures with autonomic symptoms

answer

- a "funny feeling" in epigastrium, nausea, pallor, flushing, lightheadedness - normal consciousness

question

Focal Seziures with subjective sensory or psychic phenomena

answer

- numbness, tingling, simple visual, auditory, or olfactory hallucinations such as flashing lights, buzzing, or odors - anxiety or fear; feelings of familiarity or unreality; dreamy states; fear or rage; flashback experiences; hallucinations - normal consciousness

question

Focal Seizures with Impairment of Consciousness

answer

- the seizure may or may not start with autonomic or psychic symptoms - consciousness impaired and confusion - automatisms included chewing, smacking the lips, walking about and unbuttoning clothes - the patient may remember initial autonomic or psychic symptoms (aura) but is amnesic for the rest of the seizure

question

Focal Seizures that become generalized

answer

- partial seizures that become generalized resemble tonic-clonic seizures; patient may not recall the focal onset - recollection of an aura and unilateral neurologic deficit during the postictal period

question

Tonic Clonic (grand mal) Seizures : Clinical Manifestations

answer

- sudden loss of consciousness sometimes with a cry - body stiffens into tonic extensor rigidity - breathing stops and the person becomes cyanotic - clonic phase of rhythmic muscular contraction follows - breathing resumes and is often noisy with excessive dalivation

question

Generalized Seizures : Postictal State

answer

confusion, drowsiness, fatigue, headache, muscular aching, and sometimes the temporary persistence of bilateral neurologic deficits such as hyperactive reflexes amnesia of the seizure and no recollection of aura

question

Absence Seizures : Clinical Manifestations

answer

sudden brief lapse of consciousness with momentary blinking, staring, or movements of lips and hands but no failing - typical lasts less than 10 seconds and stop abruptly - atypical may last more than 10 seconds

question

Absence Seizures : Postictal State

answer

no aura recalled

question

Myoclonic Seizures : Clinical Manifestations

answer

sudden, brief rapid jerks, involving the trunk or limbs

question

Myoclonic Attack : Clinical Manifestations

answer

sudden loss of consciousness with falling but no movements; injury may occur

question

Myoclonic Attack : Postictal State

answer

either a prompt return to normal or brief period of confusion

question

Resting (Static) Tremors

answer

prominent at rest and may decrease or disappear with voluntary movement; common, relatively slow, fine, pill-rolling tremor of parkinsonism, about 5 per second

question

Postural Tremors

answer

appear when affected part is actively maintaining a posture; examples include the fine rapid tremor of hyperthyroidism, anxiety, fatigue

question

Intention Tremors

answer

absent at rest, appear with movement and often get worse as the target gets closer; include disorders of cerebellar pathways, as in MS, or any other disease of the cerebellum

question

Oral-Facial Dyskinesias

answer

rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue; grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw

question

Tics

answer

brief, repetitive, stereotyped coordinated movements occurring at irregular intervals i.e., tourette's

question

Dystonia

answer

grotesque twisted postures may result

question

Athetosis

answer

slower more twisting and writhing movements that have a large amplitude; commonly involve the face and distal extremities

question

Chorea

answer

brief, rapid, jerky, irregular, and unpredictable; occur at rest or interrupt normal coordinated movements; they seldom repeat themselves; face, head, lower arms, and hands are often involved

question

Wernicke's Aphasia

answer

- fluent often rapid and effortless speech - inflection and articulation are good but sentences lack meaning and words are gibberish - may be totally incomprehensible - word comprehension, repetition, naming, reading comprehension, writing all impaired - lesion located in posterior superior temporal lobe

question

Broca's Aphasia

answer

- nonfluent - slow with few words and laborious effort - inflection and articulation are impaired but words are meaningful - small grammatical words often dropped - fair word and reading comprehension - impaired repetition, writing, and naming - lesion located in posterior inferior frontal lobe

question

Nystagmus

answer

rhythmic oscillation of eyes; caused by vision impairment early in life, disorders of the labyrinth and cerebellar system, and drug toxicity; can occur normally when watching rapidly moving objects

question

Nystagmus - Lateral Gaze

answer

nystagmus may be present in all directions but only accentuates in deviation of eyes as seen in extreme lateral gaze left or right; normal people show signs of slight nystagmus in lateral gaze

question

Left-beating nystagmus

answer

if eyes jerk quickly to patients left and slowly to the right

question

Pendular nystagmus

answer

nystagmus consisting only of coarse oscillations without quick and slow components

question

CN VII Peripheral Lesion

answer

paralyzes the entire right side of the face including forehead; right eye does not close and the eyeball rolls up; forehead not wrinkled and eyebrow not raised

question

CN VII Central Lesion

answer

Eye closes with slight weakness and forehead is wrinkled with eyebrow raised

question

Lesions Producing Spastic Muscle Tone

answer

Upper motor neuron or corticospinal tract systems

question

Spasticity

answer

- increased muscle tone that is greater when passive movement is rapid and less when passive movement is slow; greater at the extremes or movement arc; sudden limb reflexes - seen in stroke

question

Lesions Producing Rigid Muscle Tone

answer

Basal Ganglion System

question

Lead Pipe Rigidity

answer

increased resistance that persists throughout the movement arc independent of rate of movement

question

Cogwheel Rigidity

answer

rigidity with flexion and extension of the wrist and forearm, a superimpose rachetlike jerkiness seen in parkinson's patients

question

Lesions Producing Flaccid Muscle Tone

answer

lower motor neuron system (from anterior horn cell to peripheral nerves)

question

Flaccidity

answer

loss of muscle tone causing loose and floppy limbs; limbs may be hyperextensible or even flail like seen in Guillain Barre syndrome

question

Lesions producing paratonia muscle tone

answer

both hemispheres, usually in the frontal lobes

question

Paratonia

answer

sudden change in tone with passive ROM

question

Paratonia - Mitghen

answer

sudden loss of tone that increases the ease of motion

question

Paratonia - Gegenhalten

answer

sudden increase in tone making motion more difficult

question

Spastic Hemiparesis

answer

- corticospinal tract lesion in stroke - poor control of flexor muscles during swing phase - arm is flexed, immoble, and held close to side with elbow, wrists, and interphalangeal joints flexed - leg extensors spastic - ankle plantar flexed and inverted - pts may drag toe, circle leg stiffly outward and forward or lean trunk to contralateral side to clear affected leg during walking

question

Scissors Gait

answer

- spinal cord disease - caused by bilateral lower extremity spasticity including adductor spasm and abnormal proprioception - stiff gait with slow leg advancement - thighs tend to cross forward on each other with each step - steps are short - pts appear to be walking through water - common in cerebral palsy

question

Steppage Gait

answer

- foot drop - secondary to peripheral motor unit disease - pts drag the feet or light them high with knees flexed and slap them down onto the floor - walking up stairs - cannot walk on heels - tibalis anterior and toe extensors are weak

question

Parkinsonian Gait

answer

- basal ganglia defects - posture is stooped with flexion of head, arms, hips, and knees - pts are slow getting started - short shuffling steps with involuntary hastening - limited arm swings

question

Cerebellar Ataxia

answer

- dx of cerebellum or associated tracts - gait is staggering, unsteady, and wide based with exaggerated difficulty on turns - pts cannot stand steadily w feet together whether eyes are opened or closed - nystagmus, dysmetria, and intention tremor

question

Sensory Ataxia

answer

- loss of position sense in legs - gait is unsteady and wide based - pts throw their feet forward and outward and bring them down first on heels then on toes with double tapping sound - watch grown - with eyes closed they cannot stand steadily with feet together (positive Romberg)

question

Toxic Metabolic Comas

answer

arousal centers poisoned or critical substrates depleted

question

Toxic Metabolic Comas : Respiratory Pattern

answer

if regular may be normal or hypervenilation; if irregular usually Cheyne-Stokes

question

Toxic Metabolic Comas : Pupillary size and reaction

answer

- equal and reactive to light - pinpoint = opiates/cholinergics; need magnifying glass to see reaction - fixed and dilated = anticholinergics/hypothermia

question

Toxic Metabolic Comas : Causes

answer

- uremia - hyperglycemia - alcohol - drugs - liver failure - hypothyroidism - hypoglycemia - anoxia - ischemia - meningitis - encephalitis - hyperthermia - hypothermia

question

Structural Coma

answer

lesion destroys or compresses brainstem arousal areas either directly or secondary to more distant expanding mass lesions

question

Structural Coma : Respiratory Pattern

answer

- irregular especially Cheyne-Strokes or ataxic breathing

question

Structural Coma : Pupillary Size and Reaction

answer

- unequal or unreactive to light - midposition, fixed = midbrain compression - dilated, fixed = compression of CN III from herniation

question

Structural Coma : Causes

answer

- epidural, subdural, or intracerebral hemorrhage - cerebral infarct or embolus - tumor or abscess - brainstem infarct, tumor, or hemorrhage - cerebellar infarct, hemorrhage, tumor, or abscess

question

Glasgow Coma Scale

answer

higher number = more aware

question

Bilaterally Small Pupils

answer

- 1-2.5 mm - suggest damage to the sympathetic pathways in the hypothalamus or metabolic encephalopathy - diffuse failure of cerebral function that has many causes including drugs - light reactions are usually normal

question

Pinpoint Pupils

answer

- <1mm - suggests a hemorrhage in the pons or the effects of morphine, heroin, or other narcotics - light reaction may be seen w magnifying glass

question

Midposition Fixed Pupils

answer

- slightly dilated and fixed to light - suggest structural damage in the midbrain

question

Bilaterally fixed and dilated pupils

answer

- may be due to severe anoxia and its sympathomimetic effects as seen after cardiac arrest - may also be seen from atropinelike agents, phenothiazines, or tricyclic antidepressants

question

Bilaterally large reactive pupils

answer

may be due to cocaine, amphetamine, LSD or other sympathetic nervous system agonists

question

One Large Pupil

answer

herniation of the temporal lobe causing compression of the oculomotor nerve and midbrain; most commonly seen in diabetic pts with infarction of CN III

question

Decorticate Rigidity (Abnormal Flexor Response)

answer

- upper arms are flexed tight to the sides with elbows, wrists, and fingers flexed - legs are extended and internally rotated - feet are plantar flexed - implies a destructive lesion of the corticospinal tracts within or very near the cerebral hemispheres - when unilateral = chronic spastic hemiplegia

question

Hemiplegia (Early)

answer

- sudden unilateral brain damage involving the corticospinal tract - one-sided paralysis - flaccid in early course with spasticity developing larger - paralyzed arm and leg are slack falling loosely without tone - spontaneous movements or responses are limited to opposite side - leg may lie externally rotated - one side of lower face is paralyzed and that cheek puffs on expiration - both eyes may be turned away from paralyzed side

question

Decerebrate Rigidity (Abnormal Extensor Response)

answer

- jaws are clenched and neck is extended - arms are adducted and stiffly extended at the elbows with forearms pronated, wrists and fingers flexed - legs are stiffly extended at the knees with feet plantar flexed - may occur spontaneously or only in response to external stimuli (light, noise, or pain) - caused by a lesion in diencephalon, midbrain, or pons OR by metabolic disorders such as hypoxia and hypoglycemia

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