Pat. Ass. Neuro anatomy

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when do purposeful movements begin in an infant

2 months

How fair apart is two point discrimination on the fingers and toes

2-8mm apart

how many months are an infants hands are held in fist

3 months

how many pairs of spinal nerves are there

31

how far is two point discrimination on the back, chest or forearm

40-70mm

when do infants take objects with one hand

6 months transfers objects hand to hand at 7 months

how long should the plantar grasp be strong for

8 months

What reflexes appear at 6 months of age

Achilles and brachioradial tendon

Testing CN II (Optic)

Distance and near vision Fundoscopic exam

What is the motor function of CN IV (trochlear)

Downward, inward eye movement

spastic diplegia (scissoring) is due to an injury of what system

Due to injury to the pyramidal system

what kind of gait pattern is associated with lordosis

Dystrophic (waddling)

Stereogenesis

Familiar object in hand

Testing CN V (trigeminal)

Inspect for atrophy and tremors Jaw muscles with clenched teeth Superficial pain and touch Corneal reflex

Testing CN XII (hypoglossal)

Inspect tongue for symmetry, tremors, and atrophy Move tongue toward nose and chin Tongue strength Lingual speech sounds

What is the motor function of CN V (trigeminal)

Jaw opening and clenching, chewing and mastication

What spinal nerves are tested when doing the Patellar reflex

L2-L4

What spinal nerves are tested when doing the plantar reflex

L5-S2

What is the motor function of CN VII (facial)

Movement of facial expression muscles except JAW, close eyelids, labial speech sounds (bah)

How do you differentiate between peripheral single nerve loss vs multiple peripheral nerve loss (polyneuropathy

Multiple will have a glove and stocking distribution of sensory loss and all forms of sensory dicrimination will be lost while single will be in the nerves anatomical position and may still have some sensory function

Testing CN I (olfactory)

Odors -1 naris at a time with eyes closed

What test are used to test the corticospinal tracts

Rapid rhythmic movement voluntary movement deep tendon reflexes plantar reflex

What is proprioception

Recognition of body parts and awareness of body posistion

What is the function of the diencephalon and thalamus

Relays impulses between cerebrum, cerebellum, pons, and medulla Conveys ALL sensory impulses (EXCEPT OLFACTION) Integrates impulses between motor cortex and cerebrum; influencing voluntary movements and motor response Controls state of consciousness, abstract feeling

What spinal nerves are tested when doing the achillesreflex

S1-S2

What are intention tremors

Seen during intentional movements (writing, pouring water, FINGER TO NOSE test) Does not occur at rest Cerebellar disorders - multiple sclerosis or alcohol abuse

What is a resting tremor

Seen when limb is at rest Slow supination-pronation (pill-rolling) movements parkinson disease

What are enhanced physiologic tremor

Seen with arms extended and disappears while at rest caused by drug or alcohol withdraw Hyperthyroidism Hypoglycemia Medication toxicity

What is the sensory function of CN V (trigeminal)

Sensation to the cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, teeth, tongue, ear , facial skin

What type of gait is associated with a positive romberg sign

Sensory ataxia

What is the sensory function of CN I (olfactory)

Smell reception and interpretation

What is stepping, when does it appear

Stepping: touch soles of the feet to touch the surface of the table, observe for alternate flexion and extension of the legs Appears: birth to 8 weeks

when in the palmar grasp the strongest and when does it disappear

Strongest 1-2 months Disappears: 3 months

What test are used to test the integrity of the lateral spinothalamic tract

Superficial pain Temperature

What exams test primary sensory function

Superficial touch Superficial pain Temperature and Deep pressure Vibration Position of joint

What reflexes are associated with the medulla oblongata

Swallowing, coughing, vomiting, sneezing and hiccuping

what is the motor function of CN XII (hypoglossal)

Tongue movement for speech sound articulation (l,t,d,n) and swallowing

Testing CN XI (spinal accessory)

Trapezius and sternocleidomastoid muscle strength

What is asymmetric tonic neck or fencing, when does it appear, and when does it disappear

Turn head, observe for extension of the arm and leg on the same side and flexion of the opposite arm and leg Appears: by 2-3 months disappears by 6 months

How do you differentiate upper and lower motor neuron disease in the face

Upper (stroke): voluntary movements paralyzed but emotional movements are intact: can raise eyebrow Lower (bell palsy): all facial movements are paralyzed

What motor neuron injury would result in initial paralysis followed by partial recovery over and extended period

Upper motor neuron injury

What test are used to test the integrity of the posterior column

Vibration Deep pressure Position sense Sterogenosis Point location Two point discrimination

Testing CN III (oculomotor), CN IV (trochlear), CN VI (abducens)

Visual fields Eyelid drooping Pupil size, response, and accommodation Extraocular movements

what is the motor function of CN IX (glossopharyngeal)

Voluntary muscles for swallowing and phonation (guttural)

Where is the reception and interpretation of speech located

Wernicke area

Testing CN VIII (acoustic)

Whisper test Rinne Weber

What do cortical or discriminatory sensory functions test

ability to interpret sensations Inability to perform these test indicate a lesion in the sensory cortex or the posterior columns of the spinal cord

How do you test CN VIII in an infant

acoustic blink reflex: loudly clap hand and the blink should occur

Sensation in upper motor neuron disorder

affect the entire limb

what neuron initiate reflex arches

afferent (sensory) neurons

What is another name for sensory neuron

afferent neuron

what is the function of the cerebellum

aids the motor cortex of the cerebrum in the integration of voluntary movement

what is sensory function is lost in a complete transverse lesion of the spinal cord

all forms of sensation below the lesion, pain, temperature and touch are lost one to two dematomes below the lesion

when does the neuro exam begin?

as soon as the patient walks into the office

What does the white matter contain

ascending and decending spinal tracts

what areas of the body need a stronger stimulus

back, buttocks, and heavily callused areas

what is the function of the afferent (sensory) fibers of the posterior root

carry impulses from sensory receptors of the body to the spinal cord then to the brain for interpretation

what is the function of the efferent (motor) fibers of the anterior root

carry impulses from the spinal cord to the muscles and glands of the body

how does motor maturation proceed

cephalocaudal direction

What does a positive romberg test indicate

cerebellar ataxia, vestibular disfunction or sensory loss

what does a delay in sitting and walking indicate

cerebellar disorder

What is another name for the corpus callosum

commissural fibers

What is the function of the descending spinal tracts

convey impulses from the brain to various muscle groups by inhibiting or exciting spinal activity role in the control of muscle tone, posture, and precise motor movements

What are the descending spinal tracts

corticospinal reticulospinal cestibulospinal

what does absence of the abdominal reflexes indicate

corticospinal tract lesion on the side of the absent reflex

location of insult in upper motor neuron disorder

damage above the brainstem affect opposite side of body Damage below the brainstem affect the same side of the body

location of insult in lower motor neuron disorders

damage affects muscle on same side of the body

Muscle tone in lower motor neuron disorders

decreased tone, flaccid

What is the area of body distribution supplied by spinal nerves

dermatome

What is graphestesia

drawing in the hand

What do the commissural fiber interconnect

each hemisphere

what is another name for a motor neuron

efferent neuron

What are the posterior (dorsal) column spinal tracts

fasciculus gracilis and fasciculus cuneatus

what are the classic signs of acute meningitis

fever, stiff neck, altered mental status need a lumbar puncture to diagnose

What do the dorsal spinal tracts carry?

fibers for the sensation of fine touch, two-point discrimination and proprioception

What do the spinothalamic tracts carry

fibers for the sensations of light and crude touch, pressure, temperature and pain

What is the kernig sign

flexing the leg at the knee and hip when the patient is supine, then attempting to straighten the leg

What is the cerebral cortex responsible for?

general movement visceral functions perception behavior integration of all these functions

where do you test position of joint

great toe of each foot and finger

What is the sensory function of CN VIII (acoustic)

hearing and equilibruim

What is the doll's eye maneuver

hold infant under axilla in upright position, head held steady facing you, rotate the infant in one direction then the other; infants eyes should turn in the direction of rotation and then the opposite direction when rotation stops

What is the function of the pituitary gland

hormonal control of growth, lactation, vasoconstriction and metabolism

Reflexes in upper motor neuron disorder

hyperactive babinski sign is positive

When do you test temperature and deep pressure

if superficial pain sensation is not intact

what is tactile agnosia

inability to recognize objects by touch

what is a positive jolt accentuation of headache

increased headache over baseline sign for diagnostic for meningitis

muscle tone in upper motor neuron disorder

increased, spastic, contractures

what is Decerebrate or extensor posturing associated with (arms are fully extended with forearms pronated, wrist and fingers are flexed and jaw is clenched. Feet are planter flexed)

injury to the brainstem

what is decorticate or flexor posturing associated with (upper arms held tightly to the sides of the body, elbows, wrists, and fingers are flexed and the feet are plantar flexed; fine tremors or stiffness)

injury to the corticospinal tracts above the brainstem

what are reflexes dependent on

intact afferent neurons functional synapses in the spinal cord intact efferent neurons functional neuromuscular junctions competent muscle fibers

What is the function of the thalamus

integrating center for perception of various sensations such as pain and temperature Relays sensory aspects of motor information between the basal ganglia and cerebellum

what is a positive brudzinski sign

involuntary flexion of the hips and knees when flexing the neck

What is the motor function of CN VI (abducens)

lateral eye movement

muscle atrophy in upper motor neuron disorder

little to none, but decreased strength

muscle atrophy in in lower motor neuron disorders

loss of muscle strength, muscle wasting

what motor neuron injury results in permanent paralysis

lower motor neuron

what does a positive brudzinski sign indicate

meningeal irritation

What is another name for protective sensation

microfilament

What does the corticobulbar tract innervate

motor functions of the cranial nerve

What does the gray matter contain

nerve cell bodies associated with sensory pathways and the autonomic nervous system

what are upper motor neurons

nerve cell bodies for the motor pathways that all begin and end within the central nervous system

What does the absence of a reflex indicate

neuropathy or lower motor neuron disorder

where is the primary vision center

occipital

what are some risk factors for falls in older adults

one or more falls in the past year Hx of stroke Neurologic conditions Disorder of gait or balance lower extremity weakness or sensory loss impaired vision use of assistive device

How can upper motor neurons affect movement

only through the lower motor neurons

motor effect in lower motor neuron disorders

paralysis of muscles

motor effect of upper motor neuron disorder

paralysis of voluntary movments

What lobe is used for proprioception

parietal lobe

What does tactile agnosia suggest

parietal lobe lesion

what reflexes are present at birth

patellar tendon

what is the brainstem and what is its function

pathway between the cerebral cortex and spinal cord controls many involuntary functions

what is a positive kernig sign

patient has pain in the lower back and resistance to straightening the leg at the knee - indicates meningeal irritation

What is jolt accentuation of headache

patient is asked to move his head horizontally at a rate of 2-3 rotation per second

discribe cerebellar gait (cerebellar ataxia)

patients feet are wide-based, staggering and lurching from side to side accompanied by swaying of the trunk

What does loss of positional sense of joint

peripheral neuropathy Symmetric loss indicated polyneuropathy

what does loss of sensation to touch during the microfilament test

peripheral neuropathy loss of protective pain sensation that alerts patients o skin breakdown and injury

besides the medulla oblongata where else is a portion of the respiratory center located

pons

What test are used to test the reticulospinal tracts

posture and romberg gait instinctual motor reactions

fasciculations in lower motor neuron disorders

present

when is the rooting reflex present and when does it disappear

present: at birth Disappear: 3-4 months of age

what are reflexes that are present at birth

primitive reflexes

What is the function of the hypothalamus

processing center of internal stimuli for autonomic nervous system Maintains temperature, metabolism, osmolarity, and feeding

What test are used to test the integrity of the spinocerebellar tract

proprioception

What is the parasympathetic function of CN III

pupillary constriction, change lens shape

What does the babinski sign indicate

pyramidal tract disease Dorsiflexion of the great toe expected finding in children younger than 2

What is the function of the midbrain

reflex center for eye and head movement Auditory relay pathway

What is the function of the medulla oblongata

respiratory, circulatory and vasomotor activities (house the respiratory center)

what stimulates a brisk contraction in a reflex

response is transmitted outward by efferent neuron in the anterior horn via the spinal nerve and peripheral nerve of the skeletal muscle

How do you test CN V in an infant

rooting reflex: touch corner of the infants mouth; infants mouth should turn in the direction of the stimuli Sucking reflex: place your finger in the infants mouth

what is the parasympathetic function of CN X

secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract

What is the parasympathetic function of CN VII

secretion of saliva and tears

What is the parasympathetic function of CN IX

secretion of salivary glands, carotid reflex

What is the sensory function of CN X (Vagus)

sensation behind ear and part of external ear canal

What is the sensory function of CN IX

sensation of nasopharynx, gag reflex, taste (posterior 1/3 of tongue)

sensation in lower motor neuron disorders

sensory loss follows dermatomes

What is the function of the epithalamus

sexual development and behavior

How do you test CN 2,3,4,6 in an infant

shine light into babies eyes - should quickly close eyes and dorsal flex the infants hand tracts an object with both eyes Doll's eye maneuver

What is extinction

simultaneously touching two areas on each side of the body

What does the corticospinal (pyramidal) tracts permit

skilled, delicate, and purposeful movemnts

What does the vestibulospinal tract cause

the extensor muscles of the body to suddenly contract when an individual starts to fall

Where does the corticospinal tracts extend from

the primary motor area into the spinal cord

What is circumduction

toe circled stiffly outward and forward

What is point location

touching an area on the patients skin and withdrawing and having the patient to point where you were touched

What is the function of lower motor neurons

transmit neural signals directly to the muscles to permit movement

What is the function of the pons

transmits information between the brainstem and the cerebellum while relaying motor information from the cerebral cortex to the contralateral cerebellar hemisphere

what is the motor function of CN XI (spinal accessory)

turn head, shrug shoulders, some actions for phonation

what does a hyperactive reflex indicate

upper motor neuron disorder

What does the ascending spinal tracts (spinothalamic, spinocerebellar) mediate

various sensations that are necessary to perform complex discrimination tasks

with what system does the cerebellum use sensory data for reflexive control of muscle tone, balance, and posture to produce steady and precise movements

vestibular system

What is the sensory function of CN II (optic)

visual acuity and visual fields

reflexes in in lower motor neuron disorders

weak or absent

What sensory loss distribution is there when two or more nerve roots are affected

zone of sensory loss surrounded by partial loss Loss of deep tendon reflexes

What functions as the extrapyramidal pathway and processing station between the cerebral motor cortex and the upper brainstem

Basal ganglia system

What are essential tremors

Bilateral, symmetric primarily seen in hands or outstretched arms, intention tremors Worse with stress or fatigue, MAY IMPROVE WITH ALCOHOL Progressive Autosomal dominant inheritance pattern

What spinal nerves are tested when doing the biceps reflex

C5-C6

What spinal nerves are tested when doing the brachioradial reflex

C5-C6

What spinal nerves are tested when doing the tricepts reflex

C6-C8

what CN are associated with the Diencephalon and Thalamus

CN I and II

what is done in the shorter screening examination for neurologic screening

CN II - XII (taste is usually not tested) Proprioception and Cerebellar function (rapid rhythmic alternating movements, accuracy of movements, balance, gait, heel-toe walking) Sensory function (superficial touch and pain, vibration and position senses of the great toe) Deep tendon reflex (All reflexes except plantar reflex and clonus)

What CN are associated with the midbrain

CN III and IV

What CN are associated with the medulla oblongata

CN IX to XII

What CN are associated with the pons

CN V to VIII

What does pass pointing indicate

Cerebellar disease

where is sensory information from the eyes, ears, touch receptors, and musculoskeletal

Cerebellum

What part of the brain houses the higher mental functions

Cerebral cortex

what lobe contains the motor cortex associated with voluntary skeletal movement and control of eye movements

Frontal lobe

Where should you have the patient identify various sensory stimuli

Hands, lower arms, abdomen, feet and lower leg

what is tandem gait

Heel-toe walking

What is the motor function of CN III (oculomotor)

Raise eyelids, most extraocular movements

Where do the descending corticospinal tracts decussate (cross to the contralateral side)

Medulla oblongata

What structures are included in the brainstem

Medulla oblongata Pons Midbrain Diencephalon

What lobe is responsible for processing sensory data as it is received?

Parietal lobe

what is Brown-Sequard syndrome

Partial spinal sensory syndrome Pain and temperature sensation are lost one or two dermatomes below the lesion on the opposite side of the body Proprioceptive loss and motor paralysis occur on the lesion side of the body

what is placing, when does it appear?

Placing: hold infant upright under the arms and touch dorsal side of the foot to the table or chair edge, observe flexion of the hips and knees and lifting of the foot as if stepping Appears: 4 days of age

What reflexes are associated with the pons

Pupillary action and eye movement

Testing CN VII (facial)

Symmetry of facial features (smile, frown, puffed cheeks, wrinkled forehead) Taste on anterior 2/3 of tongue

What spinal neves are tested when doing the lower abdomen reflex

T10-T12

What spinal nerves are tested when doing the cremasteric reflex

T12-L2

What spinal nerves are tested when doing the upper abdomen reflex

T8-T10

Testing CN IX (glossopharyngeal) and CN X (vagus)

Taste (CN IX) Gag reflex and swallowing Palate and uvula Guttural speech sounds

What is the sensory function of CN VII

Taste - anterior 2/3 of tongue

what lobe is responsible for perception and interpretation of sounds and determination of their source

Temporal lobe

what is nuchal rigidity

stiff neck associated with meningitis and intracranial hemorrhage

What test are used to test the integrity of the anterior spinothalamic tract

superficial touch deep pressure

beside meningitis and hemorrhage what else can cause nuchal rigitdy

swollen lymph nodes and superficial trauma

What does the parietal lobe assist in the interpretation of

tactile sensations visual, taste, smell and hearing sensations

how do you test the moro reflex, when does it appear and when does it disappear

test: allow truck to drop back to a 30 angle - should have symmetric abduction and extension of the arms Appear: birth disappear 6 months

what interconnections help the basal ganglia refine motor movements

thalamus, motor cortex, reticular formation, and spinal cord

Where do lower motor neurons originate from

the anterior horn of the spinal cord and extend to the peripheral nervous system

Where do upper motor neurons comprise

the descending pathways from the brain to the spinal cord Primary role is influencing, directing and modifying spinal reflex arcs and circuits


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