Medical 9-Neurologic-Powerpoint

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Interrelationships of nervous system permit?: receiving sensory stimuli from environment...

identifying/integrating adaptative processes for maintenance...

orchestrating changes for adaptation/survival...

integrating responses of CNS/endocrine system...

controlling cognitive/voluntary behavioral processes...

controlling subconscious/involuntary functions
What are the divisions of the nervous system?: central
peripheral
What are the functions of the nervous system?: maintains/controls body functions
What are nervous system responses?: voluntary
autonomic
What are the mechanisms for nerve impulses?: sodium
chloride
potassium
proteins function as gates
Factors affecting transmission of nerve impulses are?: distance
lack of oxygen
effects of hypnotics
anesthetics
pH of ECF (acidosis
depresses nerve activity)
alkalosis: excites nerve cell
drugs can increase nerve
activity: caffeine,
theophylline (in tea and
asthma drugs) and
theorbromine (in cocoa)
Anatomy and Physiology CNS?: Parts
brain
spinal cord
Function
coordination
control for body
Anatomy and Physiology: Peripheral?: Parts
motor/sensory nerves
ganglia outside CNS

Function
carries info to/from CNS
Brain and spinal cord are protected by?: skull
vertebrae
meninges
CSF
Meninges produces and drains?: CSF
CSF circulates in/around brain as?: shock absorber
____ ____ can come from the spine, muscles, nerves or other structures in the back.: Back pain
Symptoms can include _____, _____ _____, dull ache, sharp pain and weakness in legs or feet.: tingling
burning sensation
Anatomy and Physiology Brain Circulation?: arterial
internal carotids
vertebral
basilar

venous
jugular veins
The internal carotid arteries supply ____ and the vertebral basilar arteries supply ___: 80%
20%
Define medulla?: contains nuclei for regulating blood pressure and breathing...
as well as nuclei for relaying information from the sense organs that comes in from the cranial nerves
Define pons?: the pons contains nuclei that relay movement and position information from the cerebellum to the cortex...
it also contains nuclei that are involved in breathing taste and sleep
Define midbrain?: contains nuclei that link the various sections of the brain involved in motor functions (cerebellum, basal ganglia, cerebral cortex), eye movements and auditory control. One portion, called the substantia nigra, involved in voluntary movements, when it does not function, you have the tremored movements of Parkinson's disease
Define thalamus?: the thalamus relays incoming sensory pathways to appropriate areas of the cortex, determines which sensory information actually reaches consciousness and participates in motor-information exchange between the cerebellum, basal ganglia and cortex
Define hypothalamus?: contains nuclei that controls hormonal secretions from the pituitary gland...these centers govern sexual reproduction, eating, drinking, growth, and maternal behavior such as lactation (milk-production in mammals). The hypothalamus is also involved in almost all aspects of behavior, including your biological "clock," which is linked to the daily light-dark cycle (circadian rhythms)
frontal lobe temporal lobe perception/interpretation of sounds integration of taste/smell/ balance limbic system mediates behavior patterns for survival: voluntary skeletal movement
repetitive movement
parietal lobe: processes sensory data
occipital lobe: interprets visual data
temporal lobe: perception/interpretation of
sounds
integration of taste/smell/
balance
limbic system: mediates behavior patterns
for survival
Anatomy and Physiology Cerebellum Function?: aids in integration of voluntary movement...

processes sensory information...

uses sensory data for reflex
control...

uses sensory data for reflex control
muscle tone
equilibrium
posture
Anatomy and Physiology Basal Ganglia? Function?: extrapyramidal pathway
processing station between
motor cortex/upper
brainstem
gross intentional movement
without conscious thought
Parts of the brainstem?: medulla oblongata
medbrain
pons
diencephalon
Function of the brainstem?: pathway between cerebral cortex and spinal cord

controls many involuntary functions
Anatomy and Physiology: Cranial Nerves?: twelve nerves originate from
brain

functions
motor
sensory
parasympathetic
On Old Olympic Towering Tops A Finn And German Viewed Some Hops: olfactory
optic
oculomotor
trochlear
trigeminal
abducens
facial
vestibulocochlear
glossopharyngeal
vagus
accessory
hypophyseal
olfactory: smell
optic: vision
oculomotor: eyelid and eyeball movement;
via medial and laeral rectus and inferior oblique and superior rectus muscles; lid elevation via levator muscles;

PARASYMPATHETIC-motor
pupil constriction; ciliary muscles
trochlear: innervates superior oblique
turns eye downward and
laterally
eye movement via superior
oblique muscles
trigeminal: chewing
face and mouth
touch and pain

sensation from skin of face and scalp and mucous membranes of mouth and nose; muscles of mastication (chewing)
abducens: turns eye laterally via lateral rectus muscles
facial: controls most facial
expressions
secretion of tears and saliva
taste

SENSORY: pain and temperature from ear area; deep sensations from the face; taste from anterior two thirds of the tongue

MOTOR: muscles of face and scalp

PARASYMPATHETIC - MOTOR
lacrimal, submandibular, and sublingual salivary glands
vestibulocochlear (auditory): hearing
equilibrium sensation
glossopharyngeal: taste
senses carotid blood pressure

SENSORY: pain and temperature from ear; taste and sensations from
posterior one-third of tongue and pharynx
MOTOR: skeletal muscles of throat

PARASYMPATHETIC MOTOR: parotid glands
vagus: senses aortic blood pressure
slows heart rate
stimulates digestive organs
taste

SENSORY: pain and temperature from ear; sensations from pharynx, larynx, thoracic, and abdominal viscera

MOTOR: muscles of the soft palate, larynx, and pharynx

PARASYMPATHETIC - MOTOR
thoracic and abdominal viscera; cells of secretory glands; cardiac and smooth muscle innervation to the level of the splenic flexure
spinal accessory: controls trapezius and
sternocleidomastoid
controls swallowing movements

MOTOR: skeletal muscles of the pharynx and larynx and sternocleidomastoid and trapezius muscles
hypoglossal: controls skeletal muscles of tongue
examination of olfactory cranial nerve: occlude one nares
hold vial with aromatic
substance under the nose,
and ask the patient to
deeply inspire
patient should discriminate
between odors
examination of trigeminal nerve for MOTOR function: have patient tightly clench teeth, and then palpate the muscles over the jaw for tone
examination of the trigeminal cranial nerve for SENSORY function: touch each side of the face at the scalp, cheek, and chin areas alternately using no predictable pattern with, B, a brush...ask the patient to discriminate between sensations
examination of the facial cranial nerve for MOTOR fuction: Ask the patient to:
puff out the cheeks
smile
wrinkle the forehead by
raising the eyebrows
purse the lips and blow out
show the teeth
squeeze the eyes shut
examination of the hypoglossal cranial nerve: inspect the protruded tongue for size, shape, symmetry, and fasciculation..
observe movement of the tongue from side to side
examination of coordination with rapid alternating movements: pat the knees with both hands, alternately using the palm and back of hand
location of the taste bud regions tested for sensory function of the facial and glossopharyngeal cranial nerves: lingual tonsil
palatine
foramen caecum
circumvillate papilae
fungiform papilia

cranial IX nerve:
bilateral
sour

cranial VII nerve
anterior two thirds:
salty
sweet
tracts of the spinal cord (picture): pathway of spinal tracts from spinal cord to motor cortex
note DECUSSATION of the pyramids at the level of the medulla
nervous system: whitish cords transmitting outgoing signals, from brain to organs
cervical nerves (innervate neck and arms): cords conducting nerve impulses from neck and arms to cerebellum via spinal cord
intercostal nerve: cord conducting nerve impulses between ribs
lumbar and sacral nerves (innervate legs and pelvic organs): nerves originating in lower back and extending into pelvis and legs
sacral plexus: network of nerves of sacrum
spinal cord: substance belonging to the nervous system, found in the holes of vertebrae
brachial plexus: network of nerves of the arm
cerebrum: seat of mental capacities
Parts of spinal nerves: 31 pairs
ventral/dorsal roots
function of spinal nerves: sensory/motor fibers supply/receive information
in dermatome

reflex actions
dermatomes: area of body surface innervated by particular spinal nerves

C1 usually has no cutaneous distribution
examples of nervous disorders?: carpal tunnel syndrome
cubital tunnel syndrome
carpal tunnel syndrome?: compression of the median nerve, which runs through the wrist, causing pain, numbness and tingling in first 3 fingers and base of thumb
cubital tunnel syndrome?: compression of ulnar nerve, which runs over the elbow, causing pain, numbness and tingling in ring finger and little finger
anatomy and physiology of infants and children: major brain growth/myelinization in first year of life

primitive reflexes present in neewborn

motor maturation in cephalocaudal direction

brain growth continues until 12-15 years of age
anatomy and physiology of pregnant women: hypothalamic-pituitary
neurohormonal changes
common alterations
headaches
numbness/tingling of hands
no rest after sleep
inability to sleep
anatomy and physiology of older adults: changes physiologic rather than anatomic

cerebral neurons decrease

velocity of nerve impulse conduction declines
slowed response time
diminished touch/pain
perception

seizures or convulsions
sequence of events
character of symptoms
aura
automatism
muscle tone
postictal behavior
relationship of seizure to
other events
frequency of seizure
medication
related history: present problem: gait coordination
balance
falling
legs simply give way
associated problems
medications

weakness/paresthesia
onset
character
associated symmptoms
concurrent chronic illness
(HIV, nutritional/vitamin
deficiency)
medications
related history: past medical history: trauma
meningitis
encephalitis
plumbism
deformities
congenital anomalies
cardiovascular/circulatory
problem
neurologic disorder/brain
surgery/residual effects
Related history: family history: hereditary disease
medical/metabolic disorder
alcoholism
mental retardation
epilepsy or seizure disorder/
headaches
Alzheimer disease
learning disorders
weakness/gait disorders
Related history: personal/social history: environmental/occupational
hazards
hand, eye, foot dominance
ability to care for self
sleeping/eating patterns
use of alcohol/drugs
related history: infants: prenatal history
birth history
respiratory status at birth
neonatal health
congenital anomalies
multiple handicapping
conditions
related history: children: developmental milestones
age attained
loss of previously achieved
function
performance of self-care
activities
health problems
headaches
seizure activity
clumsiness/unsteady gait
muscular weakness/failing
related history: pregnant women: weeks of gestation or EDC
convulsions/headache
seizure activity
headache
nutritional status
related history: older adults: increased stumbling/falls
decreased agility
safety modification at home
interference with performance
of ADLs
hearing loss, vision deficit,
or anosmia
development of tremor
fecal/urinary incontinence
transient neurologic deficits
exam and findings: equipment: penlight
tongue blades
sterile needles
tuning forks
familiar objects
cotton wisp
monofilament
reflex hammer
vials of aromatic substances
vials of solutions
test tubes of hot/cold water
Denver II
exam and findings: screening exam: components
cranial nerves
proprioception/cerebellar
function
sensory function
DTRs
Olfactory (I): sensory / smell
test for odor id
Optic (II): sensory/visual acuity
test for visual acuity
test visual fields
perform ophthalmologic exam
exam and findings: cranial nerves oculomotor, trochlear, abducens (III, IV, VI): inspect eyelids for drooping..
inspect pupils for
size/equality...
test consensual response/accommodation...
test extraocular eye movements....
exam and findings: cranial nerves trigeminal V: mixed/muscle tone, sensation

inspect face for atrophy/tremors...
palpate jaw for tone/strength...
test for pain/sensation...
test corneal reflex
exam and findings: cranial nerves: facial (VII) mixed/facial expressions, taste
inspect facial symmetry
test tongue for salt/sweet

acoustic (VIII) - sensory and hearing, balance
test hearing
compare bone/air conduction
test for sound lateraliza-
tion
exam and findings: cranial nerves glossopharyngeal IX: mixed/taste/swallowing
test tongue for sour/bitter
test gag reflex/swallow
Exam and findings: cranial nerves vagus (X): mixed/swallowing/speech

inspect palate/uvula for
symmetry
inspect for swallow
difficulty
evaluate guttural speech
sounds
exam and findings: cranial nerves spinal accessory (XI): motor/muscle strength
test trapezius/sternocleidomastoid muscle strength

hypoglossal (XII) motor/tongue strength

inspect tongue for symmetry/tremors/atrophy
test tongue movement
test tongue strength
evaluate lingual speech sounds
exam and findings coordination/fine motor skills: test rapid rhythmic alternating movements
evaluate rhythm/flow/speed
test accuracy of movements
evaluate accuracy/speed/
rhythm
test balance
evaluate equilibrium
observe gait
exam and findings: gait patterns: spastic hemiparesis
spastic diplegia
steppage
waddling
tabetic
cerebellar
sensory ataxia
Parkinsonian
ataxia
analgic limp
Exam and findings: sensory function: types
primary
cortical
primary functions
superficial ttough
superficial pain
temperature
deep pressure
vibration
joint position

cortical functions
stereognosis
two-point discrimination
extencition phenomenon
graphesthesia
point location

observe all sensory fucntion
tests for:
side-to-side differences
interpretation of sensation
discrimination
location

If impairment found, map boundaries by DERMATOME
Exam and findings.. types of reflexes: superficial
deep
exam and findings...superficial reflexes: upper abdominal
lower abdominal
cremasteric
plantar
exam and findings: reflexes deep reflexes?: biceps
brachioradial
triceps
patellar
achilles
exam and findings: reflexes observe superficial reflex tests for?: abdominals - equal movement of umbilicus

cremasteric - rising of testicle/scrotum

plantar - fanning of toes/dorsiflexion of great toe
exam and findings: reflexes observe deep tendon reflex test for?: bicpes - elbow flexion

brachioradial - forearm pronation/elbow flexion

patellar - lower leg extension

achilles - foot flexion

clonus
triceps - elbow extension
Exam and findings Additional procedures: monofilament test
protective sensation on
foot

meningeal signs
nuchal rigidity
brudzinski
kernig
Exam and findings: Infants: cranial nerves indirectly
tested

cranial nerves II, III, IV,
VI
optical blink reflex
gaze/tracking
doll's eye
CN V
rooting
sucking

CN VII
facial expressions
forehead wrinkling
smile

CN VIII
acoustic blink reflex
doll's eye maneuver

CN IX, X
swallowing reflex

CN XII
sucking/swallowing ability
tongue position with pinch
test
Observe movement
spontaneity
symmetry
Exam and findings: children: observe neuromuscular development progress/skills displayed during PE

evaluate developmental level

CN exam modified according to age

observe at play
gait/fine motor coordination
heel-to-toe walking, hopping, jumping

DTRs not routinely tested in young children

soft signs
unexpected findings in
school-age child considered
normal in younger child

may be gross/fine motor, sensory, reflex
exam and findings: pregnant women: same as for adult
DTRs on initial exam serve
as baseline
exam and findings: older adult: exam same as adult
meds can impair CNS function
slowed reaction time/
tremors/anxiety
test gait for decreases in
speed/balance/grace

check tactile/vibratory sense
for impairment

check DTRs for diminished response
Common abnormalities: CNS: AIDS dementia complex
multiple sclerosis
generalized seizure disorder
meningitis
Common Abnormalities: Peripheral Nervous System: myasthenia gravis
Guillain-Barre
Peripheral neuropathy
Common Abnormalities: Pregnant women
maternal obstetric palsy
Older adults
Parkinsons
Normal-pressure hydrocepha-
lus

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Number of cards 102