frontal, parietal, occipital, temporal

four lobes of the cerebral cortex

frontal

controls personality, emotion, behavior, intellect

parietal

controls sensation

occipital

controls vision

temporal

controls auditory

Wernicke's area

area of temporal associated with auditory, reception

fluent aphasia

caused by damage to Wernicke's area

Broca's area

area of frontal lobe mediates speech

non-fluent (expressive) aphasia

caused by damage to Broca's area

basal ganglia, thalamus, hypothalamus

three parts of the forebrain cerebral cortex

basal ganglia

primitive motor areas, automatic associated with movement

thalamus

relay station

hypothalamus

temp control and sleep center

pre central gyrus

primary motor area

postcentral gyrus

primary sensory area

cerebellum

motor coordination equilibrium and balance; located under occipital lobe

parietal lobe

sensation

brain stem

the central core; midbrain pons and medulla

spinal column

long and cylindrical; main highway for ascending and descending fiber tracts; connects brain to spinal nerves; mediates reflexes

gray matter

consists of nerve cell bodies and interneurons

white matter

consisting of myelinated axons passing to and from the brain or different segments of the spinal cord

nerve cell bodies

arranged in an H shape with anterior and posterior horns

spinothalamic tract and posterior columns

major sensory pathways

lateral spinothalamic tract

controls pain and temperature

anterior spinothalamic tract

controls crude or light touch

posterior columns

position proprioception, vibration, and tactile discrimination

corticospinal (pyramidal), extrapyramidal, and cerebellar

major motor pathways

corticospinal/pyramidal

conscious voluntary movement- skilled purposeful discrete; cross to other side; higher level - body map

extrapyramidal

older unconscious/lower level; reflexive/responsive, gross automatic movements; muscle tone, balance, posture

cerebellar

coordinates movement, equilibrium, and posture

peripheral nervous system

carry input to CNS via sensory afferent fibers and deliver output from CNS via motor efferent fibers

cranial nerves

enter and exit brain; 12 pairs; supply head and neck except for vagus

olfactory, optic, and acoustic

the 3 sensory nerves

trochlear, abducens, spinal, and hypoglossal

the four motor nerves

oculomotor

nerve that is mostly motor

trigeminal, facial, glossopharyngeal, vagus

the four nerves that are both motor and sensory

31 pairs

amount of spinal nerves

8 pairs

amount of cervical spinal nerves

12 pairs

amount of thoracic nerves

5 pairs

amount of lumbar nerves

5 pairs

amount of sacral nerves

1 pair

amount of coccygeal nerves

afferent

dorsal root mixed nerves

efferent

ventral root mixed nerves

dermatome

nerves of the spine that exit as dermal segmentation; areas of the skin that connect to certain spinal nerves

thumb

C6 dermatome

nipple line

T4 dermatome

umbilicus

T10 dermatome

top of foot

L5 dermatome

bottom of foot

S1 dermatome

perineum

S2-S4 dermatome

7

amount of cervical vertebrae

8

amount of cervical nerves

12

amount of thoracic vertebrae

12

amount of thoracic nerves

5

amount of lumbar vertebrae

amount of lumbar nerves

5

amount of sacral vertebrae

5

amount of sacral nerves

4

amount of coccygeal vertebrae

amount of coccygeal nerves

sympathetic and parasympathetic

2 subdivisions of autonomic nervous system

sympathetic

controls fight and flight

parasympathetic

controls everyday maintenance and pleasure

autonomic nervous system

mediates unconscious activity; innervate smooth muscle-cardiac, involuntary and glands; made up of sympathetic and parasympathetic

reflex arc

defense mechanism of nervous system; operates below consciousness; permits quick reaction to potentially painful or damaging situations; simple; deep tendon reflexes

mental status, cranial nerves, motor system, sensory system, cerebellum, gait

6 most important factors of neurological exam

headaches, dizziness, sensation changes, concentration, response time, memory, syncope, eyesight, hearing, speech, swallowing, head injury, seizures, tremors, incoordination, change in gait, vertigo

health history cues for Neuro assessment

ALS, MS, AVM, CVA, childhood seizures, trauma, neuropathies, migraines, Alzheimer's, HTN, cardiac disease, DM, surgeries, injuries

important past medical history for Neuro assessment

antidepressants, anti seizure, narcotics, anti anxiety

important medication use to document for neurological assessment (4)

AVM, headaches, epilepsy, Alzheimer's, Huntington's, Chorea

6 important family history factors for neurological assessment

ETOH, drug, tobacco, sexual practice, travel history, work/home environment, hobbies, stress, sleep, diet, exercise

11 important social history cues for neurological assessment

Denver Development Screening Test

screening test for child development milestone neurological assessment

fluent aphasia Wernicke's

injury to temporal or parietal lobe; talk and read easily but words nonsensical, jumbled or meaningless

non-fluent aphasia Brocca's

frontal lobe lesion; struggle with words, slow, monosyllabic

Glasgow coma scale

evaluates level of consciousness- degree of wakefulness - related to the amount of stimuli needed to initiate a response; does not apply to children especially under 3 years

fully awake

able to respond to various stimuli but may be disoriented and forgetful

alert

fully awake and oriented to person place and time; able to respond and carry out commands

lethargic

sleepy/drowsy but arousable with gentle shaking, calling of name, falls back to sleep easily, maybe disoriented

obtunded

sleeps most of the time makes few spontaneous movements; vigorous shaking and name calling required; capable of verbal response but likely inappropriate

stuporous

semi comatose unconscious most of the time strong painful stimuli required for withdrawal response

comatose

cannot be aroused

Olfactory

CN I

Optic

CN II

Oculomotor

CN III

Trochlear

CN IV

Abducens

CN VI

Trigeminal

CN V

Facial

CN VII

Bell's Palsy

acute peripheral facial nerve palsy of unknown cause; CN VII; paralysis or weakness on one side of the face, along with a sagging eyebrow and difficulty closing the eye

close eyes, open eyes (by PCP), wrinkle forehead, and smile

four steps for CN VII palsy exam

inability to raise eyebrows on affected side and weakness of entire half of face instead of partial

how to differentiate bells palsy from stroke

Acoustic

CN VIII

Glossopharyngeal

CN IX

Vagus

CN X

Spinal Accessory

CN XI

Hypoglossal

CN XII

spinal rigidity

meningeal irritation results in tetanic contractures of the spinal muscles

decorticate

arms to the core held in flexion internally rotated

meningeal irritation

violent headache, photophobia, fever, nausea/vomitting, and decreased level of consciousness and convulsions

nuchal rigidity

with patient in supine position flex neck; resisting this movement is a positive sign for irritation (meningitis)

Kernig's sign

patient in recumbent position, flex hip and flex at knee, attempt to extend knee; positive is resistance to extension and pain (spasm of hamstring) reliable sign of irritation (rule out Herniated Disk)

Brudzinski sign

passively flex neck forward to chest; positive response is flexion of one or both legs to pelvis (failure to raise leg with knee straight indicated irritation of meninges), arms may also flex

Romberg's test

stand with feet together and arms at sides, close eyes and hold position for 20 sec; normal able to hold with no or minimal sway; positive sways falls must widen base of feet to stop fall indicating MS ETOH loss of proprioception and vestibular function

rapid alternating movement (RAM)

pat knees with both hands with increasing speed; normal equal turning and quick rhythmic pace; abnormal lack of coordination slow clumsy sloppy response seen with cerebellar disease

cerebellar motor functions

includes Kernig's, Brudzinski, Romberg's, RAM

sensory functions

spinothalamic and posterior columns

spinothalamic tract

tested by pain (pin prick sharp vs dull), temperature (warm vs cold), light touch

hyperesthesia

increased or altered cutaneous sensitivity to touch, pain or temperature

hypoesthesia

decreased cutaneous sensitivity to touch pain or temperature

analgesic

absence of cutaneous sensitivity to touch pain or temperature

posterior column vibration test

place tuning fork over bony prominence starting distally and moving inward until senses comparing side to side; normal detects start and stop; abnormal is loss of vibratory sense = peripheral neuropathy seen in DM and ETOH

posterior column kinesthesia

tests ability to perceive passive movements of extremities; move big toe up or down and have pt report place; normal slight changes detected; abnormal loss of position sense

posterior column tactile discrimination fine touch

stereognosis, graphesthesia, two point discrimination, extinction, point location; abnormal is inability to perform indicates lesion of sensory cortex or posterior column

stereognosis

the mental perception of depth or dimensionally; usually referencing ability to perceive the form of an object by touch

graphesthesia

the ability to recognize and discern letters or numbers traced on the skin

two point discrimination

two points separated by as little as 2-4mm on the kips and finger pads, 8-15mm on the palms, and 30-40mm on the tibia or back

extinction

patient on edge of exam table with eyes closed, touch patient on trunk or legs in one place and tell patient to open eyes and point to where sensation was; repeat a second time touching in two places on opposite sides of body simultaneously and ask patient to point again; normal point to both areas; abnormal patient may have lesions of sensory cortex and parietal lobe

diabetic testing

microfilament applied for 1.5 seconds to all sites with enough pressure to cause filament to bend

deep tendon reflexes

relaxed hold of hammer strike from wrist with short snappy blow with pointed end at smaller target (thumb) and larger end for wider target using enough force to elicit response; compare side to side; responses should be equal

4+ = disease

DTR response very brisk hyperactive with clonus

3+ may indicate disease

DTR response brisker than average

2+ average

DTR response normal

1+ low normal

DTR response diminished

0 SC damage

DTR response no response

biceps reflex C5 to C6

support forearm place thumb on biceps tendon and strike blow with thumb; normal = flexion of forearm

triceps reflex C6 to C7

suspend by upper arm, strike tendon directly above elbow; normal = extension of forearm

brachioradialis C5 to C6

hold thumb to suspend forearm, strike forearm directly 2-3cm above wrist; normal = flexion and supination

quadriceps L3 to L4 knee jerk

spike tendon just below patella with knees dangling; normal = extension of lower leg

achilles S1 to S2 ankle jerk

hold foot in doors-flexion and strike tendon directly; normal = plantar flexes against hand; slowed relaxation phase in hypothyroidism

superficial reflexes

abdominal upper T8-10, abdominal lower T10-12, cremasteric L1-2, and plantar L5-S1

cremasteric muscle

communicates with spermatic cord which shortens when this muscle contracts moving the testicle closer to the body providing warmth and maintaining temperature; relaxes when temperature needs to be lowered

cremasteric reflex

in response to stress raises testicles towards the body in an attempt to protect them

frontal lesion on contralateral side

indicated by abnormal grasp reflex after infancy

snout

puckering of lips abnormal after infancy

amyotrophic lateral sclerosis (ALS)

one indication is snout

glabellar

hyperactive blinking response with tap to forehead

Parkinson's

indicated by glabellar

bifrontal disease

indicated by sucking abnormal after infancy

clonus

upper motor neuron disease, preeclampsia

babinski

normal in infancy until 15-18 months; abnormal fan great toe with toes abduct; lesions pyramidal tract, stroke or trauma

clonus test

support knee in slightly flexed position quickly dorsiflex foot and hold in that position; positive = rhythmic oscillation of involuntary muscle

CNI

identifies coffee and peppermint bilaterally

CNII

vision 20/20 ou, intact peripheral, Fundi visualized disc margin, without nicking, flame hemorrhages bilaterally

CN III, IV, VI

intact EOM, no ptosis or nystagmus PERRLA

CN V

sensation intact bilaterally jaw strength intact bilaterally

CN VII

facial muscles intact and symmetric

CN VIII

hearing whispered words bilaterally at 12 in, Weber midline, RInne ac>bc

CN IX, X

swallowing intact, positive gag, uvula rises midline on pronation

CN XI

positive and equal shoulder shrug head movement

CN XII

tongue midline no fasciculations

motor

no atrophy weakness tremors; gait smooth, coordinated, able to tandem

sensory

intact pin prick vibration and stereognosis bilaterally

reflexes

draw stick for DTR no Babinski intact abdominal

Huntington's

movement disorder causing involuntary movement and/or impaired voluntary movement

Multiple sclerosis

CNS autoimmune destruction of nerve fibers and myelin sheath

seizures

sudden uncontrolled electrical activity between brain cells

meningitis

inflammation of the meninges

encephalitis

inflammation of brain tissue

Lyme disease

infection that can cause meningitis temporary paralysis (Bells palsy) numbness or weakness and impaired muscle movement

amyotrophic lateral sclerosis

degenerative disease of nerve cells controlling voluntary muscle movements

myasthenia gravis

chronic autoimmune neromuscular disease causing weakness in skeletal muscles after activity

Guillan-Barre

rare autoimmune syndrome causing weakness and tingling from peripheral to central areas

peripheral neuropathy

injury or damage to nerves in the periphery (outside brain)