Clinical Neurology

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son850
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153454
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Clinical Neurology
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2012-06-20 19:34:28
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Clinical Neurology
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Clinical Neurology
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  1. Cranial Nerves (CN) originate from which region of the brain?
    Mid-Brain
  2. All CN nerves originate from the ventral aspect of the brain, except one. Which CN? Which portion of he brain?
    • CN IV (Trochlear)
    • Originates from the dorsal aspect of the brain.
  3. Name the Cranial Nerves, in order. Sensory? Motor? Both?
    • Olfactory (S)
    • Optic (S)
    • Oculomotor (M)
    • Trochlear (M)
    • Trigeminal (B)
    • Abducens (M)
    • Facial (B)
    • Auditory (Vestibulocochlear) (S)
    • Glossopharyngeal (B)
    • Vagus (B)
    • Accesory Nerve (Spinal) (M)
    • Hypoglossal (M)
  4. What is a mnemonic to remember the which nerves are sensory, motor, or both?
    Some Surgeons Make Money, But My Broher Says Beach Bums Make More

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  5. What determines Legal Blindess? Total Blindness?
    • Legal Blindness: better than 20/200 on the Snellen Chart (/w correction (i.e. glasses)) OR visual field is less than 20o in the better eye
    • Total Blindess: Inability to see anything with either eye
  6. How will vision be affected in the cases of 1, 2, & 3?
    What are the terms used for theses conditions?
    • 1. Ipsilateral Blind Eye
    • 2. Bi-temporal Hemianopsia
    • 3. Homonymous Hemianopsia
  7. Fields of Vision
  8. Patient has CNII lesion of the right eye. A light is shined on the left eye.
    1. What happens to left eye? right eye?
    2. We now shine a light on the right eye, what happens to right eye? left eye?
    • 1. Left eye constricts, Right eye constricts (consensual response)
    • 2. Left eye has no change, Right eye has no change
    • *CNII is sensory in nature, the nerve is tied to both eyes which is why there is a consensual response
  9. Patient has a CNIII lesion of the right eye. A light is shined on the left eye.
    1. What happens to the left eye? right eye?
    2. We now shine a light on the right eye, what happens to the left eye? right eye?
    • 1. Left eye constricts, Right eye has no change
    • 2. Left eye constricts (consensual response), Right eye has no change
    • *CNIII is motor in nature, but CNII is also part of the eye and the can not be tested separately which is why there is a consensual response in "2"
  10. What CN's control which muscles of the eye?
    • CN III - Inferior oblique, Superior / Medial / Inferior Rectus
    • CN IV - Superior Oblique
    • CN VI - Lateral Rectus
  11. Which Cranial Nerve (CN) opens the eye? closes the eye?
    • CN III - opens eye
    • CN VII - close eye
  12. If a patient has Medial Strabismus, what CN / muscle is affected?
    CN VI / Lateral Rectus problem
  13. If a patient has Lateral Strabismus, what CN / muscle is affected?
    CN III & IV / Medial Rectus problem
  14. What CN innervates the skin of the face? muscles of the face?
    • CN V - skin of face
    • CN VII - muscles of face
  15. What is the distribution of the CN V (Trigeminal)?
  16. What can you tell me about Bell's Palsy?
    • 1. CN VII problem
    • 2. Lower motor neuron lesion
    • 3. Cause weakness of all facial muscles
    • 4. Angle / Corner of the mouth droops
    • 5. Weakness of frontalis muscle
    • 6. Eye closure is weak
  17. What can you tell me about the Stroke / Cerebro Vascular Accident (CVA)?
    • 1. Upper Motor Neuron lesion
    • 2. Frontalis is spared
    • 3. Eye closure & blinking are not affected
    • *severe CVA may lead to Bell's Palsy
  18. What CN control the portions of the tongue?
    • CN IX - posterior 1/3 of the tongue
    • CN VII - anterior 2/3 of the tongue
  19. What can Conductive Hearing Loss be due to?
    • 1. Full of Ear Wax
    • 2. Outer ear infection
    • 3. Tympanic membrane infection / dislocation
  20. What can Sensorineural Hearing Loss be due to?
    • 1. Tumor
    • 2. Trauma
    • 3. Inner Ear Infection
    • 4. Normal Aging
    • 5. Congenital
  21. What does the Weber Test check for?
    If lateralization occurs (one ear hears louder than other)
  22. What is the formula for the Rinne Test?
    • ACf (Rinne Test + ACi) ≥ 2 x BC (Rinne Test)
    • Example:
    • Weber test indicates lateralization
    • Rinne Test is performed and time is 20 secs
    • Air Conduction (ACi) is 20 secs, therefore ACf = 40 secs
  23. Patient was given the Weber Test and lateralization was found on the Right ear. Rinne Test is given to patient next and results are as follows
    L: AC = 2 x BC
    R: AC < 2 x BC
    What type of hearing loss does this patient have?
    • Conductive Hearing Loss
    • *observation: if the lateralized ear is the same as the ear that does not agree with the Rinne Test, then the hearing loss type is this case
  24. Patient was given the Weber Test and lateralization was found on the Right Ear. Rinne Test is given to patient next and results are as follows
    L: AC < 2 x BC
    R: AC = 2 x BC
    What type of hearing loss does this patient have?
    • Sensorineural Hearing Loss
    • *observation: if the lateralized ear is the opposite to the ear that does not agree with the Rinne Test, then the hearing loss type is this case
  25. It is a component of CN IX. Provides voluntary control of stylopharyngeus muscle which elevates the pharynx during swallowing and speech.
    Brachial Motor (special visceral efferent)
  26. It is a component of CN IX. Innervates ipsilateral parotid gland.
    Visceral Motor (general visceral efferent)
  27. It is a component of CN IX. Innervates baroreceptors (pressure) of the carotid sinus (~ST9) and chemoreceptors of the carotid body.
    Visceral Sensory (general visceral afferent)
  28. It is a component of CN IX. Provides general sensory information from the skin of the external ear, internal surface of the tympanic membrane, upper pharynx, and posterior 1/3 of the tongue.
    General Sensory (general sensory afferent)
  29. It is a component of CN IX. Provides taste sensation from the posterior 1/3 of the tongue.
    Special Sensory (special afferent)
  30. It is a component of CN X. Provides sensory information from the larynx, esophagus, trachea, abdominal / thoracic viscera, strech receptors of the aortic arch and chemoreceptors of the aortic bodies.
    Visceral Sensory (general visceral afferent)
  31. It is a component of CN X. Carries general sensory information (pain, temp, touch) fron skin on back of ear exteranl auditory meatus, parts of the external surface of the tympanic membrane, and from larynx and pharynx
    General Sesory (general somatic afferent)
  32. The patient came to your clinic and complained of loss of smelling. What test(s) are you going to perform?
    • CN I Olfactory Sensory Exam
    • Smell Test
  33. The patient came to your clinic and complained of narrowed vision. What test(s) are you going to perform?
    • CN II Optic Visual Fields Exam
    • Finger Wiggling Test
    • *know the Angles of the Fields of Vision
  34. The patient came to your clinic and complained of lateral strabismus on the right side. What test(s) are you going to perform?
    • CN III, IV, VI Extraocular Movement Exam
    • "H" in the Sky Test
  35. The patient came to your clinic and complained of numbness and tingling sensations and pain on the right side of the face. What test(s) are you going to perform?
    • CN V Trigeminal Motor & Sensory Exam
    • Motor: Hand of side of face checking masseter and temoporalis muscles
    • Sensory: sharp / soft test
  36. The patient came to your clinic and complained of a sudden onset of weakness of the left side of the face. He is unable to close his left eye. What test(s) are you going to perform?
    • CN VII Facial Motor & Sensory Exam
    • Motor: "Funny Face" Test
    • Sensory: Taste test (CN VII controls the anterio 2/3 of tongue)
  37. The patient came to your clinic and complained of a decreased hearing on the left side. What test(s) are you going to perform?
    • CN VIII Acoustic Division Exam
    • Weber Test - tests for lateralization
    • Rinne Test - test for whether there is conductive / sensorineural hearing loss
  38. The patient came to your clinic and complained of sudden loss of balance. What test(s) are you going to perform?
    • CN VIII Vestibulocochlear Division Exam
    • Babinski-Weil: 7 steps forward, then backward; check for any imbalance
    • Mittlemeyer March: march in place (eyes open, then march in place (eyes closed); check for anything other than a proper static march
    • Swivel Test:
    • -have patient swivel body to check for dizziness
    • -then have patient shake head (not to violently) to check for dizziness
  39. The patient came to your clinic and complained of difficulty swallowing. What test(s) are you going to perform?
    • CN IX Uvula Motor Exam
    • Shine light in mouth, have patient say "Ahhhhhh" to see the innervation / deviation of the uvula
    • *Taste Test: CN IX controls the posterior 1/3 of the tongue
  40. The patient came to your clinic and complained of difficulty in the movement of the neck. What test(s) are you going to perform?
    • CN XI SCM & Trapezius Exam
    • SCM:
    • -patient lies supine-head to one side
    • -lift head-have patient resist the depression of lifted head isolating SCM muscle
    • Trapezius:
    • -shoulders raised
    • -have patient resist the depression of shoulders
  41. The patient came to your clinic and complained of difficulty in the movement of the tongue. What test(s) are you going to perform?
    • CN XII Tongue Motor Test
    • Stick tongue out, check for lateral deviation

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