Neuro Lect 2
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Red flag symptoms you absolutely can't miss!
- "worst headache of my life" (thunderclap)
- sudden blindness
- back pain worse at night
- bowel/bladder incontinence
- suicidal ideation with plan
What neurologic structure is affected with coma (decreased level of consciousness)?
What neurologic structure is affected with disorientation (lack of orientation to time and place)?
What neurologic structure is affected with amnesia (memory loss)?
What neurologic structure is affected with aphasia (speech problems)?
- frontal lobe
- temporoparietal lobe
What neurologic structure is affected with inappropriate affect (inappropriate emotional display)?
bilateral cerebral damage
What neurologic structure is affected with agnosia (inability to recognize objects)?
nondominant parietal lobe
What neurologic structure is affected with apraxia (inability to follow orders)?
What are the different levels of consciousness and how are they described?
- alert: awake and talking
- lethargic: pts are drowsy but open eyes to look at you, respond to questions then fall asleep
- obtunded: pts open eyes and look at you but respond slowly and are somewhat confused
- stuporous: pts aroused with painful stimuli
- coma: no response to painful stimuli (non localizing)
Very important abnormal behavior pattern that often indicates an acute medical problem.
What score on the Folstein mini mental status exam suggests a cognitive disorder?
Patient can form words without difficulty but there are errors in content. Patient is unaware that responses are nonsense. Due to a lesion in the temporal/parietal lobe language area.
Wernicke's aphasia (receptive aphasia)
Patient is unable to form or find words (unable to produce words). Patient is aware of the deficit. Due to a lesion in the anterior speech area.
Broca's aphasia (expressive aphasia)
What is the possible pathologic cause of stock/glove sensory loss?
What is the possible pathology for sensory loss ascending from the feet to the trunk?
spinal cord lesion
What is the possible pathology for loss of pain and temperature sensation on one side and loss of joint position on the other side?
What is the possible pathology for "cape" distribution of pain and temperature loss?
central cord lesion (syringomyelia)
What is the possible pathology for sensory loss on the right face and left side of the body?
right lateral medullary syndrome
What is the possible pathology for sensory loss along a strict horizontal level to pain both anteriorly and posteriorly?
A tendency for one arm to pronate and drift downwards during the pronator drift test is suggestive of what?
UMN lesion on that side
Clinical term for inability to perform rapidly alternating movements that is usually caused by MS in adults and cerebellar tumors in children.
What two findings on exam strongly point to a structural lesion in an unconscious patient?
- consistent symmetry between right and left sided responses
- abnormal reflexes that point to specific areas within the brainstem
What are the two main maneuvers used to produce a noxious stimulus in a comatose patient?
- press very hard with thumb under the bony superior roof of the orbital cavity
- press pen hard on one of the pt's fingernails
Changes int he texture of skin, edema, venous prominence, callus formation, loss of nails and sweating abnormalities of the feet are manifestations of what issue?
peripheral autonomic nerve dysfunction
What are the indications for performing a lumbar puncture?
- infection (meningitis, encephalitis)
What are the contraindications for a lumbar puncture?
- suspected intracranial mass lesion/elevated ICP (risks herniate, examine for papilledema, get head CT before LP)
- infection at site of puncture
- lack of pt cooperation
What would you like to do?
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