2971 Lab Week 5 Neuro
1. Scalp-moves freely. Protects and cushions from injury
2. Skull-rigid, bony cavity. Fixed volume=1500 ml
Meninges (protective membranes)
1. Dura mater-thick, tough and outermost
2. Arachnoid mater-arachnoid villa project into the subarachnoid space to absorb
3. Pia mater-thin and vascular; helps form the choroids plexuses, which are vascular
structures in the ventricles that form CSF.
Composed of brain and spinal cord.
4 components of the brain:
1. Cerebrum-largest portion containing corpus callosum, cerebral cortex, basal
ganglia and each hemisphere is divided into 4 lobes: frontal, parietal, temporal
2. Diencephalon-relay center composed of the thalamic structures: thalamus,
epithalamus and the hypothalamus important in body temp regulation, pituitary
hormone control and ANS response; and has a role in behavior via limbic system.
3. Cerebellum-inferior to occipital lobe and behind the brain stem. Responsible for
coordination of movement. It has 2 lobes and medial part called vermis which
maintains posture and equilibrium.
4. Brain stem-midbrain, pons and medulla oblongata. Reticular formation controls
resp, cardio and vegetative functions. RAS is excitatory responsible for arousal,
and perception of sensory input. Contains CN III-XII nuclei. Medulla oblongata
center for reflexes and resp and cardio system
Spinal Cord-continuation of medulla oblongata. Dorsal horn contains sensory (afferent)
neurons; ventral horn contains motor (efferent) neurons.
Motor Pathways of the CNS
3 motor pathways:
1. Pyramidal Tract or corticospinal pathway descends from the motor area of the
cerebral cortex, through the midbrain, the pons and the medulla. Contains upper
and lower neuron cell bodies. Lower motor neurons innervate skeletal muscle
and responsible for purposeful, voluntary movement.
2. Extrapyramidal Tract-includes all motor neurons not included in the pyramidal
tract. Responsible for controlling gross movements and muscle tone.
Sensory Pathways of the CNS
Afferent neurons divided into somatic afferent (skeletal muscles, joints, tendons and skin)
and visceral afferent neurons (viscera).
1. lateral-pain and temperature sensations
2. anterior-crude or light touch
Posterior Column-carries position, vibration, and fine touch.
Internal carotid and vertebral arteries meet at circle of Willis.
Peripheral Nervous System
1. Spinal verves-31 pairs which each innervate a specific dermatome
2. Cranial Nerves-12 pairs
3. ANS-sympathetic contains fight or flight actions; parasympathetic does general
No conscious control. Three categories:
1. muscle stretch or DTR
2. Superficial reflexes
3. Pathological reflexes
ASSESSMENT OF THE NEUROLOGICAL SYSTEM
Assess physical appearance and behavior, communication, LOC, cognitive abilities and
As the pt approaches observe gait, posture and mode of dress, involuntary movements,
Physical Appearance and Behavior
Posture-relaxed, slumped or stiff
Movements-control and symmetry
Dress, Grooming and Personal Hygiene
Clean, condition, age and weather appropriate
Grooming for adequacy, symmetry and odor
Appropriate variations and symmetry
Verbal and nonverbal behavior- note if labile, blunted or flat and extremes
Voice quality (volume and pitch)
Articulation-fluency and rate
Ability to write-spelling, grammar and logical thought process
Aphasia=impairment of language function
Dysarthria=disturbance in muscle control of speech
Dysphonia=difficulty with laryngeal sounds
Apraxia=inability to convert intended speech into motor act of speech
Agraphia=loss of writing ability
Alexia=inability to grasp meaning of written words
Glascow Coma Scale
Cognitive Abilities and Mentation
Serial 7 or 3
Ask name of spouse, pt’s BD, president’s name, mother’s maiden name
Pt copies previously drawn simple figures, identifies familiar sounds, id’s right from left
Agnosia=inability to recognize form and nature of objects or persons
Apraxia=inability to perform purposeful movements
Constructional apraxia=inabilitly to reproduce figures on paper
Dyscalculia=inability to perform calculations
Thought Process and Content
Thought process should be logical, coherent, and goal oriented and reality based.
Confabulation=making up of answers unrelated to facts
Echolalia=involuntary repetition of words
Neologism=word meaningful only to pt
Have you ever felt so bad you wanted to hurt yourself? Now?
PT should be able to verbalize self worth
Exteroceptive Sensation-expose legs, arms and abdomen.
Light Touch-cotton wisp with very light strokes distal to proximal
Superficial pain—sharp or dull
Anesthesia=absence of touch sensation
Hypesthesia=diminished sense of touch
Analgesia=insensitivity to pain
Hypalgesia=diminished sensitivity to pain
Hyperalgesia=increased sensitivity to pain
1. Motion and Position (up and down of body part
2. vibration Sense-use tuning fork over bony prominences
1. Stereognosis-ability to ID objects by manipulating and touch.
Astereognosis=inability to recognize nature of objects
2. Graphesthesia-ability to ID numbers, letters or shapes drawn on the skin
Graphanesthesia=inability to recognize a number or letter drawn on the skin.
3. Two-Point discrimination (pt should be able to discriminate sharp objects 5 mm
apart on fingertips.
4. Extinction-Touch opposite sides of the body at same site and ask if felt; then
remove one side and ask where the sensations are felt..
I. Olfactory Nerve-ID smells, alternate left and right nostrils
Anosmia=loss of sense of smell
II. Visual acuity, visual fields, funduscope eval
III. Oculomotor-cardinal fields of gaze, eyelid elevation, Pupil reactions
IV. Trochlear-cardinal fields of gaze
V. Trigeminal-a.motor-contraction of temporalis and masseter
b.sensory-cotton wisp sensation ophthalmic, maxillary and
mandibular.; pain sensation, temperature sensation, blink reflex
VI. Abducens-cardinal fields of gaze
VII. Facial a. motor-symmetry of face
b.sensory-taste tip=sweet, salty and sour; borders are sour, back
and soft palate are bitter
Ageusia=loss of taste
Hypogeusia=diminution of taste
VIII. Acoustic- a. Coclear divisionhearing, Weber and Rinne
b. Vestibular Division-vertigo and nystagmus
IX and X.-Glossopharyngeal and Vagus-soft palate and uvula and gag reflex,
XI. Spinal Accessory-turn head with resistance, shrug shoulders
XII. Hypoglossal-tongue movements and lingual sounds
Pronator Drift-have pt extend arms out in front with arms out in front, palms up for 20
Smooth, precise, and harmonious muscular activity
Incoordination is categorized into 3 different types:
3. posterior column syndromes
1.Index finger to nose, alternate index finger to nose, then with eyes closed
2. Touch finger to nose, have pt touch your index finger-start 18 inches away then change
rapidly; have pt change hands.
3. Rapid alternating movements-pat knees palms up then down rapidly alternating
4. Have pt touch thumb to each of the fingers of the hand; repeat other hand
5. Heel shin slide
6. Draw figure 8 with a foot, repeat other foot
7. Tap each foot by rapidly extending
dyssynergy=lack of coordinated action
Dysmetria=impaired judgement of distance, range, speed and force of movement
dysdiadochokinesia=inability to perform rapidly alternating movements
1. Have pt walk on toes, then heels
2. Tightrope walk with arms at sides
3. Hop in place on one foot and then on the other
4. Romberg’s test-stand with feet together, arms at sides first eyes open then closed
Pt should be relaxed and comfortable. Position so that extremities are symmetrical.
+1=present but diminished
+3=mildly increased but not abnormal
+4=markedly hyperactive, clonus may be present
Flex arm to between 45-90*
Place thumb firmly on the biceps tendon just above the crease of the antecubital fossa.
Flex arm to 45*
Tap brachioradialis above the styloid process of the radius
With pointed end of reflex hammer tap triceps just above its insertion above the
Place hand over quads to feel contrax, tap patellar tendon just below patella
Slightly dorsiflex the patient’s foot
Tap Achilles tendon just above the insertion point.
With pt in recumbent position, arms at sides, and knees slightly bent; use tip of cotton
applicator to stimulate the skin by stroking in a diagonal downward and inward direction.
Lower abd reflex
Stimulate area below the umbilicus, stroke in diagonal downward and inward to the
Stroke outer aspect of the sole of the foot from heel across to just below the great toe.
Male patient should be lying down with thighs exposed and testicles visible; stroke skin
of inner aspect of the thigh near the groin from above downward.
Pinch skin of the foreskin or the glans penis and observe for a contraxion of the
bulbocavernosus muscle in the perineum at the base of the penis.
SNOUT-tap upper or lower lip and observe for a puckering of the lips (abn after infancy)
GLABELLAR-tap on the forehead with finger between the eyebrows and watch for a
hyperactive blinking response. (Parkinson’s disease and glioblastoma of the corpus
BRUDZINSKI’S SIGN-Flex neck in a deliberate motion. Abnormal if leg(s) flex.
Depression is associated with decreased levels of norepinephrine.
Total brain weight, number of synapses, and number of neurons diminish with age
beginning at age 50.
Elderly have decreased visual acuity, visual fields, color sensitivity, papillary size and
diminished papillary response to light.
Hearing also diminishes due to ossification of the ossicles and degenerative changes in
the auditory nerve.
Elderly also demonstrate difficulties with balance and changes in coordination and
Cognitive changes include decreased memory, primarily short-term memory, increased
learning time, changes in affect, mood and orientation.