Abnormal Neuro Exam Part 1

Question 1

Stuporous - definition

Answer 1

only responds to deep pain

Question 2

Comatose

Answer 2

nonresponsive, does not respond to deep pain

Question 3

Decerebrate Rigidity - characteristics

Answer 3

• Opisthotonos
• Extensor rigidity of all
  limbs
• Stupor or coma
• Midbrain lesion
• +/- respiratory problems
• +/- heart rate and blood
  pressure problems

Question 4

Decerebellate Rigidity - characteristics

Answer 4

• Opisthotonus
• Extensor rigidity of thoracic limbs +/-
  pelvic limbs
• Aware of environment
• Other cerebellar signs
• Cerebellar lesion

Question 5

Schiff Sherrington indicates a lesion where?

Answer 5

T3-L3

Question 6

Schiff Sherrington indicates what about the lesion?

Answer 6

Acute, severe but not a prognostic indicator

Question 7

What does Schiff Sherrington look like?

Answer 7

􀂄􀂄􀂄􀂄 Extensor rigidity of

thoracic limbs

Question 8

Why does Schiff Sherrington occur?

Answer 8

Lack of inhibition to the
extensors of thoracic
limbs (border cells)

Question 9

What does a head turn indicate?

Answer 9

supratentorial with head turning towards the side of the lesion

Question 10

Heat tilts come in what to flavors of lesions?

Answer 10

cerebellar or vestibular

Question 11

Head tilt indicates the lesion is where?

Answer 11

usually towards the side of the lesion

Question 12

structures associated with paradoxical head tilt

Answer 12

• caudal cerebellar peduncle

- flocculonodular lobe of the cerebellum

Question 13

characteristics associated with cerebellar and vestibular head tilts

Answer 13

􀂄􀂄 Head tilt (paradoxical)
􀂄􀂄 Nystagmus / ocular tremors
􀂄􀂄 Falling / wide-based stance
􀂄􀂄 Ataxia - hypermetria
􀂄􀂄 Circling

Question 14

Characteristics associated with cerebellar head tilts

Answer 14

Rebound Phenomenon
- Decerebellate rigidity
- Elevated 3rd eyelid,
pupillary dilation,
enlarged palpebral fissure
- Increase urination
- NO CP deficits or paresis
-Menace deficits (but no visual deficits)
Rebound phenomenon

Question 15

Characteristics associated with vestibular head tilts

Answer 15

- Head tremors and eyelid contraction secondary to
nystagmus
- Positional strabismus
- +/- CP deficits
or paresis (> ipsilateral)

Question 16

Vestibular lesions come in what two flavors?

Answer 16

Central and peripheral

Question 17

Characteristics of vestibular central lesions?

Answer 17

• Vertical Nystagmus
• Changing Nystagmus
• Other CN deficits
  other than 7 or 8
• CP deficits

Question 18

3 characterizations of circling lesions

Answer 18

• Cerebellar / Vestibular (infra)
• Supratentorial
• Towards the side of lesion

Question 19

Differentials for Ventral Neck Flexion

Answer 19

-Neck pain
- Myopathy / neuropathy
- Myasthenia gravis
- Thiamine deficiency
- Hyperthyroidism
- Organophosphate toxicity
- Ethylene glycol toxicity
- Electrolyte abnormalities
– K, Na, Ca, phosphate

Question 20

Two main reasons for ataxia

Answer 20

• Lack of an axis

- Failure of muscular coordination

Question 21

Three types of ataxia

Answer 21

Three types
1. Vestibular ataxia - falling, leaning
2. Cerebellum ataxia – hypermetria;
dz of cerebellum or spinocerebellar
tracts of the spinal cord
3. Proprioceptive / sensory ataxia –
wide-based, swaying; dz in CP pathway

Question 22

What is hypermetria and what does it indicate?

Answer 22

• Over flexion of the limbs
  -Lesion in the cerebellum or spinocerebellar
  pathways (spinal cord)

Question 23

Increases in step distance indicates what

Answer 23

UMN lesions

Question 24

Decreases in step distance indicates what?

Answer 24

LMN lesions

Question 25

4 definitions of paresis

Answer 25

• “weakness” at gait
• Partial loss of
  voluntary movement
• Deficiency in the
  generation of gait
• Deficiency in the
  ability to support
  weight

Question 26

Paraparesis

Answer 26

weakness in both pelvic

limbs

Question 27

Tetraparesis

Answer 27

weakness in all four limbs

Question 28

Hemiparesis

Answer 28

weakness in the thoracic

and pelvic limbs on one side

Question 29

Monoparesis

Answer 29

weakness in one limb