cranial nerves
I (olfactory) smell
II (optic) visual acuity and fields
III (oculomotor) pupil constriction, extraocular movements
IV (trochlear) extraocular movements
V (trigeminal) clench teeth, light touch
VI (abducens) extraocular movements
VII (facial) facial movements
VIII (acoustic) hearing, romberg test
IX (glossopharengeal) gag reflex
X (vagus) say “ah” uvular and palatte movements
XI (spinal accessory) turn head and lift shoulders to ressitance
XII (hypoglossal) stick out tongue
Brain Lobes
occipital
frontal
temporal
parietal
- Occipital: vision
- Frontal: behavioral changes, personality, higher order processing
- Temporal: auditory and past experiences
- Parietal: sensory input
Spine
C1-C7
T1-T12
L1-L5
sacrum coccyx
autonomic dysreflexia
LOI?
Sx?
- spinal injury at T6 or higher
- sx: severe HTN, horrible HA, diaphresis above LOI, bradycardia, piloerection, flushing
lumbar puncture
location
positioning
between L3/L4 or L4/L5
side lying with knees drawn up and head flexed or sitting up leaning over bedside table
Aphasia/dysphasia?
Receptive aphasia?
Expressive aphasia?
- Impaired communication
- Receptive aphasia: impaired comprehension of speech and writing. Can speak full sentences but words don’t make sense
- Expressive aphasia: impaired speech and writing. can speak short phrases but have difficulty with word choice
apraxia?
Loss of ability to preform learned movements
Wernicke and Broca area
- Wernicke: language comprehension
- Wernicke (receptive) aphasia: damage to the temporal lobe
- Spontaneous speech: sparse, nonfluent
- Comprehension: relatively preserved
- Brocas: language production
- Brocas (expressive) aphasia: damage to the frontal lobe
- Spontaneous speech: voluminous and fluent but lacks meaning
- Comprehension: greatly diminished
myasthenia gravis crisis
- patho: blocks Ach (motor function), W>M
- s/sx: facial and muscle weakness (ptosis, diplopia, dysphagia, weakness improves with rest, bulbur signs (difficulty speaking and swallowing), dyspnea
- crisis: diaphragmatic weakness/RF can lead to this
- interventions: pyridostigime (inc Ach), thymectomy (may cure)
- dx: tensilon/edrophoniu) test (differentiates between myasthenic/cholingeric crisis), blood test for abs attacking Ach
guillain barre syndrome
- patho: destroys myelin sheath, reversible, quick onset
- s/sx: peripheral loss on sensation/function and paralysis can occur
- ascending muscle weakness
- if gets to diaphragm= med emergency
- interventions: plasmapheresios (removes abs destroying nerves), protect breathing and wait it out (time heals), PT
- gold standard to assess resp function: forced vital capacity
amylotrophic lateral sclerosis crisis
(ALS, lou gehrig’s disease)
- patho: begins in adulthood, no cure, neurodegenerativ edisease of motor neurons in brain and SC
- s/sx: progressive upper and lower motor dysfunction/atrophy (weakness, twitching, spasms, dysarthria), sensory/cognitive function intact (locked in), dysphagia (RED FLAG), resp compromise, death
- interventions: early (meds to treat sx), late (vent support)
