Bates Ch 17 Neuro

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1. Brain has 4 1. Cerebrum 7. Hypothalamus

regions 2. Diencephalon
3. Brainstem
4. Cerebellum
2. Brain hemisphere

Maintains homeostasis & temperature

regulation, HR, BP
Affects endocrine system
Governs emotional behaviors e.g. anger,
sexual drive
1. Frontal Hormones act directly on pituitary gland
2. Parietal structures in diencephalon
3. Temporal
8. Gray matter Aggregations neuronal cell bodies.
4. Occipatal
Rims surfaces of cerebral hemispheres =
3. Neurons Interconnecting nerve cells, consisting of forms cerebral cortex
cell bodies
9. White matter neuronal axons coated w myelin (white
4. Axons Single long fibers conduct impulses to color), allow
other parts of nervous system nerve impulses to rapidly travel
5. Basal Ganglia 10. Consciousness interactions between intact cerebral
(deep in brain) hemispheres & reticular activating (arousal)
system in (diencephalon & upper
brainstem)
11. Identify the
following...
cerebellum
occipital lobe
parietal lobe
Affects movement
corpus
6. Thalamus callosum
frontal lobe
midbrain
pons
medulla

Process sensory impulses

12. Identify the 16. Spinal cord Contains: grey matter (aggregations of nerve
following... cell nuclei & dentrites) and white matter
cerebellum connect to brain to PNS
occipital lobe
wernicke's area Cord provides: segmental relays with the
parietal lobe periphery, servings as a conduit for info flow to
postcentral and from brain. Motor and sensory nerve
gyrus pathways enter/exit through posterior/anterior
central sulcus nerve roots and spinal & pheripheral nerves.
precentral
17. How many
sulcus
pairs of
frontal lobe
spinal
lateral fissure
nerves?
broca's area
Cervical?
temporal lobe
Thoracic?
medula
Lumbar
13. Cerebellum Sacral?
Coccygeal?

31 pairs
8 cervical
12 thoracic
5 lumbar
5 sacral
Base of brain; coordinates all movement, 1 coccygeal
helps maintain
18. Peripheral CNS & peripheral nerves. project to heart,
body upright in space
nervous visceral organs, skin, & limbs
14. Lumbar L3-L4 or L4-L5 vertebral interspaces to system
puncture avoid spinal cord injuries (PNS)
15. Cauda equina. 19. Pheripheral
nerves
includes

Fan out like a horse's tail at L1-L2, where

spinal cord terminates

Spinal and pheripheral nerves carry impulses

to and from spinal cord
20. Brain stem 26. Lower motor Cell bodies in spinal cord anterior
neurons horn cell; axons transmit impulses
thru anterior roots and spinal nerves
into pheripheral nerves terminating @
neuromuscular junction
27. Afferent Carries information IN, to CNS to
brain
28. Efferent Carries information from Brain to the
CNS
29. Basal Ganglia motor pathways between cerebral
System cortex, basal ganglia, brainstem &
spinal cord.
Connects upper brain w/ spinal cord. Consist 3
Helps maintain muscle tone and
sections:
control body movements, especially
1. Midbrain (CN II-IV)
gross automatic movement (eg
2. Pons (CN V-VIII)
walking)
3. Medulla (CN IX-XII)
30. Motor pathways: Mediate voluntary movement
CN III-XIII diencephalon & brainstem Corticospinal Integrate skilled, complicated,
CN I & II actual fiber tracts emerging from brain (pyramidal tract ) delicate movements.
Carry impulse and inhibit muscle tone.
21. Cranial
nerve
Originate Motor cortex-Travels down
to lower medula-cross contralateral
side medulla-synapse w/ anterior
horn cells

Tracts synapsing brainstem w/ motor

nuclei of cns are termed
corticobulbar
31. Damage basal Does not cause paralysis.
ganglia system
Increases in muscle tone, gait and
Oh, Oh, Oh, To Touch And Feel Virgin Girls' posture disturbances,
Vaginas and Hymens
Bradykinesia: slowness or lack of
22. Ventral Motor neurons (efferent)
spontaneous & automatic movements.
Root
1. Involuntary control (cardiac) 32. Cerebellar system Receives sensory & motor input
2. Voluntary control (skeletal)
coordinates motor activity, maintains
23. Dorsal Sensory neurons (afferent)
equilibrium, & helps control posture.
Root
ie: touching hot pot sense sensory to brain. 33. Cerebellar damage Impairs coordination
Impairs gait equilibrium
24. Ganglion locations synapse occurs, & cell bodies
decreases muscle tone
located (bundle of neurons)
34. Upper motor Contralateral side (opposite)
25. Upper Lie in motor strip of cerebral cortex & several
neurons damage,
motor brainstem nuclei
above crossover
neurons
medulla will
Axons synapse with motor nuclei in brainstem
develop motor
(CNS) and spinal cord (pheripheral nerves)
impairment:
35. Lower motor ipsilateral side (same) 48. crude & light touch often preserved despite for partial
neurons damage damage to cord d/t impulses
below crossover originate on 1 body side, travel up
medulla will both side of cord.
develop motor
49. Ankle reflex Sacral 1
impairment:
50. Knee reflex Lumbar 2,3,4
36. Upper motor Increased Muscle tone
lesion Increased deep tendon reflexes 51. Supinator Cervical 5,6
exaggerated. (brachioradialis)
reflex & Biceps
*NO fasciculation/atrophy reflex

37. Damage lower ipsilateral weakness & paralysis BUT 52. Triceps reflex Cervical 6,7
motor neuron muscle tone and reflexes decreased or 53. Abdominal lower Thoracic 8,9,10
absent reflex
38. Sensory pathways reflex activity, conscious sensation, 54. Abdominal upper Thoacic 10,11,12
locate body position in space, help reflex
regulate autonomic functions (ie: BP, HR,
55. Plantar response Lumbar 5, Sacral 1
respirations)
56. Anal reflex Sacral 2,3,4
39. Sensory relay impulses from skin, mucous
receptors membranes, muscle, tendons, viscera, 57. Common/concerning HA
through pheripheral projections to symptoms Dizziness/vertigo
posterior root ganglion where 2nd Weakness (generalize, proximal,
ganglia directs impulses to into spinal distal)
cord ->brain Numbness, abnormal or absent
sensation
40. Sensory impulses Travel to sensory cortex via 2 pathways:
Fainting or blacking out (near
1. spinothalamic tract: smaller sensory
syncope & syncope)
neurons w/ unmyelinated or thinly
Seizures
myelinated axons
Tremors or involuntary movements

2. posterior columns: larger neurons w/ 58. Primary HA migrane, cluster, and trigeminal,
heavily myelinated axons autonomic cephalagias

41. Spinothalamic arises in free endings in skin: pain, 59. Secondary HA structural, systemic or infectious (life
tract temperature, crude touch threatening)

42. Posterior column per 60. HA warning signs -sudden onset like "thunderclap" or
tract "worst HA of my life"
-new onset after 50 y/o
43. Small fiber DM patients
-associated papilledema, neck
neuropathy
stiffness, or focal neurologic deficits
reports sharp, burning, or shooting foot
-Precipitated by valsalva maneuver
pain.
or exertion
44. Large-fiber DM patients numbness and tingling or -recent head trauma
neuropathy no sensation at all. -change in patter from past HA
45. Lesions in sensory impairs finer discrimination -Lack of a similar HA in the past
cortex -Lack of similar HA in the past
ie: cannot appreciate size shape, texture. 61. episodic and tend to Migrane and tension
46. Disease posterior Position & Vibratory sense loss w/ peak over several
column preservation of other sensation. hours.

47. Severe transverse Loss of all sensation

spinal cord
damage
62. New and persisting Tumor, abscess, or mass 77. Peripheral Sudden, > or = day, sensorineural hearing
progressively severe HA lesion vertigo: Meniere loss, pressure fullness, n/v/nystagmus
Disease
Dull, increased by
78. Peripheral Insdious or acute (loop diuretic,
cough/sneeze same time and
vertigo: Drug aminoglycosides, salicylates, alcohol)
same location
Toxicity may or may not reverse, hearing
63. Unilateral HA Migrane & cluster HA imparied, tinnitus, n/v
64. HA arises in temporal areas Migraine and Tension HA 79. Peripheral CN VIII compression, Vestibular,
vertigo: Acoustic imparired one side, may involve CN V
65. retro-orbital Cluster HA
Neuroma VII
66. Nausea and vomiting are Migrane, tumor,
80. Central Vertigo Sudden, brainstem deficits, dysartharia,
commong in these types of subarachnoid HA
ataxia, crossed motor and sensory
HA
deficits
67. Valsalva and lying down mass lesion d/t change
81. Have patient Fatigue?
increases pain ICP
clarify weakness Apathy?
68. Aura/Prodrome present & Migrane HA Drowsiness?
Actual loss of strength?
3/5 POUND feature present:
82. True Motor Arise from CNS, peripheral nerve,
Pulsatile or throbbing,
Weakness neuromuscular junction or a muscle
One day duration or last 4-72
hrs, 83. Abrupts onset of motor & sensory deficits in TIA & stroke
Unilateral, weakness
n/v,
84. Progressively Guillain-Barre syndrome
Disabling/ interruption ADLs
subacute onset
69. Atypical HA suspicious for stroke of lower
especially women using extremity
contraceptives weakness
70. Older patient with Ask about medications 85. Chronic gradual Primary and metastatic spinal cord
dizziness/vertigo onset weakness tumors
ie: lower extremity
71. Feeling light headed, weak in Presyncope from 86. Focal or Central causes: ischemic, thrombotic, or
legs or about to faint Vasovagal stimulation, asymmetric mass lesion
orthostatic hypotension, weakness
arrhythmia Peripheral causes nerve injury to the
neuromuscular junction disorders to
or SE: BP & other meds myopathies
72. Vestibular dx: peripheral Vertigo 87. Identify patterns Proximal: in shoulder and or hip girdle
etiology (inner ear eg: benign of weakness
positional vertigo, labyrinthitis, Distal: hands and or feet
Meniere dx)
Symmetric: same areas both side
73. Spining sensation True Vertigo
74. Ataxia (problem w/ gait & Suspicious Vertebrobasilar Asymmetric: focal: portion of
balance) TIA or stroke consider face/extremity, monoparesis: in an
diplopia fossa tumor, migrane with extremity , paraparesis both lower
dysarthria (difficult forming brainstem aura extremity, hemiparesis half of the body.
words)
75. Peripheral vertigo: Benign Sudden, tilting head/rolling
positional vertigo: to affected side
<1min last few weeks,
n/v/nystagmus
76. Peripheral vertigo: Vestibular Sudden, Hrs-2wks,
Neuronitis (Acute labyrinthitis n/v/d/nystagmus
88. Myopathies from ETOH, drugs Proximal limb 101. Sudden, but True syncope
(gluccocorticoids), inflammatory weakness temporary LOC &
muscle disorder (polymyositis & postural tone from
dermatomyositis) transient global
hypoperfusion of
89. Proximal typically asymmetric Neuromuscular
brain
weakness gets worse w/ effort junction disorder:
(fatigability) associated w/ bulbar Myasthenia Gravis 102. Hear external voices, near syncope or presyncope
symptoms (diplopia, ptosis, feel lightheaded, or
dysarthria, dysphagia) weak, fail to lose
consciousness
90. Questions to ask to assess Proximal Difficulty combing
weakness hair? reaching shelf? 103. LOC etiology Seizures
getting out of chair?
climbing stairs? "Neurocardiogenic" conditions e.g.
vasavagal syncope, postural
Does weakness gets tachycardia syndrome, carotid sinus
worse w/ repetition syncope, orthostatic hypotension,
or improve after
rest? cardiac dx causing arrhythmias e.g.
ventricular tachycardia,
any associated bradyarrhythmias.
sensory or other
symptoms. Stroke or subarachnoid hemorrhage
unlikely unless both hemispheres
91. Questions to ask to evaluate distal Difficulty opening
affected
weakness jar? or using
scissors? 104. Most common cause vasovagal syncope
screwdriver? syncope
problem tripping
105. Syncope from Onset & offset: often sudden,
when walking?
arrhythmia reflecting loss & recovery cerebral
92. Bilateral predominatly distal suggest perfusion
weakness often with sensory loss polyneuropathy in
106. Syncope vagally Slow onset/offset
DM
mediated
93. Pins and needle numbness Paresthesias: altered hypotension prodrome nausea, diaphoresis,
sensation pallor triggered by fearful or
unpleasant event then
94. Light touch or pinprick, may cause Dysesthesias
burning or irritating sensation 107. acute symptomatic head trauma, alcohol, cocaine, and
seizure other drugs; w/drawl from alcohol,
95. Burning pain Painful sensory
benzodiazepines, and barbiturates,
neuropathies seen in
metabolic insults (high/low sugar
DM.
or calcium or sodium), acute stroke,
96. Local nerve compression or Seen in hand and meningitis or encephalitis
"entrapment" numbness in
108. Generalized seizure Tonic clonic, motor activity, bladder
distributions specific
or bowel incontinence, and post
to median, ulnar, or
ictal state
radial nerve
97. Vertebral bone spurs or herniated Nerve root tongue biting/bruising of limbs
discs compression with
109. Childhood/adolescent generalized epilepsy
dermatomal sensory
seizure
loss
110. Adults seizure Partial seizure
98. Central lesion Stroke or MS
111. more than 1 seizure consider epilepsy
99. Pattern of stocking then glove Polyneuropathies (ei:
DM)
100. Multiple patchy areas sensory loss mononeuritis
in different limbs multiplex (DM, RA)
112. Tremor a rhythmic oscillatory movement of a 118. TIA Transient episode of neurological
body part resulting from contraction of dysfunction caused by focal brain,
opposing muscle spinal cord, or retinal ischemia
w/o acute infarction'.
most common movement disorder
AHA/ASA recommends:
113. low-frequency Parkinson DX
neurodiagnostic imaging within 24
unilateral resting
hrs. of symptom onset & routine
tremor, rigidity,
noninvasive imaging of carotid &
bradykinesia
intracranial vessels.
114. High frequency Essential tremors
119. ABCD2 scoring system: Age ≥60y/o
bilateral upper
system for predicting Initial BP ≥140/90mm Hg
extremity w both
ischemic stroke within Clinical features of focal weakness
limb movement &
2, 7, 90 days post TIA or impaired speech w/o focal
sustained posture
weakness
& subside when
Duration 10-59 minutes or ≥60
limb relaxed;
minutes
head, voice, leg
Diabetes
tremor may also
be present 120. Distal symmetric Most common type.
sensorimotor
115. Unpleasant Restless leg syndrome
polyneuropathy Slowly progressive, often
sensation in legs
asymptomatic, risk for ulcerations,
especially at Reversible causes = pregnancy, renal dx,
arthropathy, & amputation.
night, gets worse iron deficiency
w rest & improves
Symptoms = burning electrical
w movement of
pain in lower extremities, usually
symptomatic
nocturnal
limbs
121. Autonomic Initial = unilateral thigh pain &
116. Glasgow Coma
dysfunction, proximal lower extremity
Scale
mononeuropathies & weakness
polyradiculopathies
including diabetic
amyotrophy
122. Semmes Weinstein
Monofilament
GCS < or = 8 Severe
GCS 9-12 Moderate
GCS >13 Minor
117. Ischemic stroke 'an infarction of CNS tissue' may be
symptomatic or silent.

'symptomatic ischemic strokes manifest

by clinical signs of focal or global
cerebral, spinal, or retinal dysfunction'

document silent stroke as

'CNS infarction that was asymptomatic'
5.07, 10gram of monofilaments

(+) test if patient cannot feel

monofilament.
123. Herpes Herpes zoster = reactivation of latent 127.
Zoster varicella virus infection within sensory
Vaccination ganglia
unilateral painful vesicular rashes in
dermatomal distribution
higher in females, lifetime = 1:3
1:4 adults experience complications:
postherpetic neuralgia (persistent pain in area
of rash), bacterial skin infections, ophthalmic
complications, cranial & peripheral
neuropathies, encephalitis, pneumonitis,
128.
hepatitis.
Increasing age = strongly associated w
herpes zoster infection & postherpetic
neuralgia
Adults 60 or older: 1 dose regardless prior
episode
Delirium DSM A. Disturbance in attention & awareness
V B. Disturbance develops over short period
time (hrs/days) change baseline fluctuate
in severity during course of day
C. A& C not better explained by another
preexisting or neurocognitive disorder, do
not occur of a severely reduce arousal,
such as coma
D. There is evidence disturbance is direct
physiological consequence of another
medical conditions, substance
intoxications, or withdrawal, or exposure to
toxin, or due to multiple etiologies.
ICD-10 A. impair consciousness and attention w/
delirium reduced ability to direct focus and sustain
attention
B. global disturbance of cognitive
C. Psycho motor disturbance
D. Disturbance of sleep wake cycle

w/chronic medical conditions can receive

E. Emotional disturbance
HZV
129. Delirium or Delirium
124. Who should Malignant conditions: Bone marrow or
Dementia:
NOT receive lymphatic system or those who receive
Acute
HZV? system immunosuppressive therapy
130. Delirium or Delirium
Medical contraindications: pregnancy or Dementia:
severe immunodeficiency Course
Fluctuating
CD4+, HIV,T lymphocyte count <200 cells/ul 131. Delirium or Delirium
125. Delirium Multifactorial syndrome = acute confusional Dementia:
state marked by sudden onset, fluctuating, Awareness-
inattention, & at times increase susceptibility impaired
& immediate precipitating factors. 132. Delirium or Delirium
126. Confusion 1. acute change mental status and fluctuating Dementia:
Assessment course Attention
Method disturbed
(CAM) 2. Inattention 133. Delirium or Delirium
diagnostic Dementia:
Algorithm 3. Disorganized Thinking memory: poor
working and
4. Abnormal level of consciousness immediate
recall.
Dx delirium requires 1&2 and either 3 or 4.
134. Delirium or Dementia
Dementia:
memory poor
short term
135. Delirium or Dementia
Dementia:
delusion more
fixed
136. Delirium or Delirium 150. homonymous hemianopsias Occipital and Parietal lobe
Dementia: or quadrantanopsias in stroke
fragmented sleep postchiasmal lesions) w
normal visual acuity
137. Delirium or Dementia
Dementia: sleep- 151. Prechiasmal and anterior Retinal emoboli
wake reversal defects
138. dementia Decline in memory and cognitive 152. Anisocoria Difference of >0.4mm in 1
ability interfere with ADLS pupil diameter compared to
other.
139. Depression 1. have you been feeling down,
depressed, or hopeless (depressed 153. Palsy seen in CN? CNIII; (motor) lg pupil reacts
mood) poorly to light or aniscoria
2. have you felt little interest or worsens in light.
pleasure in doing things (anhedonia).
154. Ptosis & Opthalmoplegia & Intracranial aneurysm
patient is awake
Yes to any of 2, do PH9
155. Ptosis & Opthalmoplegia & Transtenorial herniation
140. MMSE Orientation to time (5)
patient is comatose
Orientation to place (5)
Registration (3) 156. Horner syndrome & simple Both pupil react to light &
Count 7s, WORLD (5) aniscoria aniscoria worsens in dark,
Recall (3) small pupil has abnormal
Name Obj (2) dilation
Repeat (1)
Follow commands (3) miosis,ptosis,anhdrosis
Close your eyes (1) 157. CN III, IV, & VI dysconjugate gaze,
Write sentence (1) monocular diplopia
Copy drawing (1)
158. Nystagmus w/ gait ataxia & Cerebellar dx
dysarthria
0-17: marked impairment
18-23 moderate impairment 159. Ptsosis CN? DX? CN III (Motor) nerve palpsy,
24-30 normal Horner syndrome (ptosis,
miosis, forehead anhidrosis),
141. DSM-5 Major 5 or more of the following???
myasthenia gravis
depressive
episodes 160. Difficult clenching jaw or Masseter and lateral
moving to its opposite side pterygoid weakness
142. Diagnostic criteria ...
Depression 161. unilateral weakness in CNV Pontine lesion

143. Loss of smell CNI (Sensory); Sinus conditions, head 162. Bilateral weakness in CN V Bilateral hemispheric disease
occurs in? CN? trauma, smoking, aging, use of cocaine, 163. CNS stroke patterns Ipsilateral facial & body
Parkinson's disease sensory loss d/t contralateral
144. Visual Acuity & CN II; (sensory) cortical or thalamic lesions
optic fundi checks 164. Brainstem lesions Ipsilateral face but
which CN? contralateral body sensory
145. Blurred margins in Papilledema loss
vision check 165. Isolated sensory loss pheripheral nerve disorders,
means lesion in trigeminal nerve (V)
146. Pallor during optic atrophy 166. acoustic neuroma Blinking absent &
vision check sensorineural hearing loss
147. cup enlargement Glaucoma 167. flattening of nasolabial fold facial weakness, CNVII
in vision check and drooping lower lid
148. Bitemporal defect in optic chiasm, pituitary tumor
hemianopsias
149. Poor visual acuity Optic neuritis
168. Bell's palsy affects both upper & lower face, taste 187. muscle hypotonia PNS dx
loss, hyeracusis (increased sensitivity or flaccidity
to certain frequency and volume
188. velocity Corticospinal tract dx
range of sound), increased/decreased
dependen
tearing
increased tone
169. Central lesion affects lower face only worsens @
extreme range
170. Whispered test CNIII,
which CN 189. Velocity Spasticity, seen in corticospinal tract
dependent diseases
171. Conductive hearing excess cerumen, otosclerosis, otitis
increased tone
loss media
worsens at the
172. Sensorineural aging extremes of
hearing loss range. Rate
173. Vertigo w/ hearing Meniere dx dependent,
loss & nystagmus increasing with
rapid movement
174. Uvula does not rise Lesion CN X.
when the patient 190. Increased with Rigidity
says "AH" resistance,
throughout ROM
175. Palate side fails to Unilateral paralysis
and in both
rise & is pulled
directions, it is
toward normal side
not rate-
176. difficulty Pharyngeal or palatal weakness. dependent
swallowing
191. Absent strength Paralysis or plegia
177. Unilateral absence Lesion CN IX and X
192. 1/2 of the body Hemiparesis
of gag reflex
paralysis
178. Trapezius weakness CN XI; Pheripheral nerve disorder
193. Impaired strength Paresis
with atrophy and
or weakness
fasciculations
194. legs paralysis Paraplegia
179. Shoulder droops, Trapezius paralysis
scapula displaced 195. Quadriplegia All 4 limb paralysis
down & laterally 196. Muscle strongest When shortest
180. Bilateral weakness CN XII; pt unable to raise head off 197. Muscle weakest when longest
SCM muscle pillow
198. grade muscular
181. Tongue atrophy ALS, past polio response
and fasciculation s
182. protruded tongue Unilateral cortical lesion
deviates away form
the side of the
cortical lesion
183. Tongue deviates to CN XII lesion
weak side
184. Pseudohypertrophy Increased bulk w/diminished strength.
ie: Duchenne form of muscular 199. peripheral radial Wrist extensor weakness
dystrophy nerve damage &
hemiplegia of
185. Mild atrophy d/t corticospinal tract injury stroke or MS
muscle disuse seen
in
186. Fasciculations with Peripheral motor neuron disease
atrophy and muscle
weakness
200. Cervical radiculopathy, de Quervain Weak hand grip 212. unable to stand Cerebellar ataxia
tenosynovitis, carpal tunnel with feet together
syndrome, arthritis, epicondylitis eyes open/closed
201. Weak finger abduction ulnar nerve 213. Pain and spinothalamic tractsp
disorders temperature
202. Hip symmetric weakness of myopathy. 214. position and posterior column
proximal muscles vibrations
203. Symmetric weakness distal polyneuropathy & 215. light touch both pathways
weakness PN disorders
216. Decerebrate Neck: extended
204. nystagmus, dysarthria, hypotonia, Cerebellar dx Arms: adducted
ataxia w muscle Forearms: pronated
coordination. wrist and fingers: flexed
205. Rapid alternating movements = dysdiadochokinensis
Lesions on diencephalon, midbrain or
movements slow, irregular, clumsy = cerebellar dx
pons. Hypoxia, hypoglycemia
Upper motor neuron 217. Decorticated: Upper arms: flexed tight to sides,
weakness & basal elbows, wrist, and fingers flexed
ganglia dx also
impair these destructive lesion of corticospinal
movements but not tracts within or near cerebral
same manner hemispheres.
206. Point-to-point movements: clumsy, cerebellar dx 218. small pinpoint 1-2.5cm damage to sympathetic
unsteady, inappropriately speed, pupils pathways in hypothalamus, metabolic
force, directions variable encephalopahty, including drugs
219. Midposition fixed 5-6cm: fixed to light: structural
Incoordination worsens moderately
pupils damage to midbrain
w eyes closed = loss of position
sense. Consistent deviation to 1 side 220. Large pupils severe anoxia, sympathomimetic
worsens w eyes closed = past effects (seen after cardiac arrest)
pointing = cerebellar or vestibular atropine like agent, phenothiazides,
dx tricyclic,

207. Heel walk inability corticospinal tract

Bilaterally large reactive: LSD,
damage
amphetamines, cocaine, sympathetic
208. Hopping difficulty weakness, lack of agonist.
position sense,
221. One large pupil fixed and dialated, hernation temporal
cerebellar
lobe causing compression of
dysfunction.
oculomotor nerve and midbrain.
209. Ataxia = uncoordinated, reeling, cerebellar dx,
instability = intoxication, position commonly seen DM patient w/
sense loss. infarctions CN III
210. Shallow knee bends difficulty proximal weakness
(extensors of hip);
quadriceps
weakness (knee
extensor) or both
211. Romberg test Position sense. pt
stands fairly well w
eyes open loses
balance when eyes
closed is + for
romberg test