Term
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Definition
| Alert, lethargy (loud voice), obtundation (gently shake), stupor (painful stimulus), coma (repeated painful stimuli) |
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Term
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Definition
| loss of voice, defect in larynx or its nerve supply (vagus) |
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Term
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Definition
| less severe impairment in volume, quality or pitch of voice |
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Term
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Definition
| defect in the muscular control of the speech apparatus (lips, tongue, palate, pharynx) → nasal, slurred or indistinct speech |
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Term
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Definition
| disorder in producing or understanding language |
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Term
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Definition
i. Fluent, rapid, voluble, effortless – articulation good, but sentences lack meaning; words malformed or invented & speech may be incomprehensible
ii. All language tests impaired
iii. Posterior superior temporal lobe legion |
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Term
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Definition
i. nonfluent, slow with few words & laborious effort; impaired inflection & articulation – words meaningful with fair comprehension
ii. impaired repetition, writing, naming (though pt recognizes object)
iii. word and reading comprehension fair to good
iv. posterior inferior frontal lobe |
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Term
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Definition
starts w/ focal manifestation – may be simple partial or complex partial
i. partial seizures may become generalized (resembling tonic/clonic, including the confused postictal state) – however, can recognized that a pertial seizure has become generalized by
1. recollection of an aura
2. unilateral neurological deficit during postictal phase |
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Term
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Definition
| do not impair consciousness – postictal state is normal |
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Term
| simple partial with motor sx |
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Definition
1. Jacksonian : tonic then clonoc mvmts that start unilaterally in hand, foot, face, then spread to other parts of the body
2. Other : turning of head and eyes to one side or tonic & clonic mvmts of an arm or leg w/o Jacksonian spread |
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Term
| simple partial with sensory |
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Definition
| numbess, tingling ; visual, auditory or olfactory hallucinations |
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Term
| simple partial with ANS sx |
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Definition
| funny feeling in epigastrum, nausea, pallor, flushing, lightheadedness |
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Term
| simple partial with psychiatric sx |
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Definition
| anxiety, fear, deja vu, unreality, dreamy states, fear or rage, flashbacks |
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Term
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Definition
impair consciouness & confusion – may or may not have ANS & psych sx
i. Automatisms: automatic motor behaviors like chewing, smacking the lips, walking about, unbuttoning clothes – may even be more complex like driving a car
ii. Patient may remember the aura but is amnesic for the rest of the seizure |
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Term
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Definition
: begin with bilateral body mvmts, impairment of consciousness or both
i. Suggest bilateral cortical disturbance |
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Term
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Definition
sudden LOC, sometimes w/ a cry
i. Tonic phase: body stiffens into extensor rigidity; breathing ceases → cyanosis
ii. Clonic phase: breathing resumes & is noisy w/ excess salivation; rhythmic muscular contraction; injury, tongue biting and incontinence may occur
iii. Postictal state – confusion, drowsiness, fatigue, HA & possible bilateral neurologic deficits (hyperactive reflexes and Babinski’s responses) – person has amnesia for the seizure & recalls no aura |
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Term
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Definition
sudden brief loss of consciousness with momentary blinking, staring or mvmts of lips and hands but no falling
i. No aura recalled in postictal state
ii. Petit mal absences: last < 10 sec & stop abruptly – prompt return to normal
iii. Atypical absences: last > 10 sec – some postictal confusion |
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Term
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Definition
sudden LOC w/ falling but no mvmts
i. Either a prompt return to normal or brief period of confusion |
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Term
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Definition
| may mimic seizures but are due to a conversion reaction |
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Term
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Definition
(static)most prominent at rest & may decrease/disappear w/ voluntary mvmt
i. Ex. Slow, fine “pill-rolling” tremor of Parkinson’s |
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Term
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Definition
action) appear when affected part is maintaining a posture – may worsen w/ intention
i. Ex. Fine rapid tremor of hyperthyroidism, anxiety & fatigue |
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Term
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Definition
absent at res, appear with activity – often getting worse as target is neared
i. Ex. Cerebellar pathway disorders as in MS |
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Term
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Definition
rhythmic, repetitive, bizarre mvmts that chiefly involve the face, mouth, jaw & tongue
i. Grimacing, pursing of the lips, protrusions of tongue open/closing of mouth & jaw deviations
ii. Limbs and trunk less commonly involved
iii. Ex. Late complication of psychotropic drugs (phenothiazines) = tardive dyskinesia
iv. Ex. Long-standing psychoses in elderly and in edentulous persons (w/o teeth) |
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Term
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Definition
brief, repetitive, stereotyped, coordinated mvmts at irregular intervals
i. Repetitive grimacing, winking, shoulder shrugging
ii. Ex. Tourette’s and drugs (phenothiazines & amphetamines) |
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Term
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Definition
brief, rapid, jerky, irregular mvmt that seldom repeat themselves
i. Occur at rest or interrupt normal coordinated mvmts
ii. Sydenham’s chorea (rheumatic fever) & Huntington’s disease |
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Term
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Definition
slow twisting & writhing with large amplitude – usually face & distal extremities, often spasticity
i. Ex. Cerebral palsy |
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Term
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Definition
similar to athetoid – involve larger body portions (trunk); grotesque, twisting
i. Ex. Phenothiazines, primary tonic dystonia & spasmodic torticollis |
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Term
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Definition
lesion of UMN of corticospinal tract – anywhere from cord to cortex
i. Rate dependent hypertonia – tone > when passive mvmt is rapid & < when passive mvmt is slow
ii. Tone is > at extremes of mvmt arc
iii. Clasp-knife resistance: with rapid passive mvmt, initial hypertonia may give way suddenly as limb relaxes (“spastic catch”)
iv. Cause: stroke – esp late or chronic stage |
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Term
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Definition
lesion to basal ganglia system
i. Increased resistance through mvmt arc, independent of rate = lead-pipe rigidity
ii. Flexion/extension of wrist or forearm → ratchet like jerkiness = cogwheel rigidity
iii. Cause: Parkinsonism |
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Term
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Definition
lesion to LMN anywhere from anterior horn cell to peripheral nerve
i. Hypotonia → loose & floppy limb, limbs may be hyper-extensible or flail like
ii. Cause: Guillain – Barre syndrome, also initial phase of cord injury or stroke |
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Term
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Definition
lesion to both hemispheres, usually in frontal lobe
i. Sudden change in tone with passive ROM
ii. Mitgehen: sudden loss of tone that increases the ease of motion
iii. Gegenhalten: sudden increase in tone that makes mvmt more difficult
iv. Causes: dementia |
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Term
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Definition
lesion in corticospinal tract as with stroke
i. One arm held immobile close to side with elbow, wrist & interphalangeal joints flexed
ii. Leg extended with plantar flexion of the foot
iii. In walking, pt either drags the leg or circumducts the foot |
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Term
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Definition
associated with bilateral spastic paresis of the legs
i. Gait is stiff, each leg advanced slowly with the thighs crossing forward of each other w/ each step
ii. Steps are short – pt appears to be walking thru the water |
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Term
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Definition
associated with foot drop – secondary to lower motor neuron disease
i. Drag their feet or lift them high with knees flexed & bring them down w/ a slap
ii. Appears to walking up stairs – unable to walk on their heels (gait may involve one or both sides) |
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Term
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Definition
associated with basal ganglia defects of Parkinson’s
i. Posture is stooped, head & neck forward – hips and knees slightly flexed; arms flexed at elbows & wrists
ii. Pt is slow to start; short & shuffling steps; arm swings decreased – pt turns @ stiffly “all in 1 piece” |
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Term
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Definition
associated with disease of cerebellum or associated tracts
i. Gate is staggering, unsteady & wide based – exaggerated difficulty on the turns
ii. Cannot stand steady with feet together when eyes are open or closed |
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Term
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Definition
associated with loss of position sense in the legs – polyneuropathy or posterior column damage
i. Gait unsteady and wide based
ii. Pts throw feet foreword & out, then bring them down (heels 1st, then toes → doubling tapping sound)
iii. Watch the ground closely – will have positive Romberg sign |
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Term
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Definition
abnormal flexor response)
i. Upper arms held tight at the sides with elbows, wrists and fingers flexed
ii. Legs extended & internally rotated – feet are plantar flexed
iii. Implies lesion in corticospinal tract w/i or near cerebral hemispheres
iv. When unilateral = chronic spastic hemiplegia |
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Term
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Definition
i. Sudden unilateral damage to corticospinal tract → hemiplegia
ii. Flaccidity in early course → spasticity late
iii. Paralyzed arm & leg are slack (leg may be externally rotated), fall loosely to bed when raised – spontaneous mvmt or response to stimuli only on opposite side
iv. One side of lower face may be paralyzed & cheek puffs out with expiration
v. Both eyes may turn away from paralyzed side |
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Term
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Definition
(abnormal extensor response)
i. Jaws are clinched – neck is extended, arms adducted and stiffly extended at elbows
ii. Forearms pronated with wrists and fingers flexed
iii. Legs stiffly extended with feet plantar flexed
iv. May occur spontaneously or in response to stimuli
v. Lesions in diencephalon, pons or midbrain – may be due to hypoxia or hyperglycemia |
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Term
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Definition
| acute, fluctuating with lucid intervals, worse at night; hours to weeks; sleep always disrupted; general medical illness or drug toxicity almost always present; DTs, uremia, acute hepatic failure, acute cerebral vaculitis, atropine poisoning |
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Term
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Definition
| insidious onset; slowly progressive; months to years; sleep fragmented; general medical illness or drug toxicity absent; vitamin B12 deficiency, thyroid disorders, Alheimer's disease, vascular dementia, head trauma |
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