Professional Documents
Culture Documents
Neurology
SECTION
Neuroanatomy illustrations 166
Signs and symptoms of cerebrovascular
lesions 171
Signs and symptoms of injury to the
lobes of the brain 175
Signs and symptoms of haemorrhage to
other areas of the brain 178
Cranial nerves 179
Key features of upper and lower motor
neurone lesions 183
3
Functional implications of spinal cord
injury 184
Glossary of neurological terms 187
Neurological tests 189
Modified Ashworth scale 192
Neurological assessment 192
References and further reading 195
Postcentral
Postcentral gyrus Central
sulcus sulcus
Precentral
Parietal gyrus
lobe
Precentral
Occipital sulcus
lobe
SECTION Frontal
lobe
3
Preoccipital
NEUROLOGY
notch Lateral
sulcus
Temporal
sulci Temporal
Temporal gyri
lobe
Figure 3.1 Lateral view of right cerebral hemisphere. f0010
Optic
chiasma Thalamus
Pineal gland
Infundibulum
Cerebellum
Pituitary gland Midbrain SECTION
Pons Fourth ventricle
Brain stem Medulla
oblongata Spinal
3
cord
NEUROLOGY
f0030 Figure 3.3 Mid-sagittal section of the brain.
Splenium Lateral
ventricle
(inferior horn)
Calcarine
sulcus
Thalamus Putamen
Insula
SECTION Globus
Claustrum pallidus
3 Temporal horn
of lateral Third Hippocampus
ventricle ventricle
NEUROLOGY
Subthalamic
nucleus
Pons Substantia
nigra
Figure 3.5 Coronal section of the brain. f0050
Primary motor
Primary somatic cortex
sensory cortex
Supplementary
Primary auditory motor cortex
cortex
Primary
visual
cortex
168 Figure 3.6 Lateral view of sensory and motor cortical areas. f0060
Visual
association
cortex
SECTION
Primary
Olfactory cortex visual
cortex 3
f0070 Figure 3.7 Medial view of sensory and motor cortical areas.
NEUROLOGY
Anterior
cerebral artery
SECTION
3 Lateral
Pontine
spinothalamic
reticulospinal
Anterior
NEUROLOGY
spinothalamic Vestibulospinal
Tectospinal
Anterior
corticospinal
Figure 3.9 Ascending and descending spinal cord tracts. f0090
SECTION
NEUROLOGY
f0100 Figure 3.10 Middle cerebral artery.
The anterior cerebral artery arises from the internal carotid p0050
artery and is connected by the anterior communicating
artery. It follows the curve of the corpus callosum and sup-
plies the medial aspect of the frontal and parietal lobes, cor-
pus callosum, internal capsule and basal ganglia (caudate
172 nucleus and globus pallidus).
NEUROLOGY
Spastic paresis of lower limb Bilateral motor leg area
p0070 The posterior cerebral artery arises from the basilar artery. It
supplies the occipital and temporal lobes, midbrain, choroid
plexus, thalamus, subthalamic nucleus, optic radiation,
corpus callosum and cranial nerves III and IV. The posterior
communicating arteries connect the posterior cerebral arter-
ies to the middle cerebral arteries anteriorly. 173
NEUROLOGY
consciousness tracts
Pseudobulbar palsy, emotional Bilateral supranuclear
instability fibres, cranial nerves
IX–XII
Locked-in syndrome Bilateral medulla or
pons
Coma, death Brainstem
NEUROLOGY
Optic radiation Upper homonymous
Visual pathways quadrantanopia
Putamen s0130
Thalamus s0140
Pons s0150
NEUROLOGY
s0170 Cranial nerves
p0230 The cranial nerves form part of the peripheral nervous sys-
tem and originate from the brain. Each nerve is named
according to its function or appearance and is numbered
using Roman numerals from I to XII. The numbers roughly
correspond to their position as they descend from just above
the brainstem (I and II), through the midbrain (III and IV),
pons (V to VII) and medulla (VIII to XII).
179
180
SECTION
Name Function Test Abnormal signs
Olfactory (I) Smell Identify a familiar odour, e.g. Partial or total loss of smell
coffee, orange, tobacco, with Altered or increased sense
one nostril at a time of smell
Optic (II) Sight Visual acuity: read with one Visual fields defects, loss of
eye covered visual acuity, colour-blind
Peripheral vision: detect
objects or movement from
the corner of the eye with the
other eye covered
Oculomotor (III) Movement of eyelid and Follow the examiner’s finger, Squint, ptosis, diplopia, pupil
eyeball, constriction which moves up and down and dilation
of pupil, lens side to side, keeping the head
accommodation in mid-position
Trochlear (IV) Movement of eyeball As for oculomotor Diplopia, squint
upwards
Trigeminal (V) Mastication, sensation Test fascial sensation Trigeminal neuralgia, loss of
for eye, face, sinuses and Clench teeth (the examiner mastication and sensation in
teeth palpates the masseter and eye, face, sinuses and teeth
temporalis muscles)
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Abducens (VI) Movement of eyeball into As for oculomotor Gaze palsy
abduction, controls gaze
Facial (VII) Facial movements, Test ability to move the face, Bell’s palsy, loss of taste and
sensation and taste for e.g. close eyes tightly, wrinkle ability to close eyes
anterior two-thirds of brow, whistle, smile, show
tongue, secretion of teeth
saliva and tears
Vestibulocochlear Hearing, balance Examiner rubs index finger and Tinnitus, deafness, vertigo,
(VIII) thumb together noisily beside ataxia, nystagmus
one ear and silently beside the
other. Patient identifies the
noisy side
Glossopharyngeal Sensation and taste for Swallow Loss of tongue sensation
(IX) posterior third of tongue, Evoke the gag reflex by and taste, reduced salivation,
swallow, salivation, touching the back of the dysphagia
regulation of blood throat with a tongue
pressure depressor
Vagus (X) Motor and sensation for As for glossopharyngeal Vocal cord paralysis,
heart, lungs, digestive tract dysphagia, loss of sensation
and diaphragm, secretion from internal organs
of digestive fluids, taste,
swallow, hiccups
NEUROLOGY
3
181
SECTION
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NEUROLOGY
182
SECTION
Name Function Test Abnormal signs
Accessory (XI) Motor to soft palate, Rotate neck to one side and Paralysis of innervated
larynx, pharynx, trapezius resist flexion, i.e. contract muscles
and sternocleidomastoid sternocleidomastoid. Shrug
shoulders against resistance
Hypoglossal (XII) Tongue control and strap Stick out the tongue. Dysphagia, dysarthria,
muscles of neck Push tongue into the left and difficulty masticating
right side of the cheek
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s0180 Key features of upper and lower motor neurone
lesions
NEUROLOGY
flexor weakness in innervated by
lower limb affected spinal
Whole limb(s) segment/root,
involved plexus or
peripheral nerve
183
184
SECTION
Functional implications of spinal cord injury
s0210
Level Motor control Personal Equipment Mobility
independence
C1–C2 Swallow, talk, chew, Type, turn pages, Hoist, respirator, mouthstick, Wheelchair
blow (cough absent) use telephone and reclining powered wheelchair
computer using breath/chin control
C3 Neck control, weak As above Hoist, respirator, mouth/head Wheelchair
shoulder elevation stick, wheelchair as above
C4 Respiration, neck Feed possible Mouth/head stick, hoist, mobile Wheelchair
control, shoulder shrug arm supports, wheelchair as above
C5 Shoulder external Feed, groom, roll Adapted feeding/grooming Wheelchair
rotation, protraction, in bed, weight shift, equipment and hand splints,
elbow flexion, push wheelchair on mobile arm supports, powered
supination flat, use brake wheelchair with hand controls or
lightweight manual with grips
C6 Shoulder, elbow Tenodesis grip, drink, Adapted equipment and splints, Bed mobility,
flexion, wrist write, personal ADL, transfer board, hand-controlled bed to chair
extension, pronation. transfers, dress upper car, lightweight manual transfers,
Weak elbow extension, body, light domestic wheelchair, powered for short wheelchair, car
wrist flexion and thumb chores, push distances
control wheelchair on slope
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C7 Elbow extension, finger Dress lower body, Bath board, shower chair, hand- All transfers,
flexion and extension, personal and skin controlled car, wheelchair as wheelchair, car
limited wrist flexion care, showering, above
all transfers, pick
up from floor,
wheelchair sports
C8 Wrist flexion, hand Bladder and bowel Grab rails, standing frame, non- Stand in frame
control care adapted wheelchair
T1–T5 Top half of intercostals Trunk support, Bilateral knee–ankle orthoses Full wheelchair
and long back muscles improved balance, with spinal attachment, standing independence,
assisted cough, frame/table transfer floor to
negotiate kerbs with chair, mobilize
wheelchair, routine with assistance
domestic chores for short
distances
T6– Abdominals Good balance, weak Bilateral knee–ankle orthoses, Mobilize
T12 to normal cough, crutches or frame independently
improved stamina indoors, transfer
chair to crutches
L1–L2 Hip flexion Calipers Stairs, transfer
floor to crutches
NEUROLOGY
3
185
SECTION
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NEUROLOGY
186
SECTION
Level Motor control Personal Equipment Mobility
independence
L3–L5 Knee extension, Ankle–foot orthoses, crutches/
weak knee flexion, sticks
dorsiflexion and
eversion
S1–S2 Hip extension Improved standing Normal gait
balance without aids
S2–S4 Bladder, bowel and
sexual function
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s0220 Glossary of neurological terms
NEUROLOGY
Anosognosia denial of ownership or the existence
of a hemiplegic limb
Aphasia inability to generate and understand
language whether verbal or written
Astereognosis inability to recognize objects by
touch alone, despite intact sensation
Ataxia shaky and uncoordinated voluntary
movements that may be associated
with cerebellar or posterior column
disease
Athetosis involuntary writhing movements
affecting face, tongue and hands
Bradykinesia slowness of movement
Chorea irregular, jerky, involuntary
movement
Clonus more than three rhythmic
contractions of the plantarflexors
in response to sudden passive
dorsiflexion
Diplopia double vision
Dysaesthesia perverted response to sensory stimuli
producing abnormal and sometimes
unpleasant sensation
187
NEUROLOGY
s0230 Neurological tests
to close their eyes. Stroke the patient’s skin with the cotton
wool at random points, asking them to indicate every time
they feel the touch.
Indicates: altered touch sensation. p0420
NEUROLOGY
only when they close their eyes.
s0330 Temperature
p0510 A quick test involves using a cold object such as a tuning fork
and asking the patient to describe the sensation when applied
to various parts of the body. For more formal testing, two test
tubes are filled with cold and warm water and patients are
asked to distinguish between the two sensations.
p0520 Indicates: altered temperature sensation.
s0340 Two-point discrimination
p0530 Requires a two-point discriminator, a device similar to a pair
of blunted compasses. With the patient’s eyes open, demon-
strate what you are going to do. Get the patient to close their
eyes. Alternately touch the patient with either one prong
or two. Reduce the distance between the prongs until the
patient can no longer discriminate between being touched by
one prong or two prongs. Varies according to skin thickness
but normal young patients can distinguish a separation of
approximately 5 mm in the index finger and approximately
4 cm in the legs. Compare left to right.
p0540 Indicates: impaired sensory function.
191
SECTION
Modified Ashworth scale s0360
3
Grade Description
0 No increase in muscle tone
NEUROLOGY
NEUROLOGY
u0110 Indoor and outdoor mobility
u0120 Continence
u0130 Vision
u0140 Hearing
u0150 Swallowing
u0160 Fatigue
u0170 Pain
u0180 Other ongoing treatment
u0190 Past physiotherapy and response to treatment
u0200 Perceptions of own problems/main concern
u0210 Expectations of treatment
s0400 Objective examination
s0410
u0220 Posture and balance
p0830 Alignment
u0230 Neglect
u0240 Sitting balance
u0250 Standing balance
o0120 – Romberg’s test
s0420
u0260 Voluntary movement
p0890 Range of movement
u0270 Strength
193
Reflexes s0450
Deep tendon reflexes p1070
u0360
– biceps (C5/6) o0180
– triceps (C7/8) o0190
– knee (L3/4) o0200
– ankle (S1/2) o0210
Plantar reflex u0370
Hoffman’s reflex u0380
Muscle and joint range s0460
Passive range of movement p1150
u0390
Sensory s0470
u0400
Light touch p1170
Pin prick u0410
Two-point discrimination u0420
Vibration sense u0430
Joint position sense u0440
Temperature u0450
Vision and hearing u0460
s0480
Functional activities p1250
Bed mobility u0480
Sitting balance u0470
194 Transfers u0490
NEUROLOGY
u0610 Memory
s0520 Emotional state