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Key Terms Chapter 16: The Neurological Exam

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    in vision, a change in the ability of the eye to focus on objects at different distances
    accommodation–convergence reflex
    coordination of somatic control of the medial rectus muscles of either eye with the parasympathetic control of the ciliary bodies to maintain focus while the eyes converge on visual stimuli near to the face
    anterograde amnesia
    inability to form new memories from a particular time forward
    loss of language function
    movement disorder related to damage of the cerebellum characterized by loss of coordination in voluntary movements
    Babinski sign
    dorsiflexion of the foot with extension and splaying of the toes in response to the plantar reflex, normally suppressed by corticospinal input
    lateral regions of the cerebellum; named for the significant input from the cerebral cortex
    check reflex
    response to a release in resistance so that the contractions stop, or check, movement
    clasp-knife response
    sign of UMN disease when a patient initially resists passive movement of a muscle but will quickly release to a lower state of resistance
    conduction aphasia
    loss of language function related to connecting the understanding of speech with the production of speech, without either specific function being lost
    conductive hearing
    hearing dependent on the conduction of vibrations of the tympanic membrane through the ossicles of the middle ear
    conjugate gaze
    coordinated movement of the two eyes simultaneously in the same direction
    in vision, the movement of the eyes so that they are both pointed at the same point in space, which increases for stimuli that are closer to the subject
    coordination exam
    major section of the neurological exam that assesses complex, coordinated motor functions of the cerebellum and associated motor pathways
    cortico-ponto-cerebellar pathway
    projection from the cerebral cortex to the cerebellum by way of the gray matter of the pons
    cranial nerve exam
    major section of the neurological exam that assesses sensory and motor functions of the cranial nerves and their associated central and peripheral structures
    study of a tissue based on the structure and organization of its cellular components; related to the broader term, histology
    deep tendon reflex
    another term for stretch reflex, based on the elicitation through deep stimulation of the tendon at the insertion
    double vision resulting from a failure in conjugate gaze
    fluid accumulation in tissue; often associated with circulatory deficits
    obstruction in a blood vessel such as a blood clot, fatty mass, air bubble, or other foreign matter that interrupts the flow of blood to an organ or some part of the body
    episodic memory
    memory of specific events in an autobiographical sense
    expressive aphasia
    loss of the ability to produce language; usually associated with damage to Broca’s area in the frontal lobe
    extrinsic muscles of the tongue
    muscles that are connected to other structures, such as the hyoid bone or the mandible, and control the position of the tongue
    small muscle twitch as a result of spontaneous activity from an LMN
    opening from the oral cavity into the pharynx
    in motor responses, a spontaneous muscle action potential that occurs in the absence of neuromuscular input, resulting from LMN lesions
    flaccid paralysis
    loss of voluntary muscle control and muscle tone, as the result of LMN disease
    presentation of a loss of muscle tone, observed as floppy limbs or a lack of resistance to passive movement
    flocculonodular lobe
    lobe of the cerebellum that receives input from the vestibular system to help with balance and posture
    rhythmic pattern of alternating movements of the lower limbs during locomotion
    gait exam
    major section of the neurological exam that assesses the cerebellum and descending pathways in the spinal cord through the coordinated motor functions of walking; a portion of the coordination exam
    in a neurological exam, intuitive experiential knowledge tested by interacting with common objects or symbols
    perception of symbols, such as letters or numbers, traced in the palm of the hand
    cut through half of a structure, such as the spinal cord
    hemorrhagic stroke
    disruption of blood flow to the brain caused by bleeding within the cranial vault
    overly flexed joints
    low muscle tone, a sign of LMN disease
    decrease in blood volume
    inferior cerebellar peduncle (ICP)
    input to the cerebellum, largely from the inferior olive, that represents sensory feedback from the periphery
    inferior olive
    large nucleus in the medulla that receives input from sensory systems and projects into the cerebellar cortex
    internuclear ophthalmoplegia
    deficit of conjugate lateral gaze because the lateral rectus muscle of one eye does not contract resulting from damage to the abducens nerve or the MLF
    medial rotation of the eye around its axis
    intrinsic muscles of the tongue
    muscles that originate out of, and insert into, other tissues within the tongue and control the shape of the tongue
    ischemic stroke
    disruption of blood flow to the brain because blood cannot flow through blood vessels as a result of a blockage or narrowing of the vessel
    jaw-jerk reflex
    stretch reflex of the masseter muscle
    localization of function
    principle that circumscribed anatomical locations are responsible for specific functions in an organ system
    medial longitudinal fasciculus (MLF)
    fiber pathway that connects structures involved in the control of eye and head position, from the superior colliculus to the vestibular nuclei and cerebellum
    mental status exam
    major section of the neurological exam that assesses cognitive functions of the cerebrum
    middle cerebellar peduncle (MCP)
    large, white-matter bridge from the pons that constitutes the major input to the cerebellar cortex
    motor exam
    major section of the neurological exam that assesses motor functions of the spinal cord and spinal nerves
    neurological exam
    clinical assessment tool that can be used to quickly evaluate neurological function and determine if specific parts of the nervous system have been affected by damage or disease
    paramedian pontine reticular formation (PPRF)
    region of the brain stem adjacent to the motor nuclei for gaze control that coordinates rapid, conjugate eye movements
    partial loss of, or impaired, voluntary muscle control
    plantar reflex
    superficial reflex initiated by gentle stimulation of the sole of the foot
    in a neurological exam, the act of doing something using ready knowledge or skills in response to verbal instruction
    procedural memory
    memory of how to perform a specific task
    pronator drift
    sign of contralateral corticospinal lesion when the one arm will drift into a pronated position when held straight out with the palms facing upward
    receptive aphasia
    loss of the ability to understand received language, such as what is spoken to the subject or given in written form
    red nucleus
    nucleus in the midbrain that receives output from the cerebellum and projects onto the spinal cord in the rubrospinal tract
    retrograde amnesia
    loss of memories before a particular event
    Rinne test
    use of a tuning fork to test conductive hearing loss versus sensorineural hearing loss
    Romberg test
    test of equilibrium that requires the patient to maintain a straight, upright posture without visual feedback of position
    rubrospinal tract
    descending tract from the red nucleus of the midbrain that results in modification of ongoing motor programs
    small, rapid movement of the eyes used to locate and direct the fovea onto visual stimuli
    sensorineural hearing
    hearing dependent on the transduction and propagation of auditory information through the neural components of the peripheral auditory structures
    sensory exam
    major section of the neurological exam that assesses sensory functions of the spinal cord and spinal nerves
    short-term memory
    capacity to retain information actively in the brain for a brief period of time
    Snellen chart
    standardized arrangement of letters in decreasing size presented to a subject at a distance of 20 feet to test visual acuity
    increased contraction of a muscle in response to resistance, often resulting in hyperflexia
    spinocerebellar tract
    ascending fibers that carry proprioceptive input to the cerebellum used in maintaining balance and coordinated movement
    midline region of the cerebellum known as the vermis that receives proprioceptive input from the spinal cord
    perception of common objects placed in the hand solely on the basis of manipulation of that object in the hand
    (also, cerebrovascular accident (CVA)) loss of neurological function caused by an interruption of blood flow to a region of the central nervous system
    superficial reflex
    reflexive contraction initiated by gentle stimulation of the skin
    superior cerebellar peduncle (SCP)
    white-matter tract representing output of the cerebellum to the red nucleus of the midbrain
    transient ischemic attack (TIA)
    temporary disruption of blood flow to the brain in which symptoms occur rapidly but last only a short time
    prominent ridge along the midline of the cerebellum that is referred to as the spinocerebellum
    vestibulo-ocular reflex (VOR)
    reflex based on connections between the vestibular system and the cranial nerves of eye movements that ensures that images are stabilized on the retina as the head and body move
    flocculonodular lobe of the cerebellum named for the vestibular input from the eighth cranial nerve
    Weber test
    use of a tuning fork to test the laterality of hearing loss by placing it at several locations on the midline of the skull
    Wernicke’s area
    region at the posterior end of the lateral sulcus in which speech comprehension is localized
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