Week 11 Lobes and principal fissures of the cerebral cortex, cerebellum, and brainstem (left hemisphere, lateral view). Make a chart differentiating between descending and ascending spinal tracts. What occurs if the spinal cord is incompletely severed? Describe the nervous system. Name the three major units of the brain. Differentiate between the descending spinal tracts and the ascending spinal tracts of the spinal cord. What is the function of the pituitary gland? Name the fourth cranial nerve and state its function. List the risk factors for cerebrovascular accidents. Why is the 5.07 monofilament test used? Explain the 0 to 4+ scale for scoring deep tendon reflexes. Scoring deep tendon reflexes You are observing the neurologic examination of a 75-year-old man. You notice that before beginning the physical examination, the examiner asks the patient whether he is currently taking any medication. Why is it important to assess medications used by older adults? What is the potential long-range effect on a child if meningitis occurs during the first year of life? EI, a 44-year-old patient, comes in for a follow-up visit regarding his diabetes. Today he is complaining of numbness, tingling, and burning in his feet. His recent laboratory studies demonstrate an elevated hemoglobin A1c and hyperlipidemia. You diagnose him with peripheral neuropathy. 1- What are the possible etiologies of the peripheral neuropathy? What is the most likely cause? 2- Describe the patient’s objective findings with peripheral neuropathy. 3- What is the best physical assessment technique to determine peripheral neuropathy.

The chart below illustrates the differences between descending and ascending spinal tracts:


Function Conduct nerve impulses from the brain to the spinal cord, allowing for voluntary movement Relay sensory information from the periphery to the brain for processing
Location Located on the ventral side of the spinal cord Located on the dorsal side of the spinal cord
Examples Corticospinal tract (responsible for voluntary movement) Rubrospinal tract (involved in muscle tone) Spinothalamic tract (transmits pain and temperature sensations) Dorsal column-medial lemniscus system (carries proprioception, touch, and vibration sensations)

When the spinal cord is incompletely severed, it can result in a condition known as incomplete spinal cord injury. This means that there is still some level of communication between the brain and the body below the level of the injury. The severity and extent of the symptoms will depend on the location and extent of the damage. Incomplete spinal cord injuries can result in a variety of symptoms, including loss of motor function, sensory deficits, and changes in bowel and bladder function. In some cases, individuals with incomplete spinal cord injuries may be able to regain some function through rehabilitation and treatment.

The nervous system is a complex network of specialized cells called neurons that transmit information through electrical and chemical signals. It is divided into two main parts: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS includes the brain and spinal cord, while the PNS consists of the nerves that connect the CNS to the rest of the body.

The three major units of the brain are the cerebrum, cerebellum, and brainstem. The cerebrum is the largest part of the brain and is responsible for higher cognitive functions such as memory, language, and decision making. The cerebellum is located at the back of the brain and plays a crucial role in coordinating movement and balance. The brainstem connects the brain to the spinal cord and controls basic bodily functions such as breathing and heart rate.

Descending spinal tracts are responsible for conducting nerve impulses from the brain to the spinal cord, allowing for voluntary movement. Examples of descending spinal tracts include the corticospinal tract, which is responsible for voluntary movement, and the rubrospinal tract, which is involved in muscle tone.

Ascending spinal tracts, on the other hand, relay sensory information from the periphery to the brain for processing. Examples of ascending spinal tracts include the spinothalamic tract, which transmits pain and temperature sensations, and the dorsal column-medial lemniscus system, which carries proprioception, touch, and vibration sensations.

The pituitary gland, also known as the “master gland,” is a small, pea-sized gland located at the base of the brain. It is responsible for secreting hormones that regulate various bodily functions, including growth, metabolism, reproduction, and stress response.

The fourth cranial nerve is known as the trochlear nerve. Its function is to control the movement of the superior oblique muscle, which is responsible for downward and inward eye movements.

Risk factors for cerebrovascular accidents, also known as strokes, include hypertension (high blood pressure), smoking, diabetes, obesity, high cholesterol, and a family history of strokes. Other factors that can increase the risk of strokes include age, gender (males are generally at higher risk), and certain medical conditions, such as atrial fibrillation and sickle cell disease.

The 5.07 monofilament test is used to assess the sensation of vibration in the feet. It is commonly used to detect peripheral neuropathy, a condition characterized by damage to the nerves in the peripheral nervous system. The test involves applying the monofilament to specific locations on the foot and asking the patient if they can feel the vibration. If the patient cannot feel the vibration, it may indicate a loss of sensation and possible nerve damage.

The 0 to 4+ scale is a scoring system used to assess deep tendon reflexes. It is typically used to evaluate the function of the spinal cord and nerves. The scale ranges from 0, indicating no response, to 4+, indicating a very brisk response. Scoring reflexes helps determine the integrity of the nervous system and can provide information about potential underlying neurological conditions or injuries.

When assessing older adults, it is important to assess the medications they are taking because they may be more susceptible to medication-related side effects and drug interactions. Age-related changes in metabolism and organ function can affect how medications are processed in the body, leading to an increased risk of adverse effects. Additionally, older adults often have multiple chronic conditions and may be taking multiple medications, increasing the likelihood of potential interactions between drugs.

If meningitis occurs during the first year of life, there can be potential long-range effects on a child’s development. Meningitis is an infection that causes inflammation of the protective membranes surrounding the brain and spinal cord. In infants, the immature immune system and the delicacy of the developing brain and nervous system make them more vulnerable to the effects of meningitis. Possible long-term effects may include cognitive impairments, hearing loss, seizures, and motor abnormalities.

The possible etiologies of peripheral neuropathy are diverse and can include diabetes, vitamin deficiencies, alcoholism, autoimmune diseases, infections, and exposure to toxins. In the case of the patient with diabetes mentioned, the most likely cause of peripheral neuropathy would be diabetic neuropathy, as diabetes is a common cause of nerve damage.

Objective findings in peripheral neuropathy may include decreased or altered sensation in the affected areas, reduced or absent reflexes, muscle weakness or atrophy, and changes in skin color or texture. The patient may describe symptoms of numbness, tingling, burning, or pain in their feet.

The best physical assessment technique to determine peripheral neuropathy would be a thorough sensory examination. This may involve testing for light touch, sharp-dull discrimination, vibration sensation, and proprioception using various tools such as cotton swabs, pins, tuning forks, and a proprioception testing device, respectively.