1. BRAIN POWER! “ Any fool can know. The point is to understand.” -Albert Einstein Chapter 8

2. CHAPTER 8 DISEASES OF THE NERVOUS SYSTEM

3. Neurological Diseases PNS

4. Anatomy of the Nervous System Central Nervous System (CNS) – Brain, spinal cord Peripheral Nervous System (PNS-Links CNS to body) – Cranial nerves (from brain) – Peripheral nerves (from spinal cord) Autonomic nervous system controls smooth muscle and cardiac muscle – Parasympathetic vs. Sympathetic Nervous system Somatic (voluntary) system – skeletal m.

5. Cranial nerves

6. NUMBERNAMETYPEKEY FUNCTION IOlfactorySSmell IIOpticSVision IIIOculomotorMEye movement, pupil size, focusing lens IVTrochlearMEye movement VTrigeminalBSensations – head & teeth; chewing VIAbducentMEye movement VIIFacialBFace and scalp movement, salivation, tears, taste VIIIVestibulocochlearSBalance, hearing IXGlossopharyngealBTongue movement, swallowing, salivation, taste XVagusBSensory from: GI, respiratory; Motor: larynx, pharynx, parasympathetic, abdomen and thoracic organs XIAccessoryMHead movement, accessory motor with vagus XIIHypoglossalMTongue movement

7. Mneumonics Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal – “Oh, Oh, Oh, To Touch And Feel Various Girl's Very Angelic Hands” – “Some Say Marry Money, But My Brother Says Big Business Makes Money”

8. Neurological Exam Observe – Attitude, mentation (alert, lethargic, coma, etc), Gait Agitation, anxiety Seizures – Posture (Higher center) Upright or sternal Head tilt (vestibular?VIII) Wide based stance (ataxia, weakness)

9. Neuro Exam Gait – Walking and running on flat, non-slippery surface Walk slowly back and forth with turns and circles – Proprioceptive deficits (knuckling)-spinal cord defect – Paresis (weakness)/paralysis (no movement) – cerebral cortex, brainstem, spinal cord or peripheral spinal nerves or muscles – Circling/pacing – Tight circling with head tilt – vestibular (VIII) With dementia – ipsilateral cerebral cortex

10. Posterior Paresis Reflexes present or exaggerated in the rear legs if lesion is between T3-L3 Reflexes are diminished or absent in the rear legs if lesion is between L4-S2

11. Neuro Exam – Ataxia/incoordination – cerebellum, vestibular system, or spinal cord – Dysmetria - cerebellar Hypermetria – too long movements Hypometria – movements too short http://www.youtube.com/watch?v=0QOKP FMt0Rc&feature=endscreen&NR=1

12. Neurologic Exam Cranial Nerves - I (S) Olfactory: ether /alcohol on cotton—will pull away - II (S) Optic: follow moving objects; drop cotton ball - III (M), IV (M), VI (M) Oculomotor, trochlear, abducent: look up, down, sideways - V (B) Trigeminal: sensory to face, motor to muscles of mastication, weakness in jaw muscles

13. Neurologic Exam – VII (M) Facial: unilateral droop; drool; no menace – VIII (S) Vestibulocochlear: balance (nystagmus, head tilt); hearing – IX (B), X (B), XI (M) Glossopharyngeal, Vagus, Accessory: swallowing; muscle atrophy – XII (M) Hypoglossal: loss of tongue movement; unilateral atrophy

14. Neuro Exam – Cranial Nerves Blind II No menace II/VII Anisocoria II, III Atrophy of temporal muscles V Dropped jaw V Nares, lip pinch, cornea V – Inside ear Lip/ear droop VII No blink VII Head tilt VIII

15. Neuro exam – Cranial Nerves Nystagmus VIII Deafness VIII Difficulty swallowing IX, X Loss of gag reflex IX, X Laryngeal paralysis IX, X Weakness, asymmetry of tongue XII

16. Cranial nerve http://www.youtube.com/watch?v=S8f9- GPW9IE&feature=related http://www.youtube.com/watch?v=S8f9- GPW9IE&feature=related

17. Female Brain

18. Male Brain

19. Neuro Exam Postural reactions – Knuckling – Hopping – Wheelbarrowing – Hemiwalking http://www.youtube.com/watch?v=IXpGX6xhJd M

20. Knuckling

21. Neuro Exam Muscle Tone – Atrophy – occurs slowly from disuse Rapidly from nerve damage – Lower Motor Neuron signs – decreased reflexes and muscle tone (spinal cord) – Upper Motor Neuron – reflexes & muscle tone increased (brain) – Test by flexing/extending joints

22. Neuro exam – Spinal Reflexes Thoracic limb withdrawal – pinch toe Patellar – strike patellar ligament – extension of stifle Pelvic limb withdrawal – pinch toe Sciatic – Strike between greater trochanter and ischium – flexion of stifle and hock Cranial tibial – strike cranial tibial m just below proximal end of tibia – flex hock Perineal – pinch perineum/anus – anal sphincter contraction, tuck tail Panniculus – stimulate skin over dorsum just lateral to vertebral column – twitch of cutaneous trunci m.

23. Neuro Exam: Upper Motor Neuron vs. Lower Motor Neuron signs UMNLMN Muscle tone N or I D Spinal reflexes N or I D Motor fxn Spastic Flaccid Muscle atrophy Mild Severe disuse neuro Bladder Tense Flaccid

24. Patellar Reflex

26. Reflex examination http://www.youtube.com/watch?v=NFqFABsIa7 Q&feature=related http://www.youtube.com/watch?v=NFqFABsIa7 Q&feature=related

27. Pelvic Limb Withdrawal – Or Not

28. Panniculus Test