Neuro Exam
Your client, 41 year-old David, suffered a TBI in which severe trauma disrupted and breached the blood-brain barrier, damaging descending motor pathways in the brainstem.
To verify the presence of an upper motor neuron lesion affecting his lower extremity functional mobility, you decide you will perform this reflex test, looking to see if he exhibits great toe dorsiflexion and fanning of the lateral 4 toes.
What is the Babinski Sign Test?
This type of stroke occurs when a blood vessel in the brain bursts or ruptures, often due to underlying conditions like atherosclerosis, aneurysms, or AVMs.
What is a Hemorrhagic Stroke?
This condition is characterized by a buildup of CSF in the brain's ventricles. While there is no cure for the condition, it can be treated by surgically inserting a shunt, which drains the excess CSF into places that the body can absorb it.
What is Hydrocephalus?
The primary cellular barrier of the blood-brain barrier consists of tight junctions between these specialized cells that line cerebral capillaries.
What are endothelial cells?
The brain receives its anterior arterial blood supply primarily from these two large vessels that branch directly from the common carotid arteries.
What are the Internal Carotid Arteries?
Your client has a systemic infection causing circulating inflammatory cytokines to breach a weakened blood-brain barrier. Knowing that this neuroinflammation limits neurotransmission and arousal pathways, you decide to perform this fundamental initial part of the neuro exam to determine if the client is alert, lethargic, or obtunded before proceeding with functional tasks.
What is Level of Alertness Testing (Mental Status Testing)?
Sometimes referred to as a "mini stroke," this brief focal loss of brain function can completely resolve with full recovery of neurological deficits in about 24 hours.
What is a Transient Ischemic Attack (TIA)?
This clinical problem affecting the meninges is characterized by significant bleeding below the dura and arachnoid matter due to tearing in bridging veins. It is a result of severe trauma.
What is a Subdural Hematoma?
When treating a client with Parkinson’s disease, an OT should know that pure dopamine cannot cross the blood-brain barrier, requiring clients to take this medication to manage motor symptoms.
What is L-dopa?
This key anterior branch of the internal carotid artery supplies the medial aspect of the cerebral hemispheres, making an occlusion here likely to cause severe motor and sensory deficits primarily in the contralateral lower extremity.
What is the Anterior Cerebral Artery (ACA)?
Your 29 year-old client, Robin, has hydrocephalus, causing increased ventricular pressure that compresses cerebellar outflow pathways.
Noticing intention tremors during reaching, you decide you will perform this specific neuro exam test to assess for dysmetria.
What is Finger-to-Nose Testing (Coordination & Gait Testing)?
These localized infarctions occur when small arteries that branch off major blood vessels to supply deep brain structures become blocked.
What is a Lacunar Stroke?
This type of meningeal infection is the most severe, causes an increase in CSF pressure, sudden fever, stiff neck, and altered mental status.
What is Bacterial Meningitis?
These highly specialized glial cells extend cellular "end-feet" to surround brain capillaries, playing a crucial role in maintaining, repairing, and signaling the structural integrity of the blood-brain barrier.
What are Astrocytes?
The most common site for ischemic stroke, this major blood vessel supplies the lateral surface of the cerebral cortex, resulting in contralateral upper extremity weakness, facial drooping, and aphasia.
What is the Middle Cerebral Artery (MCA)?
You have a client that has an active neuro-inflammatory disease, where capillary tight junction breakdown across the blood-brain barrier altered tissue health and drug transport dynamics.
To determine whether their inability to perform daily ADL steps stems from primary motor weakness due to their condition versus a higher-level motor planning breakdown, you decide you will perform this part of the neuro exam by asking the client to pretend to carry out a familiar command like opening a bottle or brushing teeth.
What is Apraxia Testing (Mental Status Testing)?
Also known as "border zone infarcts," this type of stroke occurs at the border between the cerebral vascular territories where tissue is furthest from arterial supply. Symptoms can include seizures, mood disturbances, and tilting of the head to one side.
What is a Watershed Stroke?
Known as a "talk then die" injury, this rapid-onset arterial bleed occurs between the dura and the skull and often causes pupil dilation due to involvement of CN III.
Its symptoms include: headaches, wavering consciousness, and cerebellar herniation.
What is an Epidural Hematoma?
Infections, traumatic brain injuries and strokes can weaken the tight junctions of the blood brain barrier, allowing unwanted pathogens into the brain issue and triggering this response.
What is Neuroinflammation?
Located at the base of the brain, this interconnected vascular ring formed by connections between the internal carotid and vertebrobasilar systems acts as a safety mechanism by providing back-up circulation if one major artery becomes blocked.
What is the Circle of Willis?
59 year-old Victor was admitted to the hospital following a subarachnoid hemorrhage in which blood breached the subarachnoid space and disrupted normal CSF circulation.
While he correctly identifies a light touch stimulus applied to either arm individually, you decide you will perform this part of the neuro exam to determine whether central sensory processing fails to register a stimulus on one side of his body when bilateral stimuli are presented simultaneously.
What is Extinction Testing?
James, a 62 year-old patient, presents after this sudden embolic event with severe vertigo, ataxia, double vision, lateral eye deviation, and bulbar symptoms such as dysphagia and dysarthria.
An MRI confirms an acute stroke with a decreased blood flow in posterior circulation, a condition which has a mortality rate of over 85% due to possible brainstem death.
What is a Vertebrobasilar Stroke?
A 22 year-old client with this condition sustains a fracture to his temporal bone, tearing his middle meningeal artery. As arterial blood rapidly accumulates above the dura, increasing intracranial pressure forces cerebellar tissue downward through the foramen magnum.
What is Cerebellar Herniation?
A 32 year-old female diagnosed with Multiple Sclerosis is evaluated in outpatient neuro rehab for cognitive fatigue and impaired motor coordination. The OT explains to the observing OT student that that during disease flare-ups, tight junctions of the blood brain barrier are compromised, causing a localized loss of this fundamental protective property and allowing pathogens into central tissue.
What is selective permeability?
A client admitted to acute neuro rehab presents with severe vertigo, nystagmus, dysarthria, and ataxia during seated postural control tasks. The OT recognizes these deficits stem from vascular disruption in this combined arterial system of circulation that supplies the brainstem and cerebellum.
What is Vertebrobasilar Circulation?