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PSYC 207
Michael Souza

The Neurological Exam 9/30/2012 10:00:00 PM Neurologist: 1. ask patient about the problem (HISTORY) 2. make general assessment of patient condition 3. possibly recommend additional tests 4. write case summary The Patient’s History -Info on patient’s background -History of disease, accidents, occurrence of symptoms -Family background reviewed as well: many diseases genetic -Observe patient’s behavior (assess mental status, look for abnormalities in speech/facial features, posture) -Facial expression and behavior reveal mental status -Handedness: which hemisphere controls speech Physical Examination *Tools: -measuring tape: measure head and body size, skin lesions, etc -stethoscope: listen to heart/blood vessels -otoscope: examine auditory canal/eardrum -flashlight: elicit pupillary reflexes -tongue blades: elicit gag/abdominal/plantar reflexes -vial of coffee: assess smell -salt & sugar: taste -tuning fork: test vibratory sensation & hearing -cotton wisp: elicit corneal reflex, test sensitivity to light touch -plastic tubes: temperature -pins: pain -hammer: elicit muscle stretch reflexes -coins/keys: recognition of objects through touch and sound -blood pressure cuff: measure blood pressure *MOST IMPORTANT PART of study: HEAD -cranial-nerve malfunctions discovered : important clues to location and nature of neural damage *Motor system: examined to assess muscle bulk, tone, power, occurrence of involuntary movement reflexes), coordination, head-to-toe Vascular Disorders 9/30/2012 10:00:00 PM •CNS functioning can be affected by vascular problems -Blood-vessel disease or damage can greatly reduce OXYGEN and GLUCOSE to brain region -longer than 10 min interference: DEATH to cells in region -Most develop in arterial system Stroke -Among the most common causes of death/injury in Western world -Interruption of bloody flow -Sudden appearance of neurological symptoms -Can be insidious, spanning over period of time -Produce infarct, an area of dead/dying tissue (from insufficiency of blood flow to region) *Capillaries: effects are more limited compared to *Large vessels: often devastating consequences *One restricted part of vessel: surrounding healthy vessels supply blood to at least some of deprived area *Region supplied by weak/diseased vessels: more serious, no possibility of compensation Cerebral Ischemia -Symptoms caused by vessel blockage preventing sufficient supply of blood to brain -Thrombosis: blood coagulated to form clot or plug that remained at the place of formation -Embolism: clot or other plug brought through blood from larger vessel and forced into smaller one: obstructs circulation (blood clot, air bubble, oil/fat deposit, small mass of cells from tumor) MOST OFTEN AFFECT MIDDLE CEREBRAL ARTERY -Cerebral arteriosclerosis: thickening and hardening of arteries -transient ischemia: temporary, recurring Migraine Stroke: -May lead to infarcts and permanent neurological deficits -Young people, especially women -Vasopasm: constriction of blood vessels, but unknown cause -Posterior cerebral artery most commonly affected -symptoms similar to transient ischemia Cerebral Hemorrhage: -Massive bleeding into substance of brain -Cause: most frequently high blood pressure, hypertension Neurological Assessment 9/30/2012 10:00:00 PM -People with closed-head traumatic brain injuries often have little or no sign of cerebral injury visible on neuroimaging, but still have significant cognitive deficits -1980s heyday of neuropsychological assessment The Changing Face of Neuropsychological Assessment -Roots lie in neurology and psychiatry -Began to diverge from medicine in 1940s -First tests designed to identify people suffering from cerebral dysfunction (organic diseases) rather than “functional disorders” linked with behavior -3 factors that enhanced the rate of change: Functional imaging: -Perhaps the biggest change in both neurology and neuropsychology -Neuroimaging: allowed investigators to identify changes in cerebral functioning -Main role of clinical neuropsychologists: from diagnostician to participant in rehabilitation (esp. chronic disease; stroke/head trauma) -Even the most sophisticated functional-imaging techniques don’t predict extent of behavioral disturbance -People with closed-head injury: way to document nature & extent of disability is through neuropsychological assessment Cognitive Neuroscience: -Diversification of methods used by individual neuropsychologists •Choice of tests: disorder being investigated & question being asked -Halstead-Reitan Battery: •retain concept of cutoff scores ➜DIFFICULTIES OF CUT OFF SCORES •performance below particular levels don’t always indicate brain damage •Cerebral organization varies with factors: sex, handedness, age, education, experience, etc. •Test problems can be solved using different strategies -> entail different cortical regions •Vary with intelligence: many tests require problem solving -Handicap in development of test batteries: absence of neurological theory -Knowledge of brain function largely based on clinical observation Cognitive Neuroscience (ctd.) •1990s-modern theoretical understanding of brain/cognition
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