Neurological exam

By H.Khorrami Ph.D.
http://www.scribd.com/khorrami4 http://khorrami1962.spaces.live.com khorrami4@yahoo.com

Instruments

 Receptive field(two point discrimination test) Vibration test

Sensory system
Fine touch Temperature Shape Deep sense Vibration Name objects

Deep sense of vibration

Tactile sense

Olfactory nerve

Optic nerve

Trochlear nerve

Corneal reflex
Desensitization

Facial nerve

Glossopharyngeal nerve(IX)

Accessory nerve(XI)

Accessory nerve

Hypoglossal nerve(XII)

Cranial Nerve
Olfactory Optic

Number
I II

Innervation(s)
Sensory Sensory

Primary Function(s)
Smell Vision Upper lid elevation, extraocular eye movement, pupil constriction, accommodation Superior oblique muscle Muscles of mastication Scalp, conjunctiva, teeth Lateral rectus muscle Muscles of facial expression Taste-anterior two thirds of tongue Hearing and balance Tongue and pharynx Taste-posterior one third of tongue Pharynx, tongue, larynx, thoracic and abdominal viscera Larynx, trachea, esophagus Sternomastoid and trapezius muscles Muscles of tongue

Test(s)
Identify odors Visual acuity, fields, color, nerve head Physiologic "H" and near point response Physiologic "H" Corneal reflex

Oculomotor

III

Motor

Trochlear Trigeminal Trigeminal Abducens Facial Facial Vestibulocochlear Glossopharyngeal Glossopharyngeal

IV V V VI VII VII VIII IX IX

Motor Motor Sensory Motor Motor Sensory Sensory Motor Sensory

Clench jaw/palpate, light touch comparison

Abduction, physiologic "H" Smile, puff cheeks, wrinkle forehead, pry open closed lids

Rinne test for hearing, Weber test for balance Gag reflex

Vagus

Motor

Gag reflex

Vagus Accessory Hypoglossal

X XI XII

Sensory Motor Motor

Shrug, head turn against resistance Tongue deviation

Signs of UMN and LMN lesions

Sign
Weakness Atrophy Fasciculation Reflexes Tone

UMN lesions
Yes Mold/No No Increased Increased

LMN lesions
Yes Yes Yes Decreased Decreased

Grading Motor Strength

Grade 0/5 1/5 2/5 3/5 4/5 5/5 Description No muscle contraction Visible muscle movement, but no movement at the joint Movement at the joint, but not against gravity Movement against gravity, but not against added resistance Movement against resistance, but less than normal Normal strength

Rating of muscle strength

Myotatic reflexes
Response
Amplitude Speed Pattern

Descending pathway effects Attention Calcium status

Chvosteks sign Trousseaus sign

Chvosteks sign

Trousseaus sign

Tendon Reflex Grading Scale

Grade 0 1+ or + 2+ or ++ 3+ or +++ 4+ or ++++

Description Absent Hypoactive "Normal" Hyperactive without clonus Hyperactive with clonus

Clasp-knife reflex

Peripheral myotatic reflexes

Biceps Triceps Brachioradialis Tromner Mayer Adductor Quadriceps Achill(ankle jerk)

Biceps reflex

Triceps reflex

Brachioradialis reflex

Adductor reflex

Knee jerk reflex

Achill reflex

Reinforcement
Jendrassick maneuvers

Corticospinal tract
Wartenberg Babinskis sign(1857-1932) Plantar reflex Oppenheims sign Gordons sign

Auditory system
Conductive Neural Rinne test, use a 512Hz tuning fork
AC>BC

Weber test, use a 256/512Hz tuning fork

R=L

Shwabach
Ex=Pt

Auditory & Vestibular system

Rinne

Weber test

Auditory system
Test Rinne Weber Schwabach Expectation AC>=BC No lateralization EX=Pt Based on Air conduction Bone conduction Bone conduction Diagnose Conductive deafness Neural/conductive/ both

Cerebellar tests

(Archi-cerebellum ) (Neo-cerebellum )

Cerebellar tests
Finger to nose Rapid alternating finger movements Rapid alternating hand movements Romberg test Heel to shin testing Rebound phenomenon

Cerebellar tests

Finger to nose

Romberg

Heel-to-shin

Auditory & Vestibular system

Nystagmus
Slow phase Fast phase

Vestibulocerebellum
Real rotation Baranys chair Caloric test

DESCRIPTION OF MEDICAL CONDITION PROBLEM Coma

NEUROLOGIC STRUCTURES AFFECTED

Decreased Level of Nonlocalizing Consciousness Lack of Orientation Temporal Lobe to Time and Place Memory Loss Temporal Lobe Frontal, Temporoparietal Lobe Bilateral Cerebral Damage Nondominate Parietal Lobe

Disorientation Amnesia

Aphasia

Speech Problems
Inappropirate Emotional Display Inability to recognize Objects Inability to Follow Orders

Inappropriate Affect

Agnosia

Apraxia

Frontal Lobe