The Neurologic Examination

And Laboratory Procedures

Dr Raymond L. Espinosa, MD,FPNA
 The Neuro Exam
• I. Mental Status:
– Level of Consciousness : awake, drowsy,
stuporous, comatose
– Appearance
– Orientation
– Stream of Thought
– Memory
– Calculation
– Judgement
– Speech
• II. Cranial Nerves:
• Olfactory- test each nostril
• Optic- Pupils, visual field, visual acuity
• III, IV, VI- extra ocular movements, ptosis
• V. Trigeminal- corneal test, facial sensation
• VII. Facial- motor
• VIII. Hearing
• IX, X- swallowing, gag
• XI- SCM, Trapezius
• XII- tongue
• III. Motor- strenght, DTRs, pathologic reflexes
• IV. Sensory- temperature,pain,position
sense,vibration
• V. Cerebellar, -nystagmus, FTNT, Ataxia,
• Alternating movements
• VI. Meningeals- nuchal rigidity, Brudzinski,
Kernig’s
 Is there a neurologic problem?

• Meningeal irritation
Headache / Vomiting with

a. Nuchal rigidity
b. (+) Brudzinski
c. (+) Kernig

6
 Neuro Exam
• I. Mental Status
• II. Cranial Nerves
• III. Motor
• IV. Sensory
• V. Cerebellar
• VI. Meningeals
 Lumbar Tap and CSF Analysis
• Cells- 0 to 5 lymphos
• Sugar-50 % or more of the RBS
• Protein- 15 mg% to 45 mg %
• Gram Stain
• Culture/Sensitivity
• CALAS test – for Cryptococcus
 Mechanisms
of the
EEG
Electro
Encephalography
 Indications for EEG
• 1. Epilepsy, Seizures
• 2. Metabolic Encephalopathies –Hepatic
• 3.Coma, Encephalitis
• 4. Brain Death
• 5. Hysterical coma, Hysterical blindness
• 6. Focal pathologies ( tumours)
 Electroencephalography
• Electrodes detect the spontaneous electrical
activity
• of the brain
• Depicts brain activity as waveforms and spikes
• Frequency- waves per second
• Background- recorded brain activity
 Electroencephalogram
• Four basic Frequencies
• Beta
• Alpha
• Theta
• Delta
Normal EEG
Focal Slowing
Generalized
Tonic
Clonic
Seizures
Absence
Seizures
Nerve Conduction
Velocity,
Electromyoraphy
Indications:
1. Peripheral
Nerve Diseases
2. Muscle Dis
3. Neuromuscular
Junction Dis
 EMG-NVC
Electromyogram-Nerve Conduction Velocity
• Indications:
• 1.Localizing the site of a peripheral nerve lesion: motor
neuron, nerve root, plexus, distal nerve
– Metabolic vs Demyelinating
• 2. Myopathies-Inflamm, Congenital, Myotonia
• 3. Neuro Muscular Junction pathology-
• Myasthenia Gravis – Rapid nerve Stimulation
• 4. Motor Neuron Disease- ALS
•
•
• Nerve
• Conduction
• Velocity
• Studies
 Computerized Tomography

• Indications:
• 1. Trauma
• 2. Hemorrhage
• 3. Space Occupying Lesions ( tumors, abscess)
• 4. Cerebral edema
• 5. Hydrocephalus
• 6. Demyelination
• 7. Cerebral Infarction
• 8. Parasitic Infections
Epidural Hematoma
Subdural Hematoma
Intracerebral Hemorrhage
Vasogenic Edema
Hydrocephalus
• HEMICRANIECTOMY
CT Angiography
Magnetic
Resonance
Imaging
Indications:
1. Stroke
2. Demyelination
3. Spine Pathology
4. Tumors
Multiple Sclerosis MRI
LN Medicine class 1981