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Is there a neurological problem? What is the site of the lesion in the nervous system? (anatomical diagnosis) What are the pathological conditions that can cause the lesion? (pathological diagnosis) What is the most likely diagnosis?
Neurological Assessment and Examination The neurological assessment involves: I. History of illness II. Clinical examination:
1. 2. 3. 4. Handedness of the patient Physical developement and general appearance Vital signs General examination - Head and neck - Chest
- Abdomen - Lower limbs - skeletal
5. Neurological examination
- Posture and deformity - Muscle state - Muscle tone - Muscle power .Superficial - Sensations
. Deep . Cortical
- Reflexes
. Superficial
. Deep . Pathological
Neurological Examination:
Mental state:
1. Conscious state
This can be assessed by using the "Glasgow Coma Scale".
Neurological Examination:
Speech: There are four main speech disorders:
1. Mutism 2. dysphonia 3. Dysarthria 4. Dysphasia
Neurological Examination:
Cranial Nerves Examination:
CN I. Olfactory nerve:
Tested by patient sniffing non irritant odors in each nostril separately.
2. 3. 4.
Visual acuity: by Snellen's chart Visual field: using either confrontation or perimeter (automated, or Bjerrum screen). Light reflex
3.
Extraocular movement
Neurological Examination:
Examination of the limbs and trunk:
- Posture and deformity - Muscle state - Muscle tone - Muscle power - Sensations - Reflexes - Coordination and gait - Sphincters
Increased tone:
a. b. c. Clasp knife spacticity: upper motor neuron lesions. Lead pipe and Cog wheel rigidity: in extra pyramidal system affection. clonus (ankle and patellar clonus) are indicative of marked hypertonia.
Neurological Assessment and Examination Examination of the limbs and trunk: Sensation
1. Superficial sensation
a. pain (pinprick). b. temperature. c. light touch (crude touch). d. fine touch.
2.
Deep sensation:
a. joint position. c. pressure sense. b. joint movement. d. vibration sense.
3.
Cortical sensation:
a. tactile localization. c. stereognosis. b. two point discrimination. d. graphaesthesia
Reflexes:
Superficial reflexes:
a. b. c. d. Plantar reflex Abdominal reflex Cremasteric reflex Anal reflex S1 T7T7-T12 L1 S4S4-S5
Deep reflexes:
a. b. c. d. e. Biceps jerk Triceps jerk Brachioradialis jerk Ankle jerk Knee jerk C5C5-C6 C6C6-C7 C5C5-C6 S1 L3L3-L4
Neurological Assessment and Examination Examination of the limbs and trunk: Reflexes:
Pathological reflexes:
a. b. c. Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk. (C7Primitive reflexes (Grasp reflex, and Glabellar reflex). Babinski reflex
Neurological Assessment and Examination Examination of the limbs and trunk: The Reflexes:
Reduced tendon reflexes:
It occurs in cases of lower motor neuron lesions.
Neurological Assessment and Examination Examination of the limbs and trunk: Coordination:
upper limbs: - finger- nose test finger- finger- finger test finger- diadochokinesia lower limbs: - heel- shin test heel- diadochokinesia
Coordination:
Romberg's test Tandem gait Defect in coordination can be caused by: - Cerebellar disorders (cerebellar ataxia). - Posterior column lesions (sensory ataxia). - Muscular weakness.
Neurological Assessment and Examination Examination of the limbs and trunk: Gait:
Circumduction gait High stepping gait Shuffling gait Ataxic gait Waddling gait Spastic gait Stamping gait
Neurological Examination:
Skeletal Examination: 1. Cranium: size, measurements (important in
hydrocephalus), and deformity.
Brain death:
1. 2. 3. 4. 5. 6. Lack of pupil response to light. Lack of corneal reflex to stimulation. Lack of occulocephalic reflex. Failure of vestibulo-occular reflex (Caloric test). vestibuloFailure of Gag or cough reflex on bronchial stimulation. No motor response in face or muscles supplied by the cranial nerves in response to painful stimuli. 7. Failure of respiratory movement when the patient is disconnected from the ventilator and the PaCO2 is allowed to rise to 50 mmHg. 8. Hypothermia. 9. Flat EEG. 10. Low constant intracranial pressure (ICP).
Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023