neurological assessment and examination-1

Neurological Assessment Neurological Assessment

and Examinationand Examination






and Examinationand Examination The basic aim is to answer the The basic aim is to answer the

following:following: Is there a neurological problem?Is there a neurological problem? What is the site of the lesion in the nervous What is the site of the lesion in the nervous

system? system? (anatomical diagnosis)(anatomical diagnosis) What are the pathological conditions that can What are the pathological conditions that can

cause the lesion? cause the lesion? (pathological diagnosis)(pathological diagnosis) What is the most likely diagnosis?What is the most likely diagnosis?

The neurological assessment involves:The neurological assessment involves:I.I. History of illnessHistory of illnessII.II. Clinical examination:Clinical examination:

1.1. Handedness of the patientHandedness of the patient2.2. Physical developement and general appearance Physical developement and general appearance 3.3. Vital signsVital signs4.4. General examination General examination

- - Head and neckHead and neck - - ChestChest

- Abdomen- Abdomen- Lower limbs- Lower limbs- skeletal - skeletal

5.5. Neurological examination Neurological examination

The neurological assessment involves:The neurological assessment involves:I.I. History of illnessHistory of illnessII.II. Clinical examination:Clinical examination:

1.1. Handedness of the patientHandedness of the patient2.2. Physical developement and general appearance Physical developement and general appearance 3.3. Vital signsVital signs4.4. General examination General examination

- - Head and neckHead and neck - - ChestChest

- Abdomen- Abdomen- Lower limbs- Lower limbs- skeletal - skeletal

5.5. Neurological examination Neurological examination

Neurological Assessment and Neurological Assessment and

ExaminationExaminationNeurological Assessment and Neurological Assessment and

ExaminationExamination

I.I. The Neurological History:The Neurological History:I.I. The Neurological History:The Neurological History:




History involves questioning and observing History involves questioning and observing the patient.the patient.

Observe how the patient walks into the Observe how the patient walks into the examining room, how he speaks, and how he examining room, how he speaks, and how he climbs to examination couch.climbs to examination couch.

History involves questioning and observing History involves questioning and observing the patient.the patient.

Observe how the patient walks into the Observe how the patient walks into the examining room, how he speaks, and how he examining room, how he speaks, and how he climbs to examination couch.climbs to examination couch.

I.I. The Neurological History:The Neurological History:I.I. The Neurological History:The Neurological History:




Personal dataPersonal data

Neurological complaintNeurological complaint

Present historyPresent history

Past historyPast history

Family historyFamily history

Drug historyDrug history

Social historySocial history

Personal dataPersonal data

Neurological complaintNeurological complaint

Present historyPresent history

Past historyPast history

Family historyFamily history

Drug historyDrug history

Social historySocial history

II. II. Neurological examinationNeurological examinationII. II. Neurological examinationNeurological examination1-1- Mental state Mental state2- 2- SpeechSpeech3- 3- Cranial nervesCranial nerves4- 4- Limbs and trunkLimbs and trunk - Posture and deformity- Posture and deformity

- Muscle state- Muscle state- Muscle tone- Muscle tone

- Muscle - Muscle powerpower - - Sensations Sensations ..Superficial Superficial

. Deep . Deep . Cortical. Cortical

- Reflexes- Reflexes . . Superficial Superficial . .

DeepDeep. Pathological. Pathological

- Coordination and gait- Coordination and gait- Sphincters- Sphincters

Neurological Examination:Neurological Examination:Neurological Examination:Neurological Examination:




Mental state:Mental state:

1.1. Conscious state Conscious state

This can be assessed by using the "Glasgow Coma Scale".This can be assessed by using the "Glasgow Coma Scale".

2.2. Orientation Orientation

3.3. Memory Memory

4.4. Emotional state Emotional state

5.5. Presence of delusions or hallucinations Presence of delusions or hallucinations

Mental state:Mental state:

1.1. Conscious state Conscious state

This can be assessed by using the "Glasgow Coma Scale".This can be assessed by using the "Glasgow Coma Scale".

2.2. Orientation Orientation

3.3. Memory Memory

4.4. Emotional state Emotional state

5.5. Presence of delusions or hallucinations Presence of delusions or hallucinations



ExaminationExaminationThe Glasgow Coma ScaleThe Glasgow Coma ScaleThe Glasgow Coma ScaleThe Glasgow Coma Scale

1.1. Eye Opening ResponseEye Opening Response- SpontaneousSpontaneous 4 points4 points- To verbal commandTo verbal command 3 points3 points- To pain To pain 2 points2 points- No response No response 1 point 1 point

2.2. Best Verbal ResponseBest Verbal Response- Oriented Oriented 5 5

pointspoints- Disoriented (Confused) Disoriented (Confused) 4 points4 points- Inappropriate words Inappropriate words 3 points3 points- Incomprehensible speech (sounds)Incomprehensible speech (sounds) 2 points2 points- No response No response 1 point 1 point

3.3. Best Motor ResponseBest Motor Response- Obeys commands Obeys commands 6 6

pointspoints- Localizing to pain Localizing to pain 5 points5 points- Flexion withdrawal in response to pain Flexion withdrawal in response to pain 4 points4 points- Spastic flexion (decorticate posturing) Spastic flexion (decorticate posturing) 3 points3 points- Extension in response to pain (decerebrate posturing) Extension in response to pain (decerebrate posturing) 2 2

pointspoints- No response No response 1 point 1 point

1.1. Eye Opening ResponseEye Opening Response- SpontaneousSpontaneous 4 points4 points- To verbal commandTo verbal command 3 points3 points- To pain To pain 2 points2 points- No response No response 1 point 1 point

2.2. Best Verbal ResponseBest Verbal Response- Oriented Oriented 5 5

pointspoints- Disoriented (Confused) Disoriented (Confused) 4 points4 points- Inappropriate words Inappropriate words 3 points3 points- Incomprehensible speech (sounds)Incomprehensible speech (sounds) 2 points2 points- No response No response 1 point 1 point

3.3. Best Motor ResponseBest Motor Response- Obeys commands Obeys commands 6 6

pointspoints- Localizing to pain Localizing to pain 5 points5 points- Flexion withdrawal in response to pain Flexion withdrawal in response to pain 4 points4 points- Spastic flexion (decorticate posturing) Spastic flexion (decorticate posturing) 3 points3 points- Extension in response to pain (decerebrate posturing) Extension in response to pain (decerebrate posturing) 2 2

pointspoints- No response No response 1 point 1 point



ExaminationExaminationThe Glasgow Coma ScaleThe Glasgow Coma ScaleThe Glasgow Coma ScaleThe Glasgow Coma Scale

Categorization:Categorization: - A score is applied to each category and the total summed to A score is applied to each category and the total summed to

give an overall value ranging from 3-15.give an overall value ranging from 3-15.

Head Injury Classification:Head Injury Classification:

- Severe Head InjurySevere Head Injury GCS score of 8 or lessGCS score of 8 or less

- Moderate Head InjuryModerate Head Injury GCS score of 9 to 12GCS score of 9 to 12

- Mild Head InjuryMild Head Injury GCS score of 13 to 15GCS score of 13 to 15

Categorization:Categorization: - A score is applied to each category and the total summed to A score is applied to each category and the total summed to

give an overall value ranging from 3-15.give an overall value ranging from 3-15.

Head Injury Classification:Head Injury Classification:

- Severe Head InjurySevere Head Injury GCS score of 8 or lessGCS score of 8 or less

- Moderate Head InjuryModerate Head Injury GCS score of 9 to 12GCS score of 9 to 12

- Mild Head InjuryMild Head Injury GCS score of 13 to 15GCS score of 13 to 15





Speech:Speech:

There are four main speech disorders:There are four main speech disorders:

1.1. Mutism Mutism

2.2. dysphonia dysphonia

3.3. Dysarthria Dysarthria

4.4. Dysphasia Dysphasia

Speech:Speech:

There are four main speech disorders:There are four main speech disorders:

1.1. Mutism Mutism

2.2. dysphonia dysphonia

3.3. Dysarthria Dysarthria

4.4. Dysphasia Dysphasia





Cranial Nerves Examination:Cranial Nerves Examination:

CN I.CN I. Olfactory nerve:Olfactory nerve:

Tested by patient sniffing non irritant odors in each nostril Tested by patient sniffing non irritant odors in each nostril separately.separately.

- Causes of anosmia in neurosurgery:Causes of anosmia in neurosurgery:

1.1. Following head injury; skull base fracture.Following head injury; skull base fracture.

2.2. Tumors involving anterior cranial fossa. Tumors involving anterior cranial fossa.


CN I.CN I. Olfactory nerve:Olfactory nerve:

Tested by patient sniffing non irritant odors in each nostril Tested by patient sniffing non irritant odors in each nostril separately.separately.

- Causes of anosmia in neurosurgery:Causes of anosmia in neurosurgery:

1.1. Following head injury; skull base fracture.Following head injury; skull base fracture.

2.2. Tumors involving anterior cranial fossa. Tumors involving anterior cranial fossa.





CN II. Optic nerve: CN II. Optic nerve:

1.1. Fundus examination:Fundus examination:

a.a. PapilloedemaPapilloedema

b.b. Optic atrophy Optic atrophy

2.2. Visual acuity: by Snellen's chartVisual acuity: by Snellen's chart

3.3. Visual field: using either confrontation or perimeter Visual field: using either confrontation or perimeter (automated, or Bjerrum screen). (automated, or Bjerrum screen).

4.4. Light reflexLight reflex


CN II. Optic nerve: CN II. Optic nerve:

1.1. Fundus examination:Fundus examination:

a.a. PapilloedemaPapilloedema

b.b. Optic atrophy Optic atrophy

2.2. Visual acuity: by Snellen's chartVisual acuity: by Snellen's chart

3.3. Visual field: using either confrontation or perimeter Visual field: using either confrontation or perimeter (automated, or Bjerrum screen). (automated, or Bjerrum screen).

4.4. Light reflexLight reflex





CN III, IV, VI.CN III, IV, VI.

1.1. Position of the eyelidsPosition of the eyelids

2.2. PupilsPupils

- Size, shape, equalitySize, shape, equality

- Light and accommodation reflexesLight and accommodation reflexes

3.3. Extraocular movementExtraocular movement


CN III, IV, VI.CN III, IV, VI.

1.1. Position of the eyelidsPosition of the eyelids

2.2. PupilsPupils

- Size, shape, equalitySize, shape, equality

- Light and accommodation reflexesLight and accommodation reflexes

3.3. Extraocular movementExtraocular movement





CN V. Trigeminal nerve:CN V. Trigeminal nerve:

- Motor:Motor: Is tested while the patient Is tested while the patient clenches their teeth; testing the power clenches their teeth; testing the power of jaw opening and lateral deviation of of jaw opening and lateral deviation of the jaw.the jaw.

- Sensory:Sensory: Test facial sensation over the Test facial sensation over the three divisions (ophthalmic, maxillary, three divisions (ophthalmic, maxillary, mandibular).mandibular).

- Reflexes:Reflexes: Test corneal and Jaw jerk Test corneal and Jaw jerk reflexes.reflexes.


CN V. Trigeminal nerve:CN V. Trigeminal nerve:

- Motor:Motor: Is tested while the patient Is tested while the patient clenches their teeth; testing the power clenches their teeth; testing the power of jaw opening and lateral deviation of of jaw opening and lateral deviation of the jaw.the jaw.

- Sensory:Sensory: Test facial sensation over the Test facial sensation over the three divisions (ophthalmic, maxillary, three divisions (ophthalmic, maxillary, mandibular).mandibular).

- Reflexes:Reflexes: Test corneal and Jaw jerk Test corneal and Jaw jerk reflexes.reflexes.





CN VII. Facial nerve: CN VII. Facial nerve:

Motor:Motor: Facial movements (upper and Facial movements (upper and lower face) lower face)

- Upper motor neuron facial palsy- Upper motor neuron facial palsy

- Lower motor neuron facial palsy- Lower motor neuron facial palsy

Sensory: Sensory: Sensation over the anterior Sensation over the anterior two two third of the tongue. third of the tongue.

Reflexes: Reflexes: Glabellar, shrimer's test.Glabellar, shrimer's test.


CN VII. Facial nerve: CN VII. Facial nerve:

Motor:Motor: Facial movements (upper and Facial movements (upper and lower face) lower face)

- Upper motor neuron facial palsy- Upper motor neuron facial palsy

- Lower motor neuron facial palsy- Lower motor neuron facial palsy

Sensory: Sensory: Sensation over the anterior Sensation over the anterior two two third of the tongue. third of the tongue.

Reflexes: Reflexes: Glabellar, shrimer's test.Glabellar, shrimer's test.





CN VIII. Vestibulocochlear nerve:CN VIII. Vestibulocochlear nerve:

- Vestibular part:Vestibular part: Balance, Nystagmus, Balance, Nystagmus, Caloric test Caloric test

- Cochlear part:Cochlear part: Hearing acuity, Rinne's Hearing acuity, Rinne's and Weber's and Weber's

teststests


CN VIII. Vestibulocochlear nerve:CN VIII. Vestibulocochlear nerve:

- Vestibular part:Vestibular part: Balance, Nystagmus, Balance, Nystagmus, Caloric test Caloric test

- Cochlear part:Cochlear part: Hearing acuity, Rinne's Hearing acuity, Rinne's and Weber's and Weber's

teststests





CN IX. Glossopharyngeal nerve:CN IX. Glossopharyngeal nerve:

- Motor:Motor: stylopharyngeus muscle. stylopharyngeus muscle.

- Sensory:Sensory: posterior third of the tongue. posterior third of the tongue.

- Reflexes:Reflexes: Gag reflex via the pharyngeal Gag reflex via the pharyngeal mucosa. mucosa.


CN IX. Glossopharyngeal nerve:CN IX. Glossopharyngeal nerve:

- Motor:Motor: stylopharyngeus muscle. stylopharyngeus muscle.

- Sensory:Sensory: posterior third of the tongue. posterior third of the tongue.

- Reflexes:Reflexes: Gag reflex via the pharyngeal Gag reflex via the pharyngeal mucosa. mucosa.





CN X. Vagus nerve:CN X. Vagus nerve:

- Motor:Motor: uvula movement. uvula movement.

- Reflexes:Reflexes: Gag reflex. Gag reflex.


CN X. Vagus nerve:CN X. Vagus nerve:

- Motor:Motor: uvula movement. uvula movement.

- Reflexes:Reflexes: Gag reflex. Gag reflex.





CN XI. Accessory nerve:CN XI. Accessory nerve:

- Test Trapezius and Sternomastoid Test Trapezius and Sternomastoid muscles (contour and power).muscles (contour and power).


CN XI. Accessory nerve:CN XI. Accessory nerve:

- Test Trapezius and Sternomastoid Test Trapezius and Sternomastoid muscles (contour and power).muscles (contour and power).





CN XII. Hypoglossal nerve:CN XII. Hypoglossal nerve:

- Extrude the tongue and push the inner Extrude the tongue and push the inner side of the cheek with it. Also detect side of the cheek with it. Also detect wasting, weakness and fasciculations.It wasting, weakness and fasciculations.It will deviate toward side of weakness. will deviate toward side of weakness.


CN XII. Hypoglossal nerve:CN XII. Hypoglossal nerve:

- Extrude the tongue and push the inner Extrude the tongue and push the inner side of the cheek with it. Also detect side of the cheek with it. Also detect wasting, weakness and fasciculations.It wasting, weakness and fasciculations.It will deviate toward side of weakness. will deviate toward side of weakness.





Examination of the limbs and trunk:Examination of the limbs and trunk:- Posture and deformity- Posture and deformity- Muscle state- Muscle state- Muscle tone- Muscle tone- Muscle power- Muscle power- Sensations - Sensations - Reflexes- Reflexes- Coordination and gait- Coordination and gait- Sphincters- Sphincters

Examination of the limbs and trunk:Examination of the limbs and trunk:- Posture and deformity- Posture and deformity- Muscle state- Muscle state- Muscle tone- Muscle tone- Muscle power- Muscle power- Sensations - Sensations - Reflexes- Reflexes- Coordination and gait- Coordination and gait- Sphincters- Sphincters

Examination of the limbs and trunk:Examination of the limbs and trunk:Examination of the limbs and trunk:Examination of the limbs and trunk:




Posture and deformityPosture and deformity- The patient's posture may indicate an underlying The patient's posture may indicate an underlying

neurological disability. neurological disability.

- Posture due to sciatica, poliomyelitis, decerebrate Posture due to sciatica, poliomyelitis, decerebrate posture. posture.

- Deformity due to peripheral nerve injury.Deformity due to peripheral nerve injury.

Posture and deformityPosture and deformity- The patient's posture may indicate an underlying The patient's posture may indicate an underlying

neurological disability. neurological disability.

- Posture due to sciatica, poliomyelitis, decerebrate Posture due to sciatica, poliomyelitis, decerebrate posture. posture.

- Deformity due to peripheral nerve injury.Deformity due to peripheral nerve injury.





Muscle stateMuscle state - Muscle atrophy and wasting- Muscle atrophy and wasting

- Muscle hypertrophy- Muscle hypertrophy

- By inspection or measuring the muscle circumference.- By inspection or measuring the muscle circumference.

Muscle stateMuscle state - Muscle atrophy and wasting- Muscle atrophy and wasting

- Muscle hypertrophy- Muscle hypertrophy

- By inspection or measuring the muscle circumference.- By inspection or measuring the muscle circumference.





Muscle toneMuscle tone- Tested by passive flexion extension movement of the Tested by passive flexion extension movement of the

wrist, elbow, hip, knee, and ankle joints.wrist, elbow, hip, knee, and ankle joints.

- Decreased tone:Decreased tone: a.a. Lower motor neuron lesions. Lower motor neuron lesions.

b.b. Cerebellar lesions. Cerebellar lesions.

- Increased tone:Increased tone:a.a. Clasp knife spacticity: upper motor neuron lesions.Clasp knife spacticity: upper motor neuron lesions.

b.b. Lead pipe and Cog wheel rigidity: in extra pyramidal system Lead pipe and Cog wheel rigidity: in extra pyramidal system affection.affection.

c.c. clonus (ankle and patellar clonus) are indicative of marked clonus (ankle and patellar clonus) are indicative of marked hypertonia.hypertonia.

Muscle toneMuscle tone- Tested by passive flexion extension movement of the Tested by passive flexion extension movement of the

wrist, elbow, hip, knee, and ankle joints.wrist, elbow, hip, knee, and ankle joints.

- Decreased tone:Decreased tone: a.a. Lower motor neuron lesions. Lower motor neuron lesions.

b.b. Cerebellar lesions. Cerebellar lesions.

- Increased tone:Increased tone:a.a. Clasp knife spacticity: upper motor neuron lesions.Clasp knife spacticity: upper motor neuron lesions.

b.b. Lead pipe and Cog wheel rigidity: in extra pyramidal system Lead pipe and Cog wheel rigidity: in extra pyramidal system affection.affection.

c.c. clonus (ankle and patellar clonus) are indicative of marked clonus (ankle and patellar clonus) are indicative of marked hypertonia.hypertonia.





Muscle powerMuscle power - The power should be tested in all limbs, comparing each - The power should be tested in all limbs, comparing each

side. side.

- The muscle power is graded from - The muscle power is graded from 0-50-5..

- Compare between upper and lower motor neuron - Compare between upper and lower motor neuron weakness.weakness.

Muscle powerMuscle power - The power should be tested in all limbs, comparing each - The power should be tested in all limbs, comparing each

side. side.

- The muscle power is graded from - The muscle power is graded from 0-50-5..

- Compare between upper and lower motor neuron - Compare between upper and lower motor neuron weakness.weakness.





SensationSensation1.1. Superficial sensationSuperficial sensation

a. pain (pinprick). a. pain (pinprick). b. temperature. b. temperature.

c. light touch (crude touch). d. fine touch.c. light touch (crude touch). d. fine touch.

2.2. Deep sensation:Deep sensation:a. joint position.a. joint position. b. joint movement.b. joint movement.

c. pressure sense.c. pressure sense. d. vibration sense.d. vibration sense.

3.3. Cortical sensation:Cortical sensation:

a. tactile localization.a. tactile localization. b. two point discrimination.b. two point discrimination.

c. stereognosis.c. stereognosis. d. graphaesthesiad. graphaesthesia

SensationSensation1.1. Superficial sensationSuperficial sensation

a. pain (pinprick). a. pain (pinprick). b. temperature. b. temperature.

c. light touch (crude touch). d. fine touch.c. light touch (crude touch). d. fine touch.

2.2. Deep sensation:Deep sensation:a. joint position.a. joint position. b. joint movement.b. joint movement.

c. pressure sense.c. pressure sense. d. vibration sense.d. vibration sense.

3.3. Cortical sensation:Cortical sensation:

a. tactile localization.a. tactile localization. b. two point discrimination.b. two point discrimination.

c. stereognosis.c. stereognosis. d. graphaesthesiad. graphaesthesia

Neurological Assessment and ExaminationNeurological Assessment and ExaminationNeurological Assessment and ExaminationNeurological Assessment and Examination


Reflexes: Reflexes: Superficial reflexes:Superficial reflexes:a.a. Plantar reflex Plantar reflex S1S1

b.b. Abdominal reflexAbdominal reflex T7-T12T7-T12

c.c. Cremasteric reflexCremasteric reflex L1 L1

d.d. Anal reflexAnal reflex S4-S5S4-S5

Deep reflexes:Deep reflexes:a.a. Biceps jerkBiceps jerk C5-C6C5-C6

b.b. Triceps jerkTriceps jerk C6-C7C6-C7

c.c. Brachioradialis jerkBrachioradialis jerk C5-C6C5-C6

d.d. Ankle jerkAnkle jerk S1S1

e.e. Knee jerkKnee jerk L3-L4L3-L4

Reflexes: Reflexes: Superficial reflexes:Superficial reflexes:a.a. Plantar reflex Plantar reflex S1S1

b.b. Abdominal reflexAbdominal reflex T7-T12T7-T12

c.c. Cremasteric reflexCremasteric reflex L1 L1

d.d. Anal reflexAnal reflex S4-S5S4-S5

Deep reflexes:Deep reflexes:a.a. Biceps jerkBiceps jerk C5-C6C5-C6

b.b. Triceps jerkTriceps jerk C6-C7C6-C7

c.c. Brachioradialis jerkBrachioradialis jerk C5-C6C5-C6

d.d. Ankle jerkAnkle jerk S1S1

e.e. Knee jerkKnee jerk L3-L4L3-L4





Reflexes: Reflexes: Pathological reflexes:Pathological reflexes:a.a. Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk.Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk.

b.b. Primitive reflexes (Grasp reflex, and Glabellar reflex).Primitive reflexes (Grasp reflex, and Glabellar reflex).

c.c. Babinski reflexBabinski reflex

Reflexes: Reflexes: Pathological reflexes:Pathological reflexes:a.a. Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk.Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk.

b.b. Primitive reflexes (Grasp reflex, and Glabellar reflex).Primitive reflexes (Grasp reflex, and Glabellar reflex).

c.c. Babinski reflexBabinski reflex





The Reflexes: The Reflexes: - Reduced tendon reflexes:Reduced tendon reflexes:

It occurs in cases of lower motor neuron lesions.It occurs in cases of lower motor neuron lesions.

- Increased tendon reflexes:Increased tendon reflexes:It occurs in cases of pyramidal lesions (upper motor neuron It occurs in cases of pyramidal lesions (upper motor neuron lesions).lesions).

The Reflexes: The Reflexes: - Reduced tendon reflexes:Reduced tendon reflexes:

It occurs in cases of lower motor neuron lesions.It occurs in cases of lower motor neuron lesions.

- Increased tendon reflexes:Increased tendon reflexes:It occurs in cases of pyramidal lesions (upper motor neuron It occurs in cases of pyramidal lesions (upper motor neuron lesions).lesions).





Coordination: Coordination: upper limbs: upper limbs:

- finger- nose test- finger- nose test

- finger- finger - finger- finger testtest

- diadochokinesia- diadochokinesia

lower limbs: lower limbs:

- heel- shin test - heel- shin test - diadochokinesia- diadochokinesia

Coordination: Coordination: upper limbs: upper limbs:

- finger- nose test- finger- nose test

- finger- finger - finger- finger testtest

- diadochokinesia- diadochokinesia

lower limbs: lower limbs:

- heel- shin test - heel- shin test - diadochokinesia- diadochokinesia

Neurological Assessment and ExaminationNeurological Assessment and ExaminationNeurological Assessment and ExaminationNeurological Assessment and Examination


Coordination: Coordination: Romberg's testRomberg's test

Tandem gaitTandem gait

Defect in coordination can be caused by:Defect in coordination can be caused by:

- Cerebellar disorders (cerebellar ataxia).- Cerebellar disorders (cerebellar ataxia).

- Posterior column lesions (sensory ataxia).- Posterior column lesions (sensory ataxia).

- Muscular weakness.- Muscular weakness.

Coordination: Coordination: Romberg's testRomberg's test

Tandem gaitTandem gait

Defect in coordination can be caused by:Defect in coordination can be caused by:

- Cerebellar disorders (cerebellar ataxia).- Cerebellar disorders (cerebellar ataxia).

- Posterior column lesions (sensory ataxia).- Posterior column lesions (sensory ataxia).

- Muscular weakness.- Muscular weakness.





Gait:Gait:- Circumduction gaitCircumduction gait

- High stepping gaitHigh stepping gait

- Shuffling gaitShuffling gait

- Ataxic gaitAtaxic gait

- Waddling gaitWaddling gait

- Spastic gaitSpastic gait

- Stamping gaitStamping gait

Gait:Gait:- Circumduction gaitCircumduction gait

- High stepping gaitHigh stepping gait

- Shuffling gaitShuffling gait

- Ataxic gaitAtaxic gait

- Waddling gaitWaddling gait

- Spastic gaitSpastic gait

- Stamping gaitStamping gait





Skeletal Examination:Skeletal Examination:

1.1. Cranium:Cranium: size, measurements (important in size, measurements (important in hydrocephalus), and deformity.hydrocephalus), and deformity.

2.2. Spine:Spine: bulge or fracture. bulge or fracture.

Skeletal Examination:Skeletal Examination:

1.1. Cranium:Cranium: size, measurements (important in size, measurements (important in hydrocephalus), and deformity.hydrocephalus), and deformity.

2.2. Spine:Spine: bulge or fracture. bulge or fracture.

Brain death:Brain death:Brain death:Brain death:




1.1. Lack of pupil response to light.Lack of pupil response to light.

2.2. Lack of corneal reflex to stimulation.Lack of corneal reflex to stimulation.

3.3. Lack of occulocephalic reflex.Lack of occulocephalic reflex.

4.4. Failure of vestibulo-occular reflex (Caloric test).Failure of vestibulo-occular reflex (Caloric test).

5.5. Failure of Gag or cough reflex on bronchial stimulation.Failure of Gag or cough reflex on bronchial stimulation.

6.6. No motor response in face or muscles supplied by the cranial No motor response in face or muscles supplied by the cranial nerves in response to painful stimuli.nerves in response to painful stimuli.

7.7. Failure of respiratory movement when the patient is disconnected Failure of respiratory movement when the patient is disconnected from the ventilator and the PaCOfrom the ventilator and the PaCO22 is allowed to rise to 50 mmHg. is allowed to rise to 50 mmHg.

8.8. Hypothermia.Hypothermia.

9.9. Flat EEG.Flat EEG.

10.10. Low constant intracranial pressure (ICP).Low constant intracranial pressure (ICP).

1.1. Lack of pupil response to light.Lack of pupil response to light.

2.2. Lack of corneal reflex to stimulation.Lack of corneal reflex to stimulation.

3.3. Lack of occulocephalic reflex.Lack of occulocephalic reflex.

4.4. Failure of vestibulo-occular reflex (Caloric test).Failure of vestibulo-occular reflex (Caloric test).

5.5. Failure of Gag or cough reflex on bronchial stimulation.Failure of Gag or cough reflex on bronchial stimulation.

6.6. No motor response in face or muscles supplied by the cranial No motor response in face or muscles supplied by the cranial nerves in response to painful stimuli.nerves in response to painful stimuli.

7.7. Failure of respiratory movement when the patient is disconnected Failure of respiratory movement when the patient is disconnected from the ventilator and the PaCOfrom the ventilator and the PaCO22 is allowed to rise to 50 mmHg. is allowed to rise to 50 mmHg.

8.8. Hypothermia.Hypothermia.

9.9. Flat EEG.Flat EEG.

10.10. Low constant intracranial pressure (ICP).Low constant intracranial pressure (ICP).

Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023

neurological assessment and examination-1

Documents

fundus examination

neurological history

clinical examination

examination couch

neurological problem

facial nerve

optic nerve

history of illness