neurological examination

7/17/2019 Neurological Examination

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NEUROLOGIC EXAMINATION

Steps:2. Symptoms and signs (by anamnesis and physical

examination)3. Symptoms and physical signs are interpreted in terms of

physiology and anatomy4. Localize the disease process5. ed!ces into pathologic diagnosis and etiologic

diagnosis". #ssess the degree of disability and determine $hether it

is temporary or permanent

History Taking%. #&oid s!ggestion to the patient2. Setting in $hich the disease occ!rred' mode of onset

and e&ol!tions' and the co!rse

3. #ssessment of the mental stat!s and the circ!mstances!nder $hich the symptoms occ!rred

Neurologic Examination%. bser&ation of general appearance' for any ob&io!s

ne!rological decit and le&el of conscio!sness. *hepatient+s le&el of conscio!sness' alertness' highercerebral f!nction' mental state and ability to gi&e ahistory become apparent d!ring the history ta,ing.-e!rological disorders aecting speech' post!re'mo&ement and gait may also become apparent at thisstage.

2. /ranial examination

• /- 0 (lfactory) smell#ir$ay has to be clear' chec, for anosmia bydierentiating dierent smells

• /- 00 (ptic)

a. 1is!al ac!ity

b. 1is!al eldsc. /onfrontationd. ield perimetrye. c!lar f!ndif. !pillary reactions assessment' light reex'

accommodation

• /- 000' 01' and 10 (c!lomotor' *rochlear' #bd!cens)

a. ye mo&ementsb. !rs!it eye mo&ementsc. -ystagm!s

• /- 1 (*rigeminal) phthalmic (1%)' 6axillary (12)'6andib!lar (13)a. Sensationb. 6otorc. 7a$ 8er,d. /orneal reex

• /- 100

a. inspect for drooping of the mo!th' loss ofnasolabial fold' eye clos!re and $rin,ling

b. #s, the patient to smile' close their eyes and loo,!p

c. # complete facial $ea,ness on one side indicatesa lo$er motor ne!rone lesion

d. acial $ea,ness on one side conned to the lo$erhalf indicates an !pper motor ne!rone lesion

• /- 1000a. 9earing

o inne+s test

o ;ebber+s testb. <alance

• /- 0= and /- = (>lossopharyngeal and 1ag!s)a. >ag reex

• /- =0 (#ccessory) testing the strength ofsternocleidomastoide!s and trapezi!s

• /- =00 (9ypoglossal)



a. 1ol!ntary gag reex saying aahb. 0n&ol!ntary gag reex to!ching soft palate on

both sidesc. -ormal gag reex symmetrical ele&ation of soft

palate and !&!lad. *ong!e inspection d!ring protr!sion' inside the

mo!th' and mo&ement

. Limb examination• 0nspection obser&ation for ob&io!s deformities'

disabilities' post!res' contract!res or in&ol!ntary limbmo&ements or any other abnormality

• *one tested by mo&ing the limbs passi&ely as theexaminer feels the degree of resistance. *one iscategorized as normal' decreased or increased.

• o$er o$er is tested in a proximal to distal

direction comparing sides $ith the patient in theseated position for the !pper limbs and the lying

position for the lo$er limbs. *he patient rstdemonstrates m!scle strength by acti&e mo&ementsand then the examiner opposes those mo&ements.

• /oordination testing cerebell!m f!nction: speech'

limbs' and gaito inger nose test

o *he heel shin testo apid alternating hand mo&ements

o ysmetria

. eexes# tendon reex res!lts from stretching a m!scle stretchreceptor $hich in t!rn discharges &ia an aerentsensory path$ay to an anterior horn cell in the spinalcord. ersistent absent reexes indicate a lo$er motor

ne!rone lesion or ne!ropathy or rarely a myopathy or inthe case of a single absent reex a root lesion.

. Sensationsa. S!percial sensation light to!ch' pain'

temperat!reb. 7oint positionc. 1ibration. Localization

?. >ait xamination

• omberg+s test

@. /onscio!sness



. 6ental state

. /ogniti&e f!nction 6ini mental stateexamination

A. ther ne!rological signs. Signs of meningism -ec, stiness' Bernig+s

sign' <r!dzins,i+s sign. rontal lobe release signs sno!t reex'

palmomental reex' grasp reex. S!percial reexes abdominal reex'

cremasteric reex. Straight leg raising test

neurological examination

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