Common Sense Aspects of the Neurological Exam Or Why Can’t Neurologists KISS? (Keep It Simple Stupid)?
Visual Loss From Brain Injury • Patients may see movement even if they can count static fingers • Don’t forget that you can get field cuts with disease of the optic chiasm or optic tract (especially in MS) • Superior cuts suggest involvement of the contralateral temporal occipital region • Inferior cuts suggest involvement of the contralateral parietal occipital region.
CN VIII (Auditory) Weber and Rinne Tests• Weber test = Tuning fork over middle of head to lateralize hearing loss• Rinne=bone conduction v air conduction
CN IX and X Palsy • Absent gag on stimulated side • Weakness of levator of palate • Dysphonia secondary to vocal cord paralysis
CN XI (Spinal Accessory Nerve) Palsy • Affects SCM and trapezius • Shoulder shrugging tests trapezius • Forward flexion of the next tests both SCM • Most often injured with pathology of the anterior cervical triangle
CN XII (Hypoglassal) Palsy • Atrophy and often fasculations on the side of the palsy • Tongue deviates towards the side of the lesion • Beware bilateral tongue atrophy and fasciculationsALS