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THE NEUROLOGICAL EXAMINATION
NEUROLOGICAL EXAM <ul><li>MENTAL STATUS </li></ul><ul><li>CRANIAL NERVES </li></ul><ul><li>MOTOR EXAM </li></ul><ul><ul><l...
MENTAL STATUS
Level of Consciousness <ul><li>Awake and alert </li></ul><ul><li>Agitated </li></ul><ul><li>Lethargic </li></ul><ul><ul><l...
LANGUAGE <ul><li>FLUENCY </li></ul><ul><li>NAMING </li></ul><ul><li>REPETITION </li></ul><ul><li>READING </li></ul><ul><li...
MEMORY <ul><li>IMMEDIATE </li></ul><ul><ul><li>REALLY A MEASURE OF ATTENTION RATHER THAN MEMORY </li></ul></ul><ul><li>REM...
ORIENTATION <ul><li>PERSON </li></ul><ul><ul><li>NOT WHO THEY ARE BUT WHO YOU ARE </li></ul></ul><ul><li>PLACE </li></ul><...
OTHER COGNITIVE FUNCTIONS <ul><li>CALCULATION </li></ul><ul><li>ABSTRACTION </li></ul><ul><li>SIMILARITIES/DIFFERENCES </l...
CRANIAL NERVES
CRANIAL NERVE EXAM <ul><li>I - OLFACTORY </li></ul><ul><ul><li>DON’T USE  A NOXIOUS STIMULUS </li></ul></ul><ul><ul><li>CO...
CRANIAL NERVE EXAM <ul><li>III/IV/VI OCULMOTOR, TROCHLEAR, ABDUCENS </li></ul><ul><ul><li>PUPILLARY RESPONSE </li></ul></u...
CRANIAL NERVES <ul><li>VII - FACIAL </li></ul><ul><ul><li>OBSERVE FOR FACIAL ASYMMETRY </li></ul></ul><ul><ul><li>FOREHEAD...
CRANIAL NERVES <ul><li>IX/X - GLOSSOPHARYNGEAL, VAGUS </li></ul><ul><ul><li>GAG </li></ul></ul><ul><li>XI - SPINAL ACCESSO...
MOTOR EXAMINATION
STRENGTH <ul><li>STRENGTH </li></ul><ul><ul><li>GRADED 0 - 5 </li></ul></ul><ul><ul><li>0 - NO MOVEMENT </li></ul></ul><ul...
STRENGTH EXAM <ul><li>UPPER AND LOWER EXTREMITIES </li></ul><ul><li>DISTAL AND PROXIMAL MUSCLES </li></ul><ul><li>GRIP STR...
Motor exam, cont <ul><li>Subtle signs of weakness on a cortical/subcortical  basis  </li></ul><ul><ul><li>Pronator drift <...
Gait evaluation <ul><li>Include walking and turning </li></ul><ul><li>Examples of abnormal gait </li></ul><ul><ul><li>High...
MUSCLE OBSERVATION <ul><li>ATROPHY </li></ul><ul><li>FASCIULATIONS </li></ul>
ABNORMAL MOVEMENTS <ul><li>TREMOR </li></ul><ul><ul><li>REST </li></ul></ul><ul><ul><li>WITH ARMS OUTSTRETCHED </li></ul><...
CEREBELLAR FUNCTION <ul><li>RAPID ALTERNATING MOVEMENTS </li></ul><ul><li>FINGER TO FINGER TO NOSE TESTING </li></ul><ul><...
Romberg Sign <ul><li>Stand with feet together - assure patient stable - have them close eyes </li></ul><ul><li>Romberg is ...
REFLEXES
MUSCLE STRETCH REFLEXES (DEEP TENDON REFLEXES) <ul><li>GRADED 0 - 5 </li></ul><ul><ul><li>0 - ABSENT </li></ul></ul><ul><u...
MSR / DTR <ul><li>BICEPS </li></ul><ul><li>BRACHIORADIALIS </li></ul><ul><li>TRICEPS </li></ul><ul><li>KNEE </li></ul><ul>...
OTHER REFLEXES <ul><li>Upper motor neuron dysfunction </li></ul><ul><ul><li>BABINSKI  </li></ul></ul><ul><ul><ul><li>prese...
TONE <ul><li>INCREASED, DECREASED, NORMAL </li></ul><ul><li>COGWHEELING </li></ul><ul><li>CLASP KNIFE </li></ul>
SENSORY EXAM
SENSORY EXAM <ul><li>VIBRATION  </li></ul><ul><ul><li>128 hz tuning fork </li></ul></ul><ul><li>JOINT POSITION SENSE </li>...
HIGHER CORTICAL SENSATIONS <ul><li>GRAPHESTHESIA </li></ul><ul><li>STEREOGNOSIS </li></ul><ul><li>DOUBLE SIMULTANEOUS STIM...
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Examination of the Cranial nerves2

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Examination of the cranial nerves

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Transcript of "Examination of the Cranial nerves2"

  1. 1. THE NEUROLOGICAL EXAMINATION
  2. 2. NEUROLOGICAL EXAM <ul><li>MENTAL STATUS </li></ul><ul><li>CRANIAL NERVES </li></ul><ul><li>MOTOR EXAM </li></ul><ul><ul><li>STRENGTH </li></ul></ul><ul><ul><li>GAIT </li></ul></ul><ul><ul><li>CEREBELLAR </li></ul></ul><ul><li>REFLEXES </li></ul><ul><li>SENSATION </li></ul>
  3. 3. MENTAL STATUS
  4. 4. Level of Consciousness <ul><li>Awake and alert </li></ul><ul><li>Agitated </li></ul><ul><li>Lethargic </li></ul><ul><ul><li>Arousable with </li></ul></ul><ul><ul><ul><li>Voice </li></ul></ul></ul><ul><ul><ul><li>Gentle stimulation </li></ul></ul></ul><ul><ul><ul><li>Painful/vigorous stimulation </li></ul></ul></ul><ul><li>Comatose </li></ul>
  5. 5. LANGUAGE <ul><li>FLUENCY </li></ul><ul><li>NAMING </li></ul><ul><li>REPETITION </li></ul><ul><li>READING </li></ul><ul><li>WRITING </li></ul><ul><li>COMPREHENSION </li></ul><ul><li>Aphasia vs. dysarthria </li></ul>
  6. 6. MEMORY <ul><li>IMMEDIATE </li></ul><ul><ul><li>REALLY A MEASURE OF ATTENTION RATHER THAN MEMORY </li></ul></ul><ul><li>REMOTE </li></ul><ul><li>3 OBJECTS AT 0/3/5 MINUTES </li></ul><ul><li>HISTORICAL EVENTS </li></ul><ul><li>PERSONAL EVENTS </li></ul>
  7. 7. ORIENTATION <ul><li>PERSON </li></ul><ul><ul><li>NOT WHO THEY ARE BUT WHO YOU ARE </li></ul></ul><ul><li>PLACE </li></ul><ul><li>TIME </li></ul>
  8. 8. OTHER COGNITIVE FUNCTIONS <ul><li>CALCULATION </li></ul><ul><li>ABSTRACTION </li></ul><ul><li>SIMILARITIES/DIFFERENCES </li></ul><ul><li>JUDGEMENT </li></ul><ul><li>PERSONALITY/BEHAVIOR </li></ul>
  9. 9. CRANIAL NERVES
  10. 10. CRANIAL NERVE EXAM <ul><li>I - OLFACTORY </li></ul><ul><ul><li>DON’T USE A NOXIOUS STIMULUS </li></ul></ul><ul><ul><li>COFFEE, LEMON EXTRACT </li></ul></ul><ul><li>II - OPTIC </li></ul><ul><ul><li>VISUAL ACUITY </li></ul></ul><ul><ul><li>VISUAL FIELDS </li></ul></ul><ul><ul><li>FUNDOSCOPIC EXAM </li></ul></ul>
  11. 11. CRANIAL NERVE EXAM <ul><li>III/IV/VI OCULMOTOR, TROCHLEAR, ABDUCENS </li></ul><ul><ul><li>PUPILLARY RESPONSE </li></ul></ul><ul><ul><li>EYE MOVEMENTS </li></ul></ul><ul><ul><ul><li>9 CARDINAL POSITIONS </li></ul></ul></ul><ul><ul><li>OBSERVE LIDS FOR PTOSIS </li></ul></ul><ul><li>V - TRIGEMINAL </li></ul><ul><ul><li>MOTOR - JAW STRENGTH </li></ul></ul><ul><ul><li>SENS - ALL 3 DIVISIONS </li></ul></ul>
  12. 12. CRANIAL NERVES <ul><li>VII - FACIAL </li></ul><ul><ul><li>OBSERVE FOR FACIAL ASYMMETRY </li></ul></ul><ul><ul><li>FOREHEAD WRINKLING, EYELID CLOSURE, WHISTLE/PUCKER </li></ul></ul><ul><li>VIII - VESTIBULAR </li></ul><ul><ul><li>ACUITY </li></ul></ul><ul><ul><li>RINNE, WEBER </li></ul></ul>
  13. 13. CRANIAL NERVES <ul><li>IX/X - GLOSSOPHARYNGEAL, VAGUS </li></ul><ul><ul><li>GAG </li></ul></ul><ul><li>XI - SPINAL ACCESSORY </li></ul><ul><ul><li>STERNOCLEIDOMASTOID M. </li></ul></ul><ul><ul><li>TRAPEZIUS MUSCLE </li></ul></ul><ul><li>XII - HYPOGLOSSAL </li></ul><ul><ul><li>TONGUE STRENGTH </li></ul></ul><ul><ul><li>RIGHT XII THRUSTS TONGUE TO LEFT </li></ul></ul>
  14. 14. MOTOR EXAMINATION
  15. 15. STRENGTH <ul><li>STRENGTH </li></ul><ul><ul><li>GRADED 0 - 5 </li></ul></ul><ul><ul><li>0 - NO MOVEMENT </li></ul></ul><ul><ul><li>1 - FLICKER </li></ul></ul><ul><ul><li>2 - MOVEMENT WITH GRAVITY REMOVED </li></ul></ul><ul><ul><li>3 - MOVEMENT AGAINST GRAVITY </li></ul></ul><ul><ul><li>4 - MOVEMENT AGAINST RESISTANCE </li></ul></ul><ul><ul><li>5 - NORMAL STRENGTH </li></ul></ul>
  16. 16. STRENGTH EXAM <ul><li>UPPER AND LOWER EXTREMITIES </li></ul><ul><li>DISTAL AND PROXIMAL MUSCLES </li></ul><ul><li>GRIP STRENGTH IS A POOR SCREENING TOOL FOR STRENGTH </li></ul><ul><li>SUBTLE WEAKNESS </li></ul><ul><ul><li>TOE WALK, HEEL WALK </li></ul></ul><ul><ul><li>OUT OF CHAIR </li></ul></ul><ul><ul><li>DEEP KNEE BEND </li></ul></ul>
  17. 17. Motor exam, cont <ul><li>Subtle signs of weakness on a cortical/subcortical basis </li></ul><ul><ul><li>Pronator drift </li></ul></ul><ul><ul><li>Orbiting </li></ul></ul>
  18. 18. Gait evaluation <ul><li>Include walking and turning </li></ul><ul><li>Examples of abnormal gait </li></ul><ul><ul><li>High steppage </li></ul></ul><ul><ul><li>Waddling </li></ul></ul><ul><ul><li>Hemiparetic </li></ul></ul><ul><ul><li>Shuffling </li></ul></ul><ul><ul><li>Turns en bloc </li></ul></ul>
  19. 19. MUSCLE OBSERVATION <ul><li>ATROPHY </li></ul><ul><li>FASCIULATIONS </li></ul>
  20. 20. ABNORMAL MOVEMENTS <ul><li>TREMOR </li></ul><ul><ul><li>REST </li></ul></ul><ul><ul><li>WITH ARMS OUTSTRETCHED </li></ul></ul><ul><ul><li>INTENTION </li></ul></ul><ul><li>CHOREA </li></ul><ul><li>ATHETOSIS </li></ul><ul><li>ABNORMAL POSTURES </li></ul>
  21. 21. CEREBELLAR FUNCTION <ul><li>RAPID ALTERNATING MOVEMENTS </li></ul><ul><li>FINGER TO FINGER TO NOSE TESTING </li></ul><ul><li>HEEL TO SHIN </li></ul><ul><li>GAIT </li></ul><ul><ul><li>TANDEM </li></ul></ul>
  22. 22. Romberg Sign <ul><li>Stand with feet together - assure patient stable - have them close eyes </li></ul><ul><li>Romberg is positive if they do worse with eyes closed </li></ul><ul><li>Measures </li></ul><ul><ul><li>Cerebellar function </li></ul></ul><ul><ul><ul><ul><li>Frequently poor balance with eyes open and closed </li></ul></ul></ul></ul><ul><ul><li>Proprioception </li></ul></ul><ul><ul><ul><ul><li>Frequently do worse with eyes closed </li></ul></ul></ul></ul><ul><ul><li>Vestibular system </li></ul></ul>
  23. 23. REFLEXES
  24. 24. MUSCLE STRETCH REFLEXES (DEEP TENDON REFLEXES) <ul><li>GRADED 0 - 5 </li></ul><ul><ul><li>0 - ABSENT </li></ul></ul><ul><ul><li>1 - PRESENT WITH REINFORCEMENT </li></ul></ul><ul><ul><li>2 - NORMAL </li></ul></ul><ul><ul><li>3 - ENHANCED </li></ul></ul><ul><ul><li>4 - UNSUSTAINED CLONUS </li></ul></ul><ul><ul><li>5 - SUSTAINED CLONUS </li></ul></ul>
  25. 25. MSR / DTR <ul><li>BICEPS </li></ul><ul><li>BRACHIORADIALIS </li></ul><ul><li>TRICEPS </li></ul><ul><li>KNEE </li></ul><ul><li>ANKLE </li></ul>
  26. 26. OTHER REFLEXES <ul><li>Upper motor neuron dysfunction </li></ul><ul><ul><li>BABINSKI </li></ul></ul><ul><ul><ul><li>present or absent </li></ul></ul></ul><ul><ul><ul><li>toes downgoing/ flexor plantar response </li></ul></ul></ul><ul><ul><li>HOFMAN’S </li></ul></ul><ul><ul><li>JAW JERK </li></ul></ul><ul><li>Frontal release signs </li></ul><ul><ul><li>GRASP </li></ul></ul><ul><ul><li>SNOUT </li></ul></ul><ul><ul><li>SUCK </li></ul></ul><ul><ul><li>PALMOMENTAL </li></ul></ul>
  27. 27. TONE <ul><li>INCREASED, DECREASED, NORMAL </li></ul><ul><li>COGWHEELING </li></ul><ul><li>CLASP KNIFE </li></ul>
  28. 28. SENSORY EXAM
  29. 29. SENSORY EXAM <ul><li>VIBRATION </li></ul><ul><ul><li>128 hz tuning fork </li></ul></ul><ul><li>JOINT POSITION SENSE </li></ul><ul><li>PIN PRICK </li></ul><ul><li>TEMPERATURE </li></ul><ul><li>Start distally and move proximally </li></ul>
  30. 30. HIGHER CORTICAL SENSATIONS <ul><li>GRAPHESTHESIA </li></ul><ul><li>STEREOGNOSIS </li></ul><ul><li>DOUBLE SIMULTANEOUS STIMULATION </li></ul><ul><li>BAROSTHESIA </li></ul><ul><li>TEXTURES </li></ul>
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