1.assessment of diagnosis by neurologist

Assessment of Diagnosis
As Conducted By A
Neurologist
HAFSA
KHAN
6932 prepared by Psy. Hafsa Khan

Who is a Neurologist?
•A medical doctor
•Trained in the diagnosis and
treatment of nervous system
disorders, including diseases of the
Brain
 spinal cord
 nerves and muscles.
•Perform neurological examination of
the
nerves of the head and neck;
muscle strength and movement;
balance
Ambulation, and reflexes; and
sensation, memory, speech, language,
and other cognitive abilities.prepared by Psy. Hafsa Khan

1st. For
patients
presenting with
symptoms
suggestive of a
neurological
problem, the
examination
should
a..Determine, on the basis of an organized and
thorough examination, whether in fact neurological
dysfunction exists.
b..Identify which component(s) of the neurological
system are affected (e.g. motor, sensory, cranial nerves,
or possibly several systems simultaneously).
c..If possible, determine the precise location of the
problem (e.g. peripheral v central nervous system;
region and side of the brain affected etc.).
d..On the basis of these findings, generate a list of
possible etiologies. Unlikely diagnoses can be excluded
and appropriate testing (e.g. brain and spinal cord
imaging) then applied in an orderly and logical fashion.
prepared by Psy. Hafsa Khan

2nd. Screening for the presence of discrete
abnormalities in patients at risk for the
development of neurological disorders. Diabetic
patients, for example (particularly those with
long standing poor control), may develop
peripheral nerve dysfunction. This may only be
detected through careful sensory testing (see
below under Sensory Testing), which would
have important clinical implications.

3rd. Cursory screening/documentation of
baseline function for those who are otherwise
healthy. In patients with neither signs nor risk
factors for neurological disease, it's unlikely
that the detailed exam would uncover occult
problems.
Cranial Nerve testing, for example, can be
easily blended into the Head and Neck
evaluation. Deciding what other aspects to
routinely include is based on judgment and
experience.

Ophthalmoscope
Tuning Fork
Hammer
Pin
wheel
Tools prepared by Psy. Hafsa Khan

Neurological
examination

The
neurological
examination
is divided into
several
components,
each focusing
on a different
part of the
nervous
system:prepared by Psy. Hafsa Khan

Mental status examination

Mental status Examination

•12 pairs of nerves
•Relay messages between
brain, head and neck
•control motor and sensory
functions, including
vision,
 smell,
 and movement of the
tongue and vocal cords.

Abnormalities can be detected by:
•assessing muscle strength and tone and
by looking for a variety of characteristic
signs.
•neurologist can see the muscles and look for
atrophy (shrinkage), twitching, or abnormal
movements.

Testing coordination provides clues about
conditions that affect the cerebellum.

Gait

How we walk—our gait—is influenced by a number of bodily mechanisms
and nervous system reflexes. The body must be held erect; the limbs, head,
and trunk must be held in the right position; the person must be oriented to
the position of all body parts; parts of motor control involved with moving
must be integrated; and so on. Because walking depends on so many
different parts of the nervous system, it can be affected by a variety of
neurological disorders.
The patient is usually asked to walk in different ways
heel-to-toe in a straight line,
turning abruptly,
walking on the toes,
walking on the heels,
running

Sensory system

The sensory exam is used to determine
areas of abnormal sensation,
the quality and type of sensation impairment,
 and the degree and extent of tissue involvement.
A sensory exam involves evaluating different types of
sensation, including
 pain,
 temperature,
 pressure and
 position.

For example, pinpricks may be
used to test the patient's
response to pain and compare
the response in different parts
or opposite sides of the body.

A cold or
warm object
may be used
to test the
sensation of
temperature.

StereognosiaGraphesthesia

Deep-Tendon ReflexBicep
Triceps
BRACHIORADIALIS
knee
Ankle

Evaluating
Babinski response
•The neurologist strokes or scratches,
heel-to-toe, the outer side of the sole of
the foot and in patients over the age of
2, the toes
normally curl downward in response. If
the toes fan upward, a brain or spinal
cord injury is indicated. A number of
neurological disorders can lead to
Babinski response prepared by Psy. Hafsa Khan

Topic:
ASSESSMNT AND DIAGNSIS OF
CRANIAL NERVES
NAME:HINA MUNIR
ROLL NO:6600

CRANIAL NERVES
The cranial nerves are a set of 12 nerves.
These total 12 pairs of cranial nerves
originate from our brain and brain stem,
 That relay messages between the brain
,head and neck and control motor and sensory
functions, including vision, smell, and
movement of the tongue and vocal cords

Locations of the Cranial Nerves
LOCATION NERVES
Anterior of Brain
(Front of Brain)
1, 2
Midbrain 3, 4
Pons 5, 6, 7, 8
Medulla 9, 10, 11, 12

ASSESSMENT OF DIAGOSIS OF CRANIAL
NERVES
1. The cranial nerve assessment involves testing
the function of all 12 sets of cranial nerves.
2. Assessment and diagnosis helps in
Localizing Central Nervous System
Dysfunction
Diagnosing Systemic Diseaseprepared by Psy. Hafsa Khan

Cont..
• Some of the functions that are commonly
tested as part of the cranial nerve exam
include:
 Eyelid strength and function
 Visual function
 Peripheral vision
 Pupillary light reflexes
 Eye muscle movements
 Strength of facial musculature
 The gag reflex; tongue and lip movements
 Ability to smell and taste
 Hearing and sensation in the face, .

ASSESSMENT OF OLFACTORY NERVE
• Ask the patient if they have noticed any change in sense of
smell: Characteristic smelling objects. Asking patient to close
eyes and examining each nostril )this can be used to further
discriminate pathologies,

ASSESSMENT OF OPTIC NERVE
• Visual activity, snellen chart
• Confrontation visual field testing: typically is used as
a screening visual field test. One eye is covered,
while the other eye fixates on a target object,

Automated Perimetry: Various forms of automated perimetry
tests measure your responses to the presence of objects in
different areas of your field of view.
Electroretinography: is a test to measure the electrical
response of the eye's light-sensitive cells, called
rods and cones.

ASSESSMENT OF 3RD TO 6TH NERVE:
• III – Oculomotor Nerve, IV – Trochlear Nerve, VI – Abducens Nerve:

• Pupillary light reflex:
That controls the diameter of the pupil, in response to the
intensity (luminance) of light that falls on the retinal ganglion
cells of the retina in the back of the eye, thereby assisting in
adaptation to various levels of lightness/darkness.

Conti..
• Pupillary accommodation –
The accommodation reflex involves both convergence of the eyes
(requiring adduction of both eyes) and simultaneous constriction
of the eyes
• Ocular movements
Ask the patient to keep their head still and follow an
object
Move the object around in an H formation, assessing
both horizontal and vertical gaze
 Watch the pupils to assess the eye movements and any signs of
nystagmus

ASSESSMENT 5th CRANIAL NERVE
• Trigeminal Nerve:
• The trigeminal nerve is the fifth cranial nerve located within
the brain, and is primarily responsible for transmitting
sensations from the face to the brain. It is composed of three
branches: the ophthalmic, maxillary, and mandibular.
• Mastication ,touch, pain, temperature
• Both sensory and motor branches of the trigeminal nerve
should be tested:
• Sensation requires both light touch and pin prick assessment
• Motor function is checked by the muscles of mastication

ASSESSMENT OF FACIAL NERVE
• Testing the facial nerve involves the
assessment of the muscles of facial
expression:
• Initially assess for symmetry in the face at
rest
• Ask the patient to perform the following
movements
– Raise their eyebrows
– Close their eyes tightly
– Blow out their cheeks
– Smile

ASSESSMENT OF VESTIBULOCOCHLEAR NERVE
• Examination of cranial nerve XIII should
cover both cochlear and vestibular function:
• Hearing can be assessed by tuning fork tests
 Rinne test
 Weber tests
 schwabach test
• Formal vestibular testing
can be performed for
Balancing assessment.

ASSESSMENT OF CRANIAL NERVES IX AND X

ASSESSMENT OF ACCESSORY NERVE
• Sternocleidomastoid can be assessed by asking
the patient to turn their head to each side, against the
examiners resistance
• Trapezius can be assessed by asking the patient to
shrug their shoulders, against the examiners resistance

ASSESSMENT OF HYPOGLOSSAL NERVE
• The hypoglossal nerve is a purely motor branch to the
muscles of the tongue:
• Ask the patient to open their mouth and inspect the
tongue for any wasting or fasciculation
• Ask the patient to protrude the tongue and move from
side to side

Neurodiagnostic Tests
Iram Shabbir
6788

Neurodiagnostics
Neurodiagnostics include the study and recording of electrical
activity in the brain and nervous system.
Neurodiagnostic testing may be conducted as part of a neurological
exam.
It is used to the effective treatment of neurological diseases and
conditions.
Technologists record electrical activity arising from the brain,
spinal cord, and peripheral nerves using a variety of techniques and
instruments.

• There are two types of
neurodiagnostic testing:
• Imaging tests or scans (e.g., CT
scan, MRI scan, PET scan)
• Electrical impulse
detection(e.g., EEG, EMG).

CT Scan(Computerized
tomography )
• Computerized tomography (CT scan) of
the body uses special x-ray equipment help
to detect a variety of diseases and
conditions. CT scanning is fast, painless
and accurate.
• In emergency cases, it can reveal internal
injuries and bleeding quickly enough to help
save lives.

In clinical settings, CT Scan provides
important insights into the Aetiology and
long-term structural abnormalities in the
brain of the patients with
• Schizophrenia
• Seizures
• Mood disorder
• Metabolic and neurological disorders of
the brain.
• Disorders with central nervous system

Magnetic resonance imaging
(MRI scan)
• Powerful
magnet
combined with
radio waves to
examine
organs, soft
tissues, and
skeletal
structures.
• .

MRI scans are especially valuable in
finding brain and spinal cord
abnormalities. They may also be
used to help diagnose tumors,
circulation (blood flow) problems,
and infection.

CT Scan
• CT Scans are usually
cheaper
• A major advantage of
CT is that it is able to
image bone, soft tissue
and blood vessels all at
the same time
• CT scans take around 5
minutes,
Magnetic Resonance
Imaging.
• Provides much more
soft tissue detail than
a CT scan.
• MRI’s usually take 30
minutes

Positron emission tomography
(PET)
• A positron emission tomography, also
known as a PET scan, uses radiation to
show activity within the body on a cellular
level.
• It is most commonly used in cancer
treatment, neurology, and cardiology.
• Combined with a CT or MRI scan, a PET
scan can produce multidimensional, color
images of the inside workings of the human
body.

Electrical impulse detection

Electroencephalogram (EEG)
• An electroencephalogram (EEG) is a test used
to evaluate the electrical activity in the brain.
Brain cells communicate with each other
through electrical impulses. An EEG can be used
to help detect potential problems associated
with this activity.
• An EEG is used to detect problems in the
electrical activity of the brain that may be
associated with certain brain disorders. The
measurements given by an EEG are used to
confirm or rule out various conditions, including

• Attention deficit disorders (e.g.,
ADHD)
• Seizure disorders (e.g., epilepsy)
• Tumors
• Head injury
• stroke
• Sleep disorders
• Alcohol or drug abuse
• Migraines (in some cases)
• Hallucinations
• Dementia

Electromyography (EMG)
• EMG is used to diagnose the
presence of neuromuscular
disorders.
• EMG is a diagnostic procedure to
assess the health of muscles and
the nerve cells that control them
(motor neurons).

Relation of Neurologist with
psychiatrist
• Neurological disorders and psychiatric
disorders are difficult to differentiate,
and a single patient might require both
psychiatric and neurological care
• Doctors specializing in clinical
neurophysiology, sometimes referred
to as psychiatric neurologists
• Physicians practicing both neurology
and psychiatry are overseen by
organization -- the American Board of
Psychiatry and Neurology

Clinical neurophysiology
• Clinical neurophysiology deals with the complex
interactions of mental illness and neurological
conditions,
• Practitioners in this field make use of a variety of
diagnostic tools, including
• MRIs
• electroencephalograms
• electronic brain-mapping activities.
• conversations
• traditional psychotherapy techniques
• modern pharmaceuticals

Neurologist
• A neurologist is a medical practitioner
who deals with diagnosis and treatment
of the diseases/disorders of the
nervous system.
• Neurologists treat conditions like
• sleep disorders,
• epilepsy, brain injuries
• migraine headaches,
• brain and spinal cord tumors, etc.

Difference
• A neurologist handles the diagnosis,
treatment and prevention of
disorders/diseases related to the
nervous system.
• A psychiatrist deals with the
diagnosis, treatment and prevention
of mental illness as well as emotional
disorders

• a neurologist must be an efficient
medical doctor or osteopath.
• Mostly some kind of additional
training is required to get the
specialty in neurology sub branches
like sleep medicine, neuromuscular

Psychiatrist
• Psychiatrist is a medical practitioner
who treats the disorders related to
mental illness. These illnesses are
recognized by similar signs and
symptoms which exhibit the activity
of mind like memory, emotions,
sensory perception, attention,
pleasure

Neurological psychologist

• A neurological psychologist is a
psychologist that specializes in
understanding how the structure and
functions of brain and nervous system
plays a role in behavior and cognition.
• Neurological psychologist differ from
other types of psychologists in that
they have a thorough understanding of
neuroanatomy and focus on brain-
behavior relationship

• A large part of what clinical neurological
psychologists do is evaluate and perform
assessments to determine impairments or
neurobehavioral problems a person may be
experiencing.
• For example, a neurological psychologist
will perform several types of tests, which
evaluate different functions of the brain.
They may perform tests to look at the
function of a specific area of the brain or
the entire brain function.

• In general, neurological
psychologists often diagnose and
treat people with traumatic brain
injuries, strokes and neuropsychiatric
conditions.
• They may also work with patients
with neurological conditions, such as
Alzheimer’s disease and
neurodevelopmental disorders
including learning disabilities

• A neurological evaluation includes much
evaluation done by psychiatrists but
still they focus more on motor and
sensory systems, reflex actions, and
many more similar types of things.
• neuropsychologists may recommend
certain types of therapy, such as
occupational or speech therapy. They
may also perform certain types of
cognitive rehabilitation.

• Neurological psychologists are needed
to determine how the physical brain
influences behaviors and function.
• it can assist doctors in developing
treatment plans for people with brain
injuries and certain neurological
conditions. It may also help doctors
prevent certain impairments more
effectively.

• For example, if an area of the brain
is damaged due to a stroke or head
trauma, neurological psychologists
may be able to assess what part of
the brain is damaged and what
impairments may be a result of that
damage. With that knowledge,
doctors can implement more
targeted treatment and help
someone improve their level of
functioning and quality of life

Thank you

1.assessment of diagnosis by neurologist

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