sensory examination speech neurogenic bladder

1. Sensory system Examination
speech
neurogenic bladder
Dr mohamed rizk khodair
lecturer of neurology
October 6 university
Mohamedrizk.med@edu.edu.eg
‫والجراحة‬ ‫الطب‬ ‫كلية‬

2. The sensory system evaluation is divided into the following
Superficial sensation :
Pain using pin prick
Touch using a piece of cotton
Temperature using hot and cold test tubes
1- compare both side to detect hemihypothesia
2- search to detect level in ( extra medullary) and search
To detect jack sensory loss in( intramedullary lesion )
3- search to detect stock and glove hypoesthesia in PN
4- compare different dermatomes ( for radicular sensory
Loss )
Head  UL  trunk  LL
proximal and distal

3. Deep sensation
1- joint sense ( sense of position and movement )  Big toe
2- bone sense : vibration sense
Medial malleolus : represents PN
ASIS : represents Posterior column
Forehead : represents thalamus
3- muscle sense : squeeze calf muscle
4- nerve sense
Romberg sign ..!!

4. Cortical sensations
Tactile localization : localize the site of pin prick over body
Tactile discrimination “ 2-point discrimination “ : localize 2 stimulation pin
pricks , normally they can be felt distinct provided their minimal distance
between them ( 5 mm on finger and 5 cm over back )
Graphosthesia : recognition number or letter drawn on hands
Stereognosis : recognition familiar object in hand (key)
Sensory attention ( perceptual rivalry ) : 2 simultaneous pricks at 2
corresponding sites of body are felt on each side at same moment

5. Speech disorders
Speech Examination: look for dysarthria ( articulation
- Speech is assessed through spontaneous conversation
Articulation is function of the following :
1- prymadial tract
2- cranial nuclei is concerned with articulation ( 5,7 10 , 12 ) their nuclei and muscle they supply
3- cerebellum for coordination of the muscles of speech
4- extrapyramidal for speech to be expressive

6. Abnormalities of Speech (types of dysarthria):
1. Flaccid dysarthria (lower motor neuron dysarthria or bulbar paralysis): slurred, progressively less distinct,
and with nasal quality.
2. Spastic dysarthria (upper motor neuron dysarthria): harsh, low-pitched, indistinct, slurred, and strained or
strangled speech.
3. Ataxic dysarthria (staccato or scanning) : slow, altered rhythm , irregular breakdowns, and explosive
speech.
4. Hypokinetic and hyperkinetic dysarthria:
• Hypokinetic (monotonous) dysarthria: in Parkinsonism and is characterized by rapid mumble, hesitant, and
low-pitched voice.
• Hyperkinetic dysarthria: includes choreiform dysarthria (interrupted jerky and irregular voice); and dystonic
dysarthria (slow rate, strangulated, and with unexpected silence or speech stress).

7. Language Examination
Aphasia : diffculty or inability of the informulation of speech , in absence in abscene of sense organ or
mental defect .

8. Language disorders (formulation)

10. Neurogenic bladder

11. Lesion affecting bladder function
1- lesion at level of reflex arc (LMNL) :
A) Lesions in the afferent fiber ( sensory atonic bladder) characterized by
• Abscense of sense of fullness bladder
• Retention of urine associated with a huge size of bladder
• Dribbling of urinary every now and then because of overflow

12. B- lesion of efferent fibers (motor atonic bladder) characterized by
• Preservation of sense of fullness of bladder
• Retention of urine associated with a moderate size of the bladder
• Inability to evacaute the bladder voluntary
• Catheterization is usually quickly done
C- lesion in afferent and efferent fibers ( autonomic )
Incompelete , involuntary & irregular

13. Lesion above reflex arc
1. Acute : retention with overflow
2. Gradual :
• Partial :precipitancy of micturation
• Compelete :automatic : compelete regular evacaution