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NEUROLOGICAL EXAMINATIONS

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PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB

BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

Published in: Health & Medicine
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NEUROLOGICAL EXAMINATIONS

  1. 1. 1 NEUROLOGICAL EXAMINATIONSPROBLEM BASED LEARNING (PBL) PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
  2. 2. WHAT IS NEUROLOGICAL EXAMINATIONS? A series of simple questions and tests provide crucial information about the nervous system.
  3. 3. COMPONENTS SENSORY EXAMINATION REFLEX EXAMINATION MENTAL STATUS EXAMINATION COORDINATION AND GAIT EXAMINATION MOTOR EXAMINATION CRANIAL NERVE EXAMINATION
  4. 4. A) Appearance Age Weight Manner of dress Grooming
  5. 5. B) Attitude and behaviour Body language Eye contact Breathing rhytm Body movement
  6. 6. c) Speech Loudness Rate Quality Spontaneity Quantity
  7. 7. d) Perception Sensory experiences External stimulus Internal stimulus
  8. 8. TEST EXAMPLE :GCS
  9. 9. TEST EXAMPLE : AMTS
  10. 10. TEST EXAMPLE : MMSE
  11. 11. 2) Reflex examination Tendon reflex Superficial reflex Pathological reflex
  12. 12. A)Tendon reflex Biceps Triceps Brachioradialis Knee jerk Ankle jerk
  13. 13. B)Superficial reflex Abdominal reflex Cremesteric reflex
  14. 14. C)Pathological reflex Plantar reflex
  15. 15. 3) Sensory examination Vibration testing Light touch treshold Temperature Cortical sensation graphesthesia
  16. 16. Cranial nerve mnemonics (function) Olfactory Oh Some Optic Oh Say Oculomotor Oh Marry Trochlear To Money Trigeminal Take But Abducent A My Facial Family Brother Vestibulocochlear Vacation! Says Glossopharyngeal Go Big Vagus Vegas Brain Accessory And Matter Hypoglossal Hawaii Most
  17. 17. I Olfactory nerve Normal Perceive scent with either nostril Abnormal response unilateral Structural brain lesion Local brain lesion bilateral Rhinitis // damage to CP
  18. 18. II Optic nerve Visual acquity Distant Snellen chart(10/20 feet) Near Near vision card (14inches) Visual field Peripheral Wiggling fingers Counting fingers White pin Central Red pin fundoscopy ophthalmoscope Pupillary light reflex Observe Ptosis irregular Size of pupils
  19. 19. V Trigerminal nerve VI VII VIII sensory Light touch Cotton wisp Corneal reflex Pain & temperatur e P- disposable pin T- cold tuning fork VIII Motor Supplies muscle of mastication Jaw-jerk reflex
  20. 20. VII Facial nerve Taste Salty,Bitter,So ur,sweet Muscle of facial expression Observe for asymmetry // involuntary facial mvmnt Normal Asymmetry but no muscle weakness Abnormal Lower motor neuron lesion Upper motor neuron lesion
  21. 21. VII Vestibulocochlear nerve Hearing Rinne test perceive the sound of the tuning fork in front of the ear Hearing loss Conductive Bone > air Sensorineural Air > bone Weber test Hear equally from both ears Conductive lateralizes the sound to the affected ear Sensorineural best heard by the non- involved ear. Vestibular Observe for nystagmus
  22. 22. IX Glossopharyngeal nerve X Vagus nerve swallowing, phonation, guttural and palatal articulation Observe palate movement Palate elevate symmetrically Unilateral palate weakness, palate fails to elevate on the weak side
  23. 23. XI Spinal Accessory Nerve • The spinal accessory supplies the trapezius and sternocleidomastoid muscles. • observe for – atrophy or asymmetry of the muscles. – quickness of shoulder shrug XII Hypoglossal Nerve • The hypoglossal nerve is motor to the tongue. • Normal Response: – the tongue should be able to protrude relatively straight. Minimal degrees of deviation (i.e. only millimeters) affecting only the tip are insignificant. • Abnormal Response: – with tongue weakness, the tongue deviates towards the weak side.
  24. 24. Motor Examination
  25. 25. Motor examination Abnormal Involuntary Movements, Posture and Bulk Compare left to right,proximal to distal observe for asymmetry, atrophy or hypertrophy. observe for abnormal involuntary movements Tone Spasticity rigidity Power power or strength is tested by comparing the patient’s strength against your own.
  26. 26. MRC Scale Grade Description 0 no contraction 1 flicker or trace of contraction 2 active movement with gravity eliminated 3 active movement against gravity 4* active movement against gravity and resistance 5 normal power
  27. 27. Coordination & Gait
  28. 28. Coordination • To perform tasks of co- ordination one requires normal motor, sensory, and cerebellar systems. Lesions affecting any of these areas could give rise to abnormal tests of co-ordination. • Examine – Upper extremities – Lower extremities Gait • observe the patient walk. • if there is a subtle abnormality this may be made more obvious by asking the patient to run. • ask the patient to perform tandem gait by walking heel to toe (eyes open).

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