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2. Examination framework
• The neurological examination can be complex and lengthy. The
following is a brief outline of an approach to a ‘full’ neurological
examination.
• • Inspection, mood, conscious level
• • Speech and higher mental functions
• • Cranial nerves II–XII
• • Motor system
• • Sensation
• • Coordination
• • Gait
• • Any extra tests

3. General inspection and mental state
• The neurological exam should start with any clues that can be gleaned from simply looking at, and
engaging with, the patient.
• • Are they accompanied by carers—and how do they interact with those people?
• • Do they use any walking aids or other forms of support?
• • Any abnormal movements?
• • Observe the gait as they approach the clinic room, if able.
• • Any speech disturbance?
• • What is their mood like?

4. Cognitive function

9. How to examine the olfactory nerve

10. Visual pathway

11. Light reflex

12. Field of vision- Usually seen with the perimetry

13. Visual acuity

14. Poor vision
If the patient is unable to see the Snellen chart at all, see
if they can:
• Count fingers (CF).
• See hand movements (HM).
• See light (PL).
• If the patient is unable to see light then record as ‘NPL’
(no
perception of light).

15. COLOR OF VISION
Usually seen with Ishihara chart
We see here with 3 colors
o Red
o Blue
o Green
 Take three pens of these color and hold pen one after another
 Ask the patient to identify these color
 Colour vision is mainly confined to the macular field
 Acquired abnormalities in colour vision are therefore a sensitive test for optic neuritis

16. Light reflex

17. Accommodation reflex

18. normal pupil is ___PERRLA
 P---Pupil is
 E—equal
 R—rounded
 R—reaction to
 L –light and
 A—accommodation present

20. Test for ocular movement- 3rd, 4th and 6th CN

21. CRANIAL NERVE V: TRIGEMINAL
 It is a mixed having both sensory and motor
 Sensory: facial sensation in 3 branches-
 Ophthalmic (V1),
 Maxillary (V2),
 Mandibular (V3).
 Motor: muscles of mastication.

26. FACIAL NERVE
Facial is a mixed nerve
Motor: Muscle of facial expression & nerve to stapedius
Sensory: Sensory to ant 2/3 of tongue

31. Bell’s palsy
Bell's palsy is an acute condition caused by swelling of the
facial nerve in the facial canal resulting in
lower motor neuron paralysis of VII.
Cause is herpes simplex viral infection

32. Rinne’s test
• Tap a 512Hz* tuning fork and hold adjacent to the ear (air
conduction,
• Then apply the base of the tuning fork to the mastoid process
(bone
Conduction)
• Ask the patient which position sounds louder.
• Normal = air conduction > bone conduction = ‘Rinne’s
positive’
• In neural (or perceptive) deafness, Rinne’s test will remain
positive
• In conductive deafness, the findings are reversed (bone >
air).
Cranial nerve VIII: vestibulocochlear
Sensory: hearing (cochlear), balance/equilibrium (vestibular)
Motor: none

33. Weber’s test
• Tap a 512Hz tuning fork and hold the base against the vertex or
forehead at the midline
• Ask the patient if it sounds louder on one side.
• In neural deafness, the tone is heard better in the intact ear
• In conductive deafness, the tone is heard better in the affected
ear.
Vestibular function
Turning test
• Ask the patient to stand facing you, arms outstretched.
• Ask them to march on the spot, then close their eyes
(continue marching).
• Watch!
• The patient will gradually turn toward the side of the
lesion—
sometimes will turn right round 180°.

34. Types of hearing loss

35.  THE GLOSSOPHARYNGEAL (IX) AND VAGUS (X)
NERVES
 The 9th and 10th nerves control pharynx, larynx and swallow.

40. Cranial nerve XII: hypoglossal
 It is purely motor nerve
 Its nucleus lie beneath floor of IV ventricle

41. UMN-
pseudobulbar
palsy
LMN- bulbar palsy

43. 1.Which nerves are involved in bulbar palsy?
- The nerve involved are IX, X ,XI , XII
2.What are symptoms of bulbar palsy?
 3 D……………
 D—Dysphagia
 D—Dysarthria
 D—Dysphonia
3.Why called bulbar palsy?
As the nerve involved in bulbar palsy are situated in medulla. Anatomically medulla have two
forward bulging that previous medulla was called bulb.
4.Why called pseudo bulbar palsy?
 As the symptoms are like that of bulbar palsy. But lesion not in the medulla it is in the cerebral cortex. That
why it is call pseudobulbar palsy that is false bulbar .

44. 1.What are the features of 3rd nerve palsy?
 Ptosis (complete )
 Divergent squint
 Pupil dilated
 Both direct and indirect light reflex are lost
 Loss accommodation reflexes
 unable to move the eye upward ,downward and medially
2. What will be the direction of eye of in III nerve
lesion ?
-Eye ball will rotated down ward and laterally

45. Questions?