The document discusses examination of the central nervous system. It covers assessment of higher functions like behavior, memory and orientation. It also discusses signs of meningeal irritation like nuchal rigidity and Kernig's sign. The cranial nerves, motor system, sensation and localizing signs are examined. The motor system examination includes gait, posture and muscle tone, power and reflexes. Sensory examination involves tests of pain, touch and temperature. Localizing signs help identify abnormalities in specific areas of the brain or spinal cord.

1. CNS Examination (Central
Nervous System)
DR. SABIR ALI
ASSISTANT PROF.
KAMCH UDAIPUR

2. CNS Examination (Central Nervous System)
1 Assessment of higher functions
2 Signs of meningeal irritation
3 Examination of cranial nerves
4 Examination of motor system
5 Sensory examination
6 Localizing sign

3. Assessment of higher functions
 General behavior - Irritability, Confusion
 Memory – Comprehension & intellect
 Orientation – time,space,person,
 Speech

4. Signs of meningeal irritation
 Nuchal rigidity – pain & stiffness of neck during flexion
 Kernig sign – pain of extension of the leg,following hip
flexion
 Brudzinski sign – involuntary flexion of knee & hips
passive flexion of the neck
https://youtu.be/tN6bbPOFAg8

6.  Inflamation of spinal meninges
 Irritation of nerve roots
 protective spasm of spinal muscles on streching of spinal
cord
 Seizures

7. Examination of cranial nerves

8. Examination of motor system
 Gait –
 Posture –
 Muscle tone

 Muscle Power
 reflexes

9. Abnormal but painless gait ind-neuromuscular disease

15.  https://youtu.be/7OcKkW8_LUU

16. Decorticate posture – bilateral flexion of upper limbs
& extension of lower limbs
Decerebrate posture- extension of all limbs with
spasticity
frog-like posture – extension of all four limbs
Posture

17. frog-like posture

18. Muscle tone

21. Muscle Power

22. Reflexes
 Important superficial reflexes include conjunctival or corneal
reflex (V/VII cranial nerve), abdominal reflex (T. 1), Cremestric
reflex (L,), and Anal reflex (S,). Superficial reflexes are lost in lower
motor neuron lesions.
 Important deep tendon reflexes with their root palsy include Jaw
jerk (Pontine reflex), Biceps (C 6-7), Triceps (C6),Knee (L3-4), and
Ankle(L7, S1,).
 Abnormal deep tendon reflexes include: (a) Hyperreflexia in upper
motor neuron lesions (b) Hypo/a-reflexia in lower motor neuron
lesions.

23. Sensory examination
 Pain by pin-prick
 Deep touch by finger pressure

24. Localizing sign
 higher functions abnormal
 Speech/vision defects
 Seizures
 Learning disabilities
 Impaired memory

25. Laboratory evaluation in CNS disease
 CSF Examination
 Neuroimaging (CT,MRI,X-ray )
 Electroencephalography (EEG,EMG,)

26.  Thank you