This document provides an overview of key aspects of the neurological exam, focusing on visual loss from brain injury, pupillary reflexes, eye movements and nystagmus, cranial nerve exams, and reflex testing. It discusses topics like afferent pupillary defects, types of nystagmus, involvement of specific cranial nerves in various palsies, and using tests of the biceps, triceps, brachioradialis, and knee jerks. The overall message is that a thorough neurological exam can provide important clues about brain and nerve function, though even experts don't know everything.

1. Common Sense Aspects of
the Neurological Exam
Or Why Can’t Neurologists KISS?
(Keep It Simple Stupid)?

2. Visual Loss From Brain
Injury
• Patients may see
movement even if they can
count static fingers
• Don’t forget that you can
get field cuts with disease
of the optic chiasm or
optic tract (especially in
MS)
• Superior cuts suggest
involvement of the
contralateral temporal
occipital region
• Inferior cuts suggest
involvement of the
contralateral parietal
occipital region.

3. Pupillary Reflexes
Afferent Pupillary Defect
(Marcus Gunn Pupil)

4. What Six Little Eye Muscles
Can Do
Eye Simulator.html.lnk

5. CN VI (ABDUCENS) AND III
(OCULOMOTOR) PALSIES

6. Directions in Nystagmus
Horizontal
Upbeating vertical
Downbeating
vertical

7. Direction in Nystagmus
Unidirectional
Bidirectional

8. Horizontal Nystagmus
First Degree
Second Degree
Third Degree

9. Horizontal Third Degree
Nystagmus

10. Bidirectional Nystagmus in a
Patient

11. Eye Movement Problems
With Brain Injury

12. Doll’s Eye Reflex

13. CN VII (Facial)
Peripheral v Central

14. Do-It-Yourself Cranial
Nerve Exam

15. CN VIII (Auditory)
Weber and Rinne Tests
• Weber test =
Tuning fork over
middle of head
to lateralize
hearing loss
• Rinne=bone
conduction v air
conduction

16. CN IX and X Palsy
• Absent gag on
stimulated side
• Weakness of
levator of palate
• Dysphonia
secondary to vocal
cord paralysis

17. CN XI (Spinal Accessory Nerve)
Palsy
• Affects SCM and
trapezius
• Shoulder shrugging
tests trapezius
• Forward flexion of
the next tests both
SCM
• Most often injured
with pathology of
the anterior
cervical triangle

18. CN XII (Hypoglassal) Palsy
• Atrophy and often
fasculations on the
side of the palsy
• Tongue deviates
towards the side of
the lesion
• Beware bilateral
tongue atrophy and
fasciculationsALS

19. Thinking About Biceps Jerk

20. Thinking About The Triceps Jerk

21. Thinking About the Brachioradialis Jerk

22. Thinking About the Knee Jerk

23. …Remember
even
Presidents
don’t know
everything