NEUROLOGICAL EXAMINATIONS
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PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
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Nerves conduction study
Nerve conduction studies are used to evaluate the function of motor and sensory nerves. They involve stimulating nerves with controlled electrical pulses and recording the responses. For motor nerve conduction studies, the compound muscle action potential is recorded from muscles. Key measurements are latency, amplitude, and conduction velocity. For sensory nerve conduction studies, the sensory nerve action potential is recorded from sensory nerves. Common sites tested include the median, ulnar, and sural nerves. The results can help diagnose various peripheral nerve and neuromuscular disorders.
Apraxia examination and evaluation
Apraxia is an inability to correctly perform learned skilled movements due to a cognitive deficit in motor programming. It is broadly divided into limb apraxia and buccofacial apraxia. Limb apraxia includes ideomotor apraxia, ideational apraxia, and limb kinetic apraxia caused by lesions in the parietal lobe, frontal lobe, and connections between the two. Buccofacial apraxia involves an inability to perform skilled mouth and tongue movements and is associated with left frontal lesions. Apraxia is assessed through tasks like pantomiming tool use, imitation of gestures, and performing commands.
Stretch reflex
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2) The muscle spindle contains intrafusal fibers that act as proprioceptors. Primary and secondary endings in the muscle spindle sense changes in muscle length and relay signals to the spinal cord.
3) The stretch reflex arc involves muscle spindles sensing stretch and activating alpha motor neurons, causing contraction of the same muscle and opposing the stretch. This reflex helps maintain muscle tone and posture.
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This document provides information about examining the motor system, including anatomy of motor pathways in the brain and spinal cord, inspection of muscles, and testing of muscle tone, power, and specific muscles. It describes how to examine muscles of the shoulder, elbow, wrist/hand, hip, and other areas, including specific tests to evaluate individual muscles like deltoid, biceps, gluteus maximus, and others. The document provides detailed instructions on posture and resistance for testing each muscle.
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This document describes a case of Miller Fisher syndrome in a 24-year-old female patient presenting with gait instability, facial weakness, eye movement abnormalities, limb numbness, and dysphagia. Electrodiagnostic testing showed normal nerve conduction but abnormal sensory Ia afferent conduction, supporting a diagnosis of Miller Fisher syndrome. Key findings included hypotonia, areflexia, loss of the H-reflex, and decreased sensory evoked potentials attributed to increased intracranial pressure. The multiple cranial neuropathies with normal MRI and abnormal afferent conduction established a diagnosis of Miller Fisher syndrome associated with benign intracranial hypertension.
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These are the sort of normal variants which can be found in any normal subject or can concomitantly be found or superimposed in pathological cases. Identifying these anomalies helps out interpreting and making correct diagnosis and to avoid any misinterpretation.
APPROACH TO VERTIGO
1) The document discusses various approaches to evaluating and treating vertigo, including distinguishing between peripheral and central causes.
2) Diagnostic tests like Dix-Hallpike, VNG, and HINTS can help determine if vertigo is peripheral or central in nature and identify specific causes.
3) Treatment depends on the underlying cause but may include medications, repositioning maneuvers, vestibular rehabilitation, and in rare cases surgery.
Plantar, babinski
This document discusses the Babinski sign and plantar reflex. It begins by defining the plantar reflex as the response to stimulation of the sole of the foot. It then describes Babinski's original 1896 observation of the pathological plantar reflex known as the Babinski sign, in which dorsiflexion of the toes occurs. The rest of the document covers the physiology and assessment of the plantar reflex and Babinski sign, variations, mimickers, and upper limb equivalents. It emphasizes that a positive Babinski sign indicates pyramidal tract dysfunction and underlying neurological disease.
ASIA IMPAIREMENT SCALE
The American Spinal Injury Association created the International Standards for Neurological Classification of Spinal Cord Injury to standardize how severity of spinal cord injuries are determined and documented. The standards provide a standardized examination of motor and sensory function to assess the extent of loss after an injury. It examines dermatomes and myotomes to determine the affected spinal cord segments. The examination involves detailed sensory and motor testing to determine sensory and motor levels, neurological level, and whether the injury is complete or incomplete.
Disorders of the Neuromuscular junction
This document provides an overview of disorders of the neuromuscular junction, including myasthenia gravis and Lambert-Eaton myasthenic syndrome. It discusses the classification, pathogenesis, clinical features, diagnosis and management of these conditions. Key points include that myasthenia gravis is caused by antibodies against acetylcholine receptors, often associated with thymoma, and presents with fatigueable muscle weakness. Lambert-Eaton syndrome involves antibodies against voltage-gated calcium channels and is commonly paraneoplastic, associated with small cell lung cancer. The document also briefly covers other acquired and congenital myasthenic syndromes, botulism, and other causes of impaired neuromuscular transmission.
Sensory Examination
The document discusses the sensory system and how it processes and transmits sensory information from peripheral receptors to the sensory cortex. It describes how different sensory modalities like pain, temperature, vibration and proprioception are carried by different nerve fiber types and pathways in the body. It provides details on testing various sensory modalities and how the patterns of sensory loss can help localize lesions to different parts of the central or peripheral nervous system.
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PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
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The document describes tests that can be used to evaluate coordination, balance, gait, and posture in patients. It explains how to test for coordination by having patients perform rapidly alternating movements with their hands and point-to-point movements touching their nose and the examiner's finger. The Romberg test is described to test balance by having patients stand with their eyes closed. Gait is evaluated by having patients walk normally, heel-to-toe, on their toes, and on their heels. The wall test is provided to assess posture.
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1) The clinical tests showed high test-retest reliability.
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Neuro exam ppt
1. The document discusses examination of the cranial nerves and neurological system. Key tests described include evaluation of gait, stance, speech, mental status and cranial nerves I-XII.
2. Specific disorders are discussed such as types of dysarthria and dysphasia, optic nerve conditions seen on fundoscopy, and lesions affecting cranial nerves.
3. Examination techniques are provided for assessing conditions of the cranial nerves including testing of smell, hearing, eye movements, facial strength, and vestibular function.
Motor and sensory examination, Examination of reflexes
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Neurological examination
This neurological examination document provides details on:
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2) The components of the neurological exam including motor function, sensory function, cranial nerves, reflexes, and mental status.
3) Descriptions of how to examine each system, what abnormalities to look for, and what they may indicate. Rating scales are provided for things like strength, reflexes, and level of consciousness.
4) Common gait patterns and their potential causes are listed at the end.
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- 3. COMPONENTS SENSORY EXAMINATION REFLEX EXAMINATION MENTAL STATUS EXAMINATION COORDINATION AND GAIT EXAMINATION MOTOR EXAMINATION CRANIAL NERVE EXAMINATION
- 4. A) Appearance Age Weight Manner of dress Grooming
- 5. B) Attitude and behaviour Body language Eye contact Breathing rhytm Body movement
- 9. TEST EXAMPLE : AMTS
- 10. TEST EXAMPLE : MMSE
- 12. A)Tendon reflex Biceps Triceps Brachioradialis Knee jerk Ankle jerk
- 15. 3) Sensory examination Vibration testing Light touch treshold Temperature Cortical sensation graphesthesia
- 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. I Olfactory nerve Normal Perceive scent with either nostril Abnormal response unilateral Structural brain lesion Local brain lesion bilateral Rhinitis // damage to CP
- 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. 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. 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. 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. 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. 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.
- 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. 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
- 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).