The document provides an overview of general physical and mental examinations for neurologic patients. It describes examinations of the head, face, skin, back, and eyes and checks for conditions like hydrocephalus, Parkinson's disease, and myasthenia gravis. It also outlines mental status examinations including tests of consciousness, memory, the Mini-Mental State Examination, and the Glasgow Coma Scale. Finally, it lists tests of lobular brain functions for the frontal, parietal, temporal, and occipital lobes.

1. General physical & Mental
examination of neurologic patient
SEMINAR by : ABHILASH DASH
Email ID : physio.abhilash@gmail.com

2. Contents
o General physical examination
o On observation
o On examination
o Mental status examination
o Level of consciousness
o Memory test
o Mini mental status examination
o Glasgow Coma Scale
o Lobular function test
o References

3. General Physical Examination
Check BMI, vital sign like Pulse rate, Blood pressure, Respiratory rate and Rhythm,
Body Temperature.
On observation of the Head
 Hydrocephalus - head and face resembles as inverted triangle, forehead being
large, bossed and bulging forward and downward.
 Microcephally – head appears as a triangle the right way up, the forehead sloping
backward, the occiput forward and cranium coming to a rounded point.
 In Acromegally- Head increased by elongation with enlargement of jaw,
forehead and nose while teeth separated, excessive folded around the eye ,hand
and feet are enlarged, digits, blunt ended and spade – like.
 In Paget’s Disease – Head is enlarged and appears unnaturally rounded ,scalp
being red, warm and covered with dilated vessels.

4. Paget’s Disease
HydrocephalusAcromegally
Microcephally

5. THE FACE
 Parkinson's face- Mask like face with reduced blinking frequency.
 Maxedema face- Puffy lids and loss of the outer third of the eyebrows,
scanty and dry hair, dry skin, expressionless face and enlargement tongue.
 Facial asymmetry, hemiatropy, pouting of lips and transverse smile occur in
Myopathies.
 Plethoric, fat, hairy face in Crushing Syndrome.
 Exopthalmos and lid retraction in Hyperthyrodism.
 LMN facial palsy
 Forward dropping of neck of muscle weakness in MG, Progressive
muscular disease.
 Fixed drooping of eyelid with winkled forehead in Ocular myopathy

6. Parkinson's face Maxedema face
Crushing Syndrome
Hyperthyrodism

7. facial palsy
facial atrophy
Ocular myopathy

8. THE SKIN
 Note for allergic lesion and Dermatographia
 Scleroderma- Calcium deposit in skin
 Adenoma sebaceum- It consist of pink ,globular coat on cheeks, nose,
chin, forehead and upper lip.
 Herpes zoster- Redness, allegetic type itching, painful skin rash and
blister formation.
 Herpes simplex- Blistering source forms in the mouth or in genital organ,
skin.
 Bed sore-particularly prone to develop anaesthetic areas .
 Scars, burns, destruction of terminal phalanges- occurs in Spyringomyelia,
Leprosy and Hereditary sensory neuropathy.

9. Adenoma sebaceum
Herpes zoster
Herpes simplex
Scleroderma

10. Hereditary sensory neuropathy
Spyringomyelia
Dermatographia

11. THE BACK
 Scoliosis is common in muscular dystrophy, ataxia.
 Gross kyphoscoliosis may cause cord compression and
paraplegia.
 Excessive lordosis common in muscular dystrophy ,myasthenia
gravis.
 Gibbus deformity of spine – Localizes angular deformity of
spine caused by spinal TB or by secondary deposits of malignancy.

12. Gibbus deformity
Scoliosis
Gross kyphoscoliosis

13. THE EYE
 Ptosis- -3rd nerve palsy, myasthenia gravis, Horner’s syndrome,
myatonic dystrophy.
Pupil-
 Unequal pupil- Unilateral 3rd nerve palsy, brain herniation
compress 3rd nerve.
 Dilated pupil -3rd nerve sympathetic paralysis.
 Constricted pupil- 3rd nerve parasympathetic paralysis, Horner’s
Syndrome.

14. On Examination
Palpation
 Feel the surface of skull for bony irregularity or deficiency. This may be
congenital, traumatic or post- operative.
 A Rigid Spine-
• Lumbar spine remain straight when there is paravertebral
muscle spasm resulting from lumbar spine or disc disease.
• In ankylosing spondylitis the whole spine move as one and
flexion occurs at hip joint.
• Patient who have in wearing spinal supports for a long time
develop a state of rigidity of their spinal movements.
Percussion
 Children with hydrocephalus and separation of sutures – tapping the skull
with fingertip produces a tympanic , impure and rather high-pitched note-
called cracked-pot sound.

15. Sign of Meningism
 Neck stiffness-
 Kerning's sign-
 Brudzinski’s sign-

16. Mental status examination
Level of Consciousness
 Full consciousness- The patient is alert, attentive, follows command , respond
promotely to external stimulus if asleep, and once awake remains attentive.
 Lethargy- The patient is drowsy but partially awaken to stimulation . Patient will
answer questions and follows command but will do slow slowly and in
attentively.
 Obtundation- The patient is difficult to arouse and needs constant stimulation
to follow a simple command. Although they are may be verbal response with
one or two words ,the patient will drift back to sleep between stimulation .
 Stupor- The patient arouse to vigorous and continuous stimulation typically a
painful stimulation is required. The only response may be an attempt to
withdraw from remove the painful stimulation.
 Coma- The patient does not respond to continuous stimulation .there no verbal
sound ,no movement, except possibly by reflex.

17. Memory test
 IMMEDIATE memory- Digit span- ask patient to repeat a sequence of 5, 6, or
7 random numbers.
 RECENT memory- Ask patient to describe present illness, duration of hospital
stay, or recent events in the news.
 REMOTE memory- Ask about events and circumstances occurring more than
5 yrs. ago.
 VERBAL memory- Ask the patient to remember a sentence or a short story
and test after 15 minutes.
 VISUAL memory- Ask the patient to remember objects on a tray and test after
15 minutes.
Causes of disorders of memory- Korasakoff’s psychosis, post traumatic
amnesia, temporal lobectomy, psychogenic amnesia

18. Glasgow Coma Scale (GCS)
Action Response Score
Eyes open Spontaneously 4
To speech 3
To pain 2
None 1
Best verbal response Oriented 5
Confused 4
Inappropriate words 3
Incomprehensive sounds 2
Best motor response Obeys commands 6
Localized pain 5
Flexion withdrawal 4
Abnormal flexion 3
Abnormal extension 2
Flaccid 1
Total 15

19. Score Score
Questions
5 “What is the year? Season? Date? Day of the week? Month?”
5 “Where are we now: State? County? Town/city? Hospital? Floor?”
3 The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient’s response is
used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials: ___________
5 “I would like you to count backward from 100 by sevens.” (93, 86, 79,72, 65,
…) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
3 “Earlier I told you the names of three things. Can you tell me what those
were?”
2 Show the patient two simple objects, such as a wristwatch and a pencil, and
ask the patient to name them.
1 “Repeat the phrase: ‘No ifs, ands, or buts.’”
3 “Take the paper in your right hand, fold it in half, and put it on the floor.”
(The examiner gives the patient a piece of blank paper.)
1 “Please read this and do what it says.” (Written instruction is “Close
your eyes.”)
1 “Make up and write a sentence about anything.” (This sentence must
contain a noun and a verb.)
1 “Please copy this picture.” (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)

20. Limitation of MMSE
 Score more than 24 is normal.
 Cognitive impairment:-20-24
 Moderate cognitive impairment:-13-20
 Severe cognitive impairment:-<12

21. LOBULAR FUNCTION TEST
Frontal lobe
 Ask the Patient if he/she had planned to visit to the doctor.
 Ask and note whether the patient is able to give the history properly and has
preserved inside about his problem.
 Forward and backward digit span.
 Ask the patient to produce as many words as possible.
 Ask the patient to name animal, fruits or vegetables as many as he can in one
minute.
 Motor Luria test.
 Luria graphic test.
 The stroop test- RED, BLACK, WHITE, GREEN, BLUE, YELLOW

22. Parietal lobe
 Ideational apraxia- Unable to perform works which involves a series of
motor activity
 Right leg orientation- Test done in fore steps by increasing difficulty.
 Finger agnosia- 3 steps increasing difficulty
 Cortical sensation- look for asterognosis, graphaesthesia, barognosis, 2
point discrimination
 Simple and complex calculation.
 Geographical orientation-
 Constructional ability test by drawing.
 Clock drawing test-

23. Temporal lobe
 Long term memory- inability to form new LTM seen in
Korsakoff’s Psychosis, Alzhemer’s Dementia,
 Short term memory.
Occipital lobe
 Prosopagnosia- in ability to recognize familiar objects.
 Visual memory

24. References
1. BICKERSTAFF ’s Neurological Examination by KAMESHWAR PRASAD
2. Neurological Assessment by RUBEN D. RESTREPO
3. Neurological Examination by WILLIAM HOWLETT
4. Neurological intervention for Physical Therapy by MARTIN KESSLER
5. A Concise Guide to Neurology by REMA PAI
6. Neurology Illustrated by KENNETH W LINDSAY, IAN BONE
7. Internet

25. THANK YOU
Can the brain understand the brain??
Can it understand the mind??
Is it a giant computer, or
Some other kind of giant machine,
Or something more!!!!!!!!!
Can the brain understand the
Brain??
Can it understand the Mind??
Is it a Giant Computer, or
Some other kind of Giant
Machine,
Or something more !