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Neurological Neurological examinationexaminationSunranSIX PARTS OF THE NEURO EXAMSIX PARTS OF THE NEURO EXAMMental State&Cognitive FunctionCranial NervesMotor SystemSensory SystemReflexesAutonomic functionMental State-Level of consciousness-Level of consciousnessNORMAL:patient awake and alert,attentive to surrounding and to the examinerDEPRESSED:SleepyLethargicStuporous-arousing only briefly in response to pain stimulationComatose-not arousable by verbal and pain stimulationCognitive FunctionA.Memory:instant;Short term-name three common objects,then recall them again after 5 minutes;Long term-verifiable events from the pastB.Calculations:Serial sevens:count backward from 100,taking away 7 each time.Real-life problemC.Orientation to person,place,and time.Cognitive Function D.Aphasia:expression,reception,repeat,name,read,writeE.ApraxiaF.AgnosiaG.exetutionOther:Insight and judgment,concentration,patients mood,content of though,appropriateness of behavior,and so on.MMSECRANIAL NERVESCRANIAL NERVES-Olfactory(I)Ask the patient to identify common scents such as coffee,vanilla,etc,with eyes closed.Do not use irritants.In testing olfactory nerve function,it is less important to determine whether the patient can correctly identify a particular odor than whether the presence or absence of the stimulus is perceivedCRANIAL NERVES-Optic (II)Visual Acuity-pocket card or wall chart or any reading matter such as news paperVisual FieldConfrontation Testing-Patient and examiner stand at eye level at about arms length.Have the patient cover his own eyeThreat Testing-applied when the patient is less than fully alert or is uncooperativeFundus(Ophthalmoscopic)ExaminationCRANIAL NERVES-Pupillary Reflexes (II,III)A normal pupil will constrict in response to direct light,as a consensual response to light in the opposite eye,and to accommodation(convergence to focus on a close object)CRANIAL NERVES-Control of Extraocular Muscle Movements (III,IV,VI)Extraocular muscle movements are controlled by the oculomotor(III),trochlear(IV),and abducens(V)nervesVolitional Eye Movement-Follow my finger,just with your eyes.Tracing the Letter HAsk about DiplopiaNystagmus is rthythmic oscillation of the eyesCRANIAL NERVES-Trigeminal Nerve(V)Facial SensationCorneal Reflex-Sweep a wisp of cotton lightly across the lateral surface of the eye(out of the direct visual field)from sclera to cornea-V,VIIMotor V Testing-Observe the symmetry of opening and closing of the mouth.Ask the patient to clench the teeth and then attempt to force jaw openingCRANIAL NERVE-Facial Strength(VII)Facial Symmetry-observe the patients face for symmetry of the palpebral fissures and nasolabial folds at rest.Ask the patient to wrinkle the forehead,then to squeeze the eyes tightly shut,then to smile or snarl,saying show your teethSupernuclear lesionNucleus or peripheral lesionBilateral Facial WeaknessCRANIAL NERVE-Auditory(VIII)Auditory acuity can be tested crudely by rubbing thumb and forefinger together about 5cm from each ear.If the patient cannot hear the rub,proceed to the follow testsRinne Test-hold the base of tuning folk on the mastoid process until the sound is no longer perceived,then bring the still vibrating fork up close to the ear.Sensorineural lossConductive lossWeber TestCRANIAL NERVE-Auditory(VIII)Weber Test-lightly strike a tuning fork and place the handle on the midline of the foreheadConductive lossSensorineural lossVestibular Function-need to be tested only if there are complaints dizziness or vertigo or evidence of nystagmusNylen-Barany(Dix-Hallpike)maneuver test for positional nystagmusCRANIAL NERVE-Glossopharyngeal(IX)&Vagus(X)Test the function of the palate,pharynx,and larynx 1.Palatal elevation-say“ah”2.Gag reflex(afferent IX,efferent X)-gently touch each side of the posterior pharyngeal wall with a cotton swab3.Sensory function-lightly touch each side of the soft palate with the tip of a cotton swab4.Voice quality-listen for hoarseness or“breathiness”,suggesting laryngeal weaknessCRANIAL NERVE-Accessory(XI)Sternocleidomastoid-press a hand against the patients jaw and have the patient rotate the head against resistance.Pressing against the right jaw tests the left sternocleidomastoid and vice versaTrapezius-have the patient shrug shoulders against resistance and assess weaknessCRANIAL NERVE-Hypoglossal(XII)Tests for hypoglossal nerve function include the following1.Atrophy or Fasciculations-with the patients tongue resting in the floor of the mouth,first inspect for atrophy or fasciculations.Then ask the patient to protrude the tongue,and observe for deviation to the weak side2.Subtle Weakness-have the patient push the tongue into each cheek against external resistance(opposite hypoglossal m.)3.Subtle Dysarthria-Ask the patient to repeat difficult phrasesSensory FunctionMotor Function运动系统A.Muscle StrengthThe classic grading system scores as follows:5,full strength;4,movement against gravity and&resistance;3,movement against gravity only;2,movement horizontally along the surface of the bed;1,palpable contraction but little visible movement;0,no contraction运动系统B.Muscle ToneDecreased(floppy,flaccid,hypotonic)NormalIncreased(Spastic vs.Rigid)C.AtaxiaCerebellar hemisphere are responsible for coordinating and fine-tuning movements(ipsilateral)1.Finger-to-Nose2.Rapid Alternating Movements3.Rebound4.Heel-Knee-ShinRombergs test is a quick and excellent screen for loss of proprioceptive feedback neuropathy or spinal cord diseaseD.Involuntary movementspasmmyoclonusdystoniatremorchoreic movementathetosisE.Others:fasciculation,myokymia,crampReflexesLight Tendon ReflexesLight Tendon Reflexesabdominal reflexcremasteric reflexplantar reflexanal reflexDeep Tendon ReflexesDeep Tendon ReflexesBicep Reflex(C5-6)Tricep Reflex(C6-7)Patellar Reflex(L2-4)Radial Reflex(C5-8)Achilles(Ankle Jerk)Reflex(S1-2)Clonus:ankle,patella,Pathologic ReflexesPathologic ReflexesBabinski SignOppenheim signGordon signHoffmann signMeningeal irritationNeck stiffnessKernig signBrudzinski signAutonomic functionskin,sweatThank you!Thank you!
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