☤Perform a neurological examination. ☤Higher function. ☤Cranial nerves. ☤ Motor system. ☤Sensory system. ☤Interpret neurological examination. 7 categories of the neurological exam. • Mental status. • Cranial nerves. • Motor system. • Reflexes. • Sensory system. • Coordination. • Station and gait. The neurological exam should be incorporated into the rest of your physical In practice, the neurological exam is tailored to the patient's.
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The goal of the examination is to identify the overall condition of the patient, to Performing the neurological examination in a standard fashion and presenting. 1 sibacgamete.ga NEUROLOGICAL EXAMINATION Professor Shumway-Cook A and Neurological examination PDF manual. NEUROLOGIC EXAM DETAILS FROM NEURO EXAM VIDEO B. If the patient is sitting too far back on the exam table, the examiner might ask patient.
Cranial nerve III oculomotor. This nerve is responsible for pupil size and certain movements of the eye. Your child's doctor may examine the pupil the black part of the eye with a light and have your child follow the light in various directions.
Cranial nerve IV trochlear nerve. This nerve also helps with the movement of the eyes, in combination with CN VI. Cranial nerve V trigeminal nerve. This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing. Your child's doctor may touch the face at different areas and watch your child as he or she bites down.
Cranial nerve VI abducens nerve. This nerve helps with the movement of the eyes. Your child may be asked to follow a light or finger to move the eyes. Cranial nerve VII facial nerve. Your child may be asked to identify different tastes sweet, sour, bitter , asked to smile, move the cheeks, or show the teeth. Cranial nerve VIII acoustic nerve.
This nerve is the nerve of hearing. A hearing test may be performed on your child. Cranial nerve IX glossopharyngeal nerve. This nerve is involved with taste and swallowing. Once again, your child may be asked to identify different tastes on the back of the tongue. The gag reflex may be tested. Cranial nerve X vagus nerve. This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech.
The information from sharp stimulus testing as described above should suffice. In the setting of Cauda Equina syndrome, for example, multiple sacral and lumbar roots become compressed bilaterally e. When this occurs, the patient is unable to urinate, as the lower motor neurons carried in these sacral nerve roots no longer function.
Thus there is no way to send an impulse to the bladder instructing it to contract. Nor will they be aware that there bladders are full. There will also be loss of anal spincter tone, which can be appreciated on rectal exam. Ability to detect pin pricks in the perineal area a. For more information about peripheral nerves and their territories of innervation, see the following link: Patterns of Impairment for Dorsal Column Dysfunction: Proprioception: Patients should be able to correctly identify the motion and direction of the toe.
In the setting of Dorsal Column dysfunction a common complication of diabetes, for example , distal testing will be abnormal. This is similar to the pattern of injury which affects the Spinothalamic tracts described above. Vibratory Sensation: Patients should be able to detect the initial vibration and accurately determine when it has stopped.
As described under testing of proprioception, dorsal column dysfunction tends to first affect the most distal aspects of the system. When this occurs, the patient is either unable to detect the vibration or they perceive that the sensation extinguishes too early i. The findings on vibratory testing should parallel those obtained when assessing proprioception, as both sensations travel via the same pathway. Motor Testing The muscle is the unit of action that causes movement.
Normal motor function depends on intact upper and lower motor neurons, sensory pathways and input from a number of other neurological systems. Disorders of movement can be caused by problems at any point within this interconnected system. A frail elderly person, for example, will have less muscle bulk then a 25 year old body builder.
With experience, you will get a sense of the normal range for given age groups, factoring in their particular activity levels and overall states of health.
Things to look for: Using your eyes and hands, carefully examine the major muscle groups of the upper and lower extremities. First you need to fully expose the muscles of both extremities for comparison that you're examining. Palpation of the muscles will give you a sense of underlying mass. The largest and most powerful groups are those of the quadriceps and hamstrings of the upper leg i. Muscle groups should appear symmetrically developed when compared with their counterparts on the other side of the body.
They should also be appropriately developed, after making allowances for the patient's age, sex, and activity level. Muscle Asymmetry While both legs have well developed musculature, the left has greater bulk. There should be no muscle movement when the limb is at rest.
Rare disorders e. Amyotrophic Lateral Sclerosis result in death of the lower motor neuron and subsequent denervation of the muscle. This causes twitching of the fibers known as fasciculations,which can be seen on gross inspection of affected muscles. ALS is accompanied by other findings and symptoms, in particular, relentlessly progressive weakness.
To see a video demonstrating features of fasciculations, click on the movie icon. Tremors are a specific type of continuous, involuntary muscle activity that results in limb movement. Parkinson's Disease PD , for example, can cause a very characteristic resting tremor of the hand the head and other body parts can also be affected that diminishes when the patient voluntarily moves the affected limb.
Benign Essential Tremor, on the other hand, persists throughout movement and is not associated with any other neurological findings, easily distinguishing it from PD. To see a video demonstrating features of benign essential tremor, click on the movie icon.
To see a video demonstrating features of Parkinson's Disease, click on the movie icon. For more information about Parkinson's Disease, see the following link: NIH Sponsored Site About Parkinson's Disease The major muscle groups to be palpated include: biceps, triceps, deltoids, quadriceps and hamstrings. Palpation should not elicit pain. Interestingly, myositis a rare condition characterized by idiopathic muscle inflammation causes the patient to experience weakness but not pain.
If there is asymmetry, note if it follows a particular pattern. Remember that some allowance must be made for handedness i. Does the asymmetry follow a particular nerve distribution, suggesting a peripheral motor neuron injury? For example, muscles which lose their LMN inervation become very atrophic.
Is the bulk in the upper and lower extremities similar? Spinal cord transection at the Thoracic level will cause upper extremity muscle bulk to be normal or even increased due to increased dependence on arms for activity, mobility, etc. However, the muscles of the lower extremity will atrophy due to loss of innervation and subsequent disuse.
Is there another process suggested by history or other aspects of the exam that has resulted in limited movement of a particular limb? For example, a broken leg that has recently been liberated from a cast will appear markedly atrophic. Diffuse Muscle Wasting: Note loss muscle bulk in left hand due to peripheral denervation. In particular, compare left and right thenar eminences. Tone: When a muscle group is relaxed, the examiner should be able to easily manipulate the joint through its normal range of motion.
This movement should feel fluid. A number of disease states may alter this sensation.
For the screening examination, it is reasonable to limit this assessment to only the major joints, including: wrist, elbow, shoulder, hips and knees.
Technique: Ask the patient to relax the joint that is to be tested. Carefully move the limb through its normal range of motion, being careful not to maneuver it in any way that is uncomfortable or generates pain. Be aware that many patients, particularly the elderly, often have other medical conditions that limit joint movement.
Degenerative joint disease of the knee, for example, might cause limited range of motion, though tone should still be normal.
If the patient has recently injured the area or are in pain, do not perform this aspect of the exam. Things to look for: Normal muscle generates some resistance to movement when a limb is moved passively by an examiner. After performing this exam on a number of patients, you'll develop an appreciation for the range of normal tone.
If the examiner moves the joint patient relaxed and there is increased resistance, this is referred to as increased tone, which can be further characterized as rigid or spastic.
Spasticity: Tone increases if the examiner moves the joint more quickly i. This is the typical finding with an upper motor neuron lesion e. Rigidity: Tone remains increased regardless of how quickly the joint is moved. One example of this is Parkinson's disease, where limb movement generates a ratchet-like sensation known as cog wheeling.
Flaccidness is the complete absence of tone. This occurs when the lower motor neuron is cut off from the muscles that it normally innervates. Strength: As with muscle bulk described above , strength testing must take into account the age, sex and fitness level of the patient. For example, a frail, elderly, bed bound patient may have muscle weakness due to severe deconditioning and not to intrinsic neurological disease.
Interpretation must also consider the expected strength of the muscle group being tested. The quadriceps group, for example, should be much more powerful then the Biceps.
For example, the patient would be able to slide their hand across a table but not lift it from the surface. For example, the patient could raise their hand off a table, but not if any additional resistance were applied.
This is quite subjective, with a fair amount of variability amongst clinicians. Ultimately, it's most important that you develop your own sense of what these gradations mean, allowing for internal consistency and interpretability of serial measurements. Nerve roots providing the greatest contribution are printed in bold. More extensive descriptions of individual muscles and their functions, along with their precise innervations can be found in a Neurology reference text.
Intrinsic muscles of the hand C 8, T 1 : Ask the patient to spread their fingers apart against resistance abduction. Then squeeze them together, with your fingers placed in between each of their digits adduction.
Cranial nerve II optic nerve. This nerve carries vision to the brain. A visual test may be given and your child's eye may be examined with a special light. Cranial nerve III oculomotor. This nerve is responsible for pupil size and certain movements of the eye. Your child's doctor may examine the pupil the black part of the eye with a light and have your child follow the light in various directions.
Cranial nerve IV trochlear nerve. This nerve also helps with the movement of the eyes, in combination with CN VI. Cranial nerve V trigeminal nerve. This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing.
Your child's doctor may touch the face at different areas and watch your child as he or she bites down. Cranial nerve VI abducens nerve. This nerve helps with the movement of the eyes. Your child may be asked to follow a light or finger to move the eyes.
Cranial nerve VII facial nerve. Your child may be asked to identify different tastes sweet, sour, bitter , asked to smile, move the cheeks, or show the teeth. Cranial nerve VIII acoustic nerve. This nerve is the nerve of hearing. A hearing test may be performed on your child. Cranial nerve IX glossopharyngeal nerve. This nerve is involved with taste and swallowing. Once again, your child may be asked to identify different tastes on the back of the tongue.