Neurologic Exam Notes PDF

THE NEUROLOGIC EXAM BIO336 Audrey Forbes-Cardinali, D.C. Mercyhurst University  THE NEUROLOGIC EXAM The neurologic exam is generally divided into six parts: 1. Mental status 2. Cranial nerves 3. Motor exam 4. Reflexes 5. Coordination and gait 6. Sensory exam ...

THE NEUROLOGIC EXAM BIO336 Audrey Forbes-Cardinali, D.C. Mercyhurst University  THE NEUROLOGIC EXAM The neurologic exam is generally divided into six parts: 1. Mental status 2. Cranial nerves 3. Motor exam 4. Reflexes 5. Coordination and gait 6. Sensory exam  MENTAL STATUS 1. Level of alertness, attention, 5. Calculations, right–left cooperation confusion, finger agnosia, 2. Orientation agraphia 3. Memory 6. Apraxia Recent memory 7. Neglect and constructions Remote memory 8. Sequencing tasks and frontal 4. Language release signs Spontaneous speech 9. Logic and abstraction Comprehension 10. Delusions and Naming hallucinations Repetition 11. Mood Reading Writing  A LERTN ESS, ATTEN TIO N , COOPERATION A N D ORIEN TATION Allows us to test regions like the reticular formation (brainstem), thalami and cerebral hemispheres at same time. Recite ………. forwards and backwards Is the patient alert and oriented to person, place and time? A&O x3 But, this is only appropriate if we know patient to have normal mental faculties  MENTAL STATUS 1. Level of alertness, attention, 5. Calculations, right–left cooperation confusion, finger agnosia, 2. Orientation agraphia 3. Memory 6. Apraxia Recent memory 7. Neglect and constructions Remote memory 8. Sequencing tasks and frontal 4. Language release signs Spontaneous speech 9. Logic and abstraction Comprehension 10. Delusions and Naming hallucinations Repetition 11. Mood Reading Writing  RECENT MEMORY AND REMOTE MEMORY Recent memory: Remote memory: Ask the patient to recount something from many years ago, but that it verifiable.  MENTAL STATUS 1. Level of alertness, attention, 5. Calculations, right–left cooperation confusion, finger agnosia, 2. Orientation agraphia 3. Memory 6. Apraxia Recent memory 7. Neglect and constructions Remote memory 8. Sequencing tasks and frontal 4. Language release signs Spontaneous speech 9. Logic and abstraction Comprehension 10. Delusions and Naming hallucinations Repetition 11. Mood Reading Writing  LANGUAGE Spontaneous speech Comprehension Naming Start with simple objects then move to parts of objects Repetition Simple statement, not a tongue twister Reading Writing This allows us to test different parts of the brain as the participate in different parts of language  MENTAL STATUS 1. Level of alertness, attention, 5. Calculations, right–left cooperation confusion, finger agnosia, 2. Orientation agraphia 3. Memory 6. Apraxia Recent memory 7. Neglect and constructions Remote memory 8. Sequencing tasks and frontal 4. Language release signs Spontaneous speech 9. Logic and abstraction Comprehension 10. Delusions and Naming hallucinations Repetition 11. Mood Reading Writing  CALCULATIONS, APRAXIA AND NEGLECT Calculations, agraphia, right-left confusion and finger agnosia all test for lesion in dominant parietal lobe (known as Gerstmann’s syndrome) Apraxia – Inability to follow motor commands Neglect - may only be seen by looking for extinction on bilateral, simultaneous testing. Drawing may show discrepancies (one side compared to the other)  MENTAL STATUS 1. Level of alertness, attention, 5. Calculations, right–left cooperation confusion, finger agnosia, 2. Orientation agraphia 3. Memory 6. Apraxia Recent memory 7. Neglect and constructions Remote memory 8. Sequencing tasks and frontal 4. Language release signs Spontaneous speech 9. Logic and abstraction Comprehension 10. Delusions and Naming hallucinations Repetition 11. Mood Reading Writing  SEQUENCING, LOGIC, DELUSIONS, AND MOOD Patients may not be able to preform sequences of patterns and get stuck May not be able to release a reflexive hand grip. Logic and Abstractions: AZ, BY, CX, DW… Logic quizzes Do you perceive things others don’t see or hear? Does the patient present with mood disorders?  CRANIAL NERVES 1. Olfaction (CN I) 2. Ophthalmoscopic exam (CN II) 3.Vision (CN II) 4. Pupillary responses (CN II, III) 5. Extraocular movements (CN III, IV,VI) 6. Facial sensation and muscles of mastication (CN V) 7. Muscles of facial expression and taste (CN VII) 8. Hearing and vestibular sense (CN VIII) 9. Palate elevation and gag reflex (CN IX, X) 10. Muscles of articulation (CN V,VII, IX, X, XII) 11. Sternocleidomastoid and trapezius muscles (CN XI) 12. Tongue muscles (CN XII)  THE MOTOR EXAM 1. Observation Involuntary movements, tremor, hypokinesia 2. Inspection Muscle wasting, fasciculations 3. Palpation Tenderness, fasciculations 4. Muscle tone 5. Functional testing Drift Fine finger movements Rapid toe tapping 6. Strength of individual muscle groups  REFLEXES 1. Deep tendon reflexes 2. Plantar response 3. Reflexes tested in special situations Suspected spinal cord damage Posturing  THE PLANTAR REFLEX The plantar reflex involves stroking the bottom of the foot with a reflex hammer Normal responses include withdrawal of foot or curling of the toes, or no movement at all Abnormal result is called the Babinski response and involves extension of great toe and flaring of the other toes  COORDINATION AND GAIT 1. Appendicular coordination Rapid alternating movements Finger–nose–finger test Heel–shin test Overshoot 2. Romberg test 3. Gait Ordinary gait Tandem gait Forced gait  THE SENSORY EXAM 1. Primary sensation—asymmetry, sensory level Pain (sharp vs. dull) Temperature (cold vs. warm) Vibration Proprioception Light touch and two-point discrimination 2. Cortical sensation Graphesthesia Stereognosis