1 Neurologic Examination Flashcards
Three-tiered approach in neurologic examination
- Is there a lesion of the nervous system?
- Where is the lesion?
- What is the lesion?
8 elements of the neurologic examination
- Mental status testing
- Higher cerebral functions
- Cranial nerves
- Sensory exam
- Motor exam
- Reflexes
- Cerebellar testing
- Gait and station
________ function defines the dominant hemisphere
Language
The nondominant hemisphere is concerned with
spatial relationships
For left-handed patients, most will be ______ dominant for language
left-hemisphere
Thus, a large cortical stroke affecting the cortex of the dominant hemisphere (the left hemisphere whether they are left- or right-hand dominant) likely will affect language functions
this suggests a central cause of vertigo
vertical or direction-changing vertigo
HINTS testing
Head impulse
Nystagmus
Skew
Remarks on Head Impulse Test (HIT)
A normal finding is visual fixation with no rapid saccadic movement.
A normal finding suggests a central cause of vertigo
A very sensitive sign for upper extreity weakness
having the patient hold the arms outstretched with palms upward and observing for any inward rotation or downward drift
______ tremors characterize Parkinson’s disease
Rest tremors
This is an abnormal postvoid residual bladder volume
> 100 mL
certainly >200 mL
Least important part of the neurologic examination
Muscle stretch reflexes
offr little value when used in isolation
Classic indicator of an upper motor neuron lesion
Babinski’s sign - abnormal reflex with movement of the great toe upward and perhaps fanning of the other toes upon mildly stimulating the lateral aspect of the foot
The reliability and accuracy of a Babinski’s sign have been called into question.
Cardinal signs of upper motor neuron syndrome
Babinski’s sign and hyperreflexia
although the absence of these signs does not reliably exclude a diagnosis of spinal cord compression
This part of the neurologic examination is said to be most informative
observation of the patient walking.
One feature common in many patients with cerebellar hemorrhage
the sudden inability to walk
These patients may also have severe nausea and vomiting
