Basic Neuro Exam Flashcards
5 components of basic neuro exam
- General assessment (mental status)
- Cranial nerves (II-XII)
- Motor systems
- Sensory systems
- Reflexes
4 things you are testing in your general assessment during basic neuro exam
- Level of alertness
- Appropriateness of responses
- Orientation to person, place, and time
- Congruency of mood
Location of cranial nerves
Telencephalon = 1
Diencephalon = 2
Midbrain = 3-4
Pons = 5
Pontomedullary junction = 6-8
Medulla = 9-12
Olfactory n. testing
Use familiar/non-irritating odors, have pt occlude one nostril and identify odor on each side
Conditions that cause loss of sense of smell
Sinus conditions Head trauma Smoking Aging Cocaine use Parkinson’s disease
Optic n. testing
Visual acuity w/ snellen chart
Visual fields by confrontation (wiggling fingers at edge of VF)
Light reaction (check for direct and consensual reaction)
Visual acuity result indicating pt is legally blind
20/200
Light reaction actually checks what 2 CNs?
CN II sensory
CN III constriction
CN III, IV, and VI testing
Cardinal signs of gaze
Near reaction (accommodation)
Also checking for nystagmus and/or ptosis
Trigeminal n. testing
Sensory: test forehead, cheeks, and jaw bilaterally with pinprick and cotton wisp. If pain sensation not intact, check temperature using hot/cold test tube
Motor: test temporalis+masseter with teeth clenching, lateral pterygoid with jaw movement side to side
Unilateral weakness of jaw musculature indicates what type of lesion
CNS pontine lesion
Bilateral weakness of jaw musculature indicates what type of lesion?
Cerebral hemispheric disease d/t bilateral cortical innervation
CNS patterns of stroke
Facial and body sensory loss on same side but from contralateral cortical or thalamic lesion
Ipsilateral face but contralateral body sensory loss in brainstem
Isolated facial sensory loss may indicate what condition
Trigeminal neuralgia
Facial n. testing
Motor: mm. of facial expression: raise eyebrows, frown, close both eyes tight, show upper and lower teeth, smile, puff out both cheeks
Sensory: taste for salty, sweet, sour, and bitter substances on anterior 2/3 tongue
Parasympathetic: secretion of saliva and tears
During facial n. testing, a widened ____ ____ and _____ ____ are indicative of weakness
Palpebral fissure; nasolabial fold
What condition affects both upper and lower face, loss of taste, hyperacusis, and increased/decreased tearing as a result of facial n. damage?
Bell’s palsy
A central lesion affecting the facial n. typically affects which part of the face?
Lower face
Vestibulocochlear n. testing
Whisper test
Weber/Rinne test
Balance testing (typically done with cerebellar testing)
Glossopharyngeal n. testing
Motor: voluntary m. for swallowing+phonation
Sensory: sensation of nasopharynx, gag reflex and taste for posterior 1/3 tongue
Parasympathetic: secretion of salivary glands and carotid reflex
Vagus n. testing
Inspect palate+uvula for symmetry
Observe for difficulties swallowing (water test)
Test for gag reflex
Check for hoarseness of voice
Spinal accessory n. testing
Shoulder shrug
Head turn against resistance
General observations for motor system
Body position and gait
Involuntary movement - tremors, tics, or fasciculations
Muscle bulk - wasting, atrophy
Muscle tone - muscle resistance to passive stretch
Testing major muscle groups of upper extremity
Shoulder shrug - CN XI Elbow flexion (C5,6) and extension (C6-8) Wrist flexion and extension (C6,7) Hand grip (C7,8, T1) Finger abduction (C8, T1) Thumb opposition (C8, T1)
Testing major muscle groups of lower extremity
Hip flexion (L2-4) and extension (S1) Hip adduction (L2-4) and abduction (L4-S1) Knee flexion (L4-S2) and extension (L2-4) Ankle plantarflexion (S1) and dorsiflexion (L4-5)
Gait observation
Casual -observe posture, balance, arm swinging, leg movement, look for ataxia
Tandem - heel-to-toe in straight line
Toe walk/heel walk - may reveal distal weakness in legs
Inability to heel-walk is a sensitive test for damage to what tract?
CST damage
Cerebellar tests and what abnormal test is
Rapid alternating movements (abnormal=dysdiadokinesia)
Finger-to-nose (abnormal=tremor)
Heel-to-shin (tests position sense)
Sensory testing utilizes dermatomes and what 3 methods of testing for spinothalamic tract, posterior columns, and both pathways at once?
Spinothalamic testing = pain and temp of dermatomes
Posterior columns = proprioception and vibration
Both pathways = light touch
What is the romberg test
Test of position sense/proprioception (posterior columns)
Pt stands with feet together and eyes open, pt closes eyes for 30-60 seconds without support, doc notes pt ability to maintain upright posture without excessive swaying
Cutaneous reflexes
Abdominal reflexes (T10-12) - contraction of abdominal muscles w/ deviation toward stimulus
Cremasteric reflex (afferent L1, efferent L2) - scrotum raises on ipsilateral side
Plantar response (babinski)
Anal reflex (S2-4) - note contraction of anal muscles (cauda equina)
Babinski sign
Use object to stroke lateral aspect of sole from heel to ball of foot. Normal response should be plantarflexion. Dorsiflexion of big toe and fanning of toes is + and suggests UMN dysfunction
Clonus
Abnormal pattern of neuromuscular activity, characterized by rapidly alternating involuntary contraction+relaxation of skeletal m.
Meningeal signs
Nuchal rigidity (stretching of spinal nn)
Brudzinskis sign (stretching of femoral n)
Kernigs sign (stretching of sciatic n)
