Basic Neurological

Question 1

General Inspection

Answer 1

Is the patient stable?
Walking aids?
Twitches, fasciculations…

Question 2

Eyes

Answer 2

Fundoscopy: papilloedema? (R-R-R)(L-L-L)
Light reflexes: direct, consensual, swinging torch test 
Visual acuity 
Visual fields 
Eye movements 
Saccades

Question 3

Head

Answer 3

Facial movements: raise eyebrows, close eyes, bare teeth (CN 7)
Palatial movements: say ‘ahhh’ (CN 9 - uvula deviates away from lesion)
Tongue: wasting? deviation? (Towards CN 12 lesion)

Sensation? Hearing? Swallowing? Speech? CN 11?

Question 4

Upper limb

Answer 4

Pronator drift
Tone: range of motion at wrist and elbow
Power: shoulder abduction (C5), elbow flexion (C5/C6), elbow extension (C7), wrist extension (C6), finger extension (C7), finger flexion (C8), finger abduction (T1), thumb abduction (T1)
Sensation: vibration and pin prick
Reflexes: Biceps (C5-C6)
Triceps (C6-C7)
Supinator (C6-C7)

Question 5

Lower Limb

Answer 5

Tone: heel off? clonus?
Power: hip flexion (L1/L2), hip extension (L5/S1), knee flexion (S1), knee extension (L3/L4), foot dorsiflexion (L4), toe dorsiflexion (L5), foot plantarflexion (S1)
Reflexes: Knee (L3-L4)
                 Ankle (S1)
                 Plantar

Question 6

Other

Answer 6

Co-ordination
Gait
Romberg’s

Proprioception?? Soft touch??

Question 7

Romberg’s test

Answer 7

Eyes open - balance with the help of visual feedback.
If proprioception is impaired they cannot maintain balance without visual feedback so they lose balance when they shut their eyes - sensory ataxia.
Impairment could mean damage to the dorsal columns or to large myelinated sensory neurones.