Chapter 41 - Clinical and laboratory examinations relevant to clinical neuropsychology

Question 1

What is included in a full neurological assessment?

Answer 1

taking a history,
observing the patient’s behaviour, and carrying out a formal neurological
examination of his/her motor, sensory, and reflex functions. A brief
mental status examination also comprises part of this assessment.

Question 2

Which points should be included in the patient history?

Answer 2

◆ What is the precise description (quality) of the complaints?
◆ Where are they localized?
◆ When did they first start?
◆ How did they start, suddenly or gradually?
◆ What course have they taken?
◆ Which situations trigger or relieve them?
◆ What treatment has been tried?

Question 3

What should be of focus in the Observation of the patient’s behaviour?

Answer 3

◆ Level of alertness. Sleepiness is called somnolence when it is mild
and stupor when it is more severe. Coma is enduring complete loss
of consciousness.
◆ Speed of movements and speech. Unusual slowness of movement is
called bradykinesia.
◆ Involuntary movements. Tremor is a rhythmic shaking of the limbs,
the head, or, rarely, the whole body. Depending on the underlying
disease, it can be most pronounced in rest, in holding the limbs
outstretched, or during active movements.
◆ Dystonia, dyskinesia, chorea, and athetosis are different types of involuntary movements that are not rhythmic.
◆ Speech. Aphasia is the disturbed production and/or understanding of
language; dysarthria is a defect in articulation, making the speech
slurred.
◆ Structuring of the patient’s account of his problems.
◆ Social appropriateness.

Question 4

What does the neurological assessment usually start with?

Answer 4

The neurological examination usually starts with the head and assessment
of the 12 cranial nerves and then proceeds to the motor functions,
sensations, and reflexes of the limbs and trunk. It should also include a
brief mental status examination.

Question 5

What are the functions of the 12 cranial nerves?

Answer 5

◆ Motor functions: - everything regarding the head (elaborated in the chapter)
◆ Senses
◆ The vestibular system in the inner ear
◆ Reflexes. The most widely used reflex is the light reflex of the pupils.

Question 6

How is motor functions of the body assessed?

Answer 6

◆ Muscle power; The maximum power of each muscle group is
described on a scale from 0 (no muscle contraction) to 5 (full power)
◆ Coordination The dexterity of both coarse and fine movements is
tested by the finger–nose test
◆ Muscle tone. Increased tone can be either spasticity or rigor; reduced tone is called flaccid.
◆ Posture and gait. Observe whether the patient stands straight or bent,
secure or insecure, and whether the movements seem clumsy
(ataxic) or asymmetrical.

Question 7

What are the sensory modalities?

Answer 7

The sensory modalities are: ◆ touch;
◆ pain;
◆ temperature;
◆ vibration;
◆ position of limbs.

Question 8

What are The most commonly tested reflexes?

Answer 8

The most commonly tested reflexes are the biceps and triceps reflexes in
the arms and the knee jerk and the ankle jerk in the legs. Note whether
the reflexes are unusually weak or brisk, whether there are side
differences, or differences between the reflexes of the arms and those of
the legs.

Question 9

A short presentation of all scanning methods are presented on which pages?

Answer 9

p. 840-848..

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