Examinations and Investigations in Neurology Flashcards
What neurophysiological studies can we do?
EEG Nerve conduction studies Electromyography Visual evoked responses Small fibre studies
What are the elements of a neurological examination?
Cranial Nerves
Appearance of limbs, power, tone, reflexes, sensation (pinprick, light touch, vibration, and proprioception), co-ordination, and gait.
Cerebellar examination
Cognitive function
Talk me through cranial nerve examination.
Assume you have already introduced yourself and obtained consent
First ask if any changes in smell or taste - CN I and VII/IX
Visual assessment - visual fields, visual acuity, eye movements, pupil reactivity (direct and consensual), and accommodation. Fundoscopy if indicated. CN II, III, IV, and VI
Sensation on the face - bilaterally in ophthalmic, maxillary, and mandibular regions of CN V. Also ask pt to clench jaw (musclesof mastication) - CN V
Facial expression - ask pt to raise eyebrows, scrunch eyes against resistance, smile, stick out tongue. CN VII
Hearing and balance assessment - whisper testing, then Rinne’s and Weber’s tests with 256 Hz tuning fork. CN VIII
Ask pt to swallow. CN IX and X
Ask pt to shrug against resistance, and twist head against resistance. CN XI
Ask pt to push tongue into side of mouth (against resistance), and inspect for deviation within the mouth. CN XII.
What do we look for on general examination of a pt in a neurological examination?
Posture Gait Obvious muscle wasting Facial asymmetry Abnormal movements e.g. tremor Fasciculations Monitoring Treatment Paraphernalia
Describe how you would assess power in the upper limbs.
Ask pt to do high chicken wings and resist you 1) pushing down and 2) pushing up.
Ask pt to do boxing stance and resist you 1) pulling forearms and 2) pushing forearms
Ask pt to make a fist then resist 1) pushing up 2) pushing down, and then grip your fingers.
Ask pt to hold out hand and resist fingers being 1) pushed down 2) pushed up
Ask pt to open fingers while you resist them.
Describe how you would assess power in the lower limbs.
Ask pt to raise leg straight and resist pressing up and down on thigh.
Bend knees and ask them to resist pushing on shin and then pulling calf.
Ask pt to resist pulling toes up and pushing toes down against resistance.
How do you assess tone in the limbs?
Ask pt to relax limb completely and move each section individually and slowly.
How do you test for clonus in the ankles, and what does that actually mean?
Hold calf and foot with relaxed lower limb. Suddenly dorsiflex foot and hold for a few seconds to see if there are jerks of the foot.
Tests for increased tone in the limb.
What is fasciculation, and what is it a sign of?
A brief spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the skin.
LMN sign
On examination of a pt with neurological signs, you ask them to stand up, walk away from you, turn around and walk back.
What signs might you elicit from this assessment?
- Slow to stand and initiate - PD
- Loss of arm swing - PD
- Festinating gait - PD
- Scissoring (involuntary leg crossing) - spasticity i.e. UMN lesion
- Waddling gait - proximal muscle weakness
- Foot drop
- Heel to toe walk - ataxia
- Romberg’s sign
- Trendelenberg gait
Which nerve roots is hip flexion testing?
L1 L2
Which muscle is hip flexion testing?
Iliopsoas
Which nerve is hip flexion testing?
Femoral
Which nerve roots is hip extension testing?
L5, S1
Which muscle is hip extension testing?
Gluteus maximus
Which nerve is hip extension testing?
Inferior gluteal
Which nerve roots is knee extension testing?
L3 L4
Which nerve roots is knee flexion testing?
S1
Which nerve roots is ankle dorsiflexion testing?
L4
Which nerve roots is ankle plantarflexion testing?
S1 S2
Which nerve roots is extension of the big toe testing?
L5
Which muscle is knee extension testing?
Quadriceps
Which muscle is knee flexion testing?
Hamstrings (semitendinosus, semimembranosus, biceps femoris)
Which muscle is ankle dorsiflexion testing?
Tibialis anterior
