Neuro Flashcards
How to test Cranial nerve 1
The olfactory nerve is tested by asking them if they have had a change in smell recently
how to test cranial nerve 2
Begin by assessing the patient’s visual acuity using a Snellen chart
how to test cranial nerve 2- second test
- Sit directly opposite the patient, at a distance of around 1 metre.
- Ask the patient to cover one eye with their hand.
- If the patient covers their right eye, you should cover your left eye (mirroring the patient).
- Ask the patient to focus on part of your face (e.g. nose) and not move their head or eyes during the assessment. You should do the same and focus your gaze on the patient’s face.
- Assess the patient’s peripheral visual field by comparing to your own and using the target. Start from the periphery and slowly move the target towards the centre, asking the patient to report when they first see it. If you are able to see the target but the patient cannot, this would suggest the patient has a reduced visual field.
How to test CN 3,4,6
- Hold your finger (or a pin) approximately 30cm in front of the patient’s eyes and ask them to focus on it. Look at the eyes in the primary position for any deviation or abnormal movements.
- Ask the patient to keep their head still whilst following your finger with their eyes. Ask them to let you know if they experience any double vision or pain.
- Move your finger through the various axes of eye movement in a ‘H’ pattern.
- Observe for any restriction of eye movement and note any nystagmus
How to test CN 5
test facial sensation by touching three spots Top (ophthalamic) mid (maxillary) bottom Mandibular
How to test CN7
Facial Nerve
Raised eyebrows: assesses frontalis – “Raise your eyebrows as if you’re surprised.”
Closed eyes: assesses orbicular oculi – “Scrunch up your eyes and don’t let me open them.”
Blown out cheeks: assesses orbicularis oris – “Blow out your cheeks and don’t let me deflate them.”
Smiling: assesses levator anguli oris and zygomaticus major – “Can you do a big smile for me?”
How to test CN8
Whisper a number 60cm away for each ear while the other ear is distracted.
If there is defness preform Rinnes and Weber test
How do you test CN9 and 10
Check the pt uvular for displacement
Ask the pt to turn there head and cough and swallow water
How to test CN11
Get pt to raise traps while you push down
Get pt to turn head one way while you push against them
How to test CN12
Ask the pt to poke tongue out, check for deviation
Push tongue into cheek and push against it assess for weakness
Whats the DANISH mnemonic stand for
-Dysdiadochokinesia
-Ataxia (gait and posture)
-Nystagmus
-Intention tremor
-Slurred, staccato speech
-Hypotonia/heel-shin test
What is Ataxia
Ataxia is a neurological condition that causes uncoordinated, jerky movements, making smooth and controlled motion difficult.
Conduct Rombergs test
- Ask the patient to put their feet together and keep their arms by their sides
- Ask the patient to close their eyes.
Interpret Rombergs Sign
Falling without correction is abnormal and referred to as a positive Romberg’s sign
What does Rombergs sign indicate
This indicates unsteadiness is due to sensory ataxia
What is Nystagmus
Nystagmus involves repetitive, involuntary oscillation of the eyes and can be either physiological (i.e. benign) or associated with cerebellar pathology.
How to assess Nystagmus
- Ask the patient to look straight ahead and examine the eyes in the primary position. Look for any abnormal movement such as nystagmus.
- Ask the patient to keep their head still and follow your finger (or another visual target) with their eyes.
- Move your finger throughout the various axes of vision in a ‘H’ pattern.
- Look for multiple beats of nystagmus (a few beats at the extremes of gaze can be a normal variant and is termed physiological nystagmus).
Interpret Finger to nose test
When patients with cerebellar pathology perform this task they may exhibit both dysmetria (lack of coordination during movement) and intention tremor (worsens during voluntary movement)
What is Dysmetria
Dysmetria: refers to a lack of coordination of movement. Clinically this results in the patient missing the target by over/undershooting.
What is Dysdiadochokinesia
inability to perform rapid, alternating movements smoothly. It is often a sign of cerebellar dysfunction
The presence of dysdiadochokinesia suggests ipsilateral cerebellar pathology.
Cerebellar Exam
1 Assess the patient’s gait
2 Assess tandem gait (heel-to-toe)
Romberg’s test
3 Carry out Romberg’s test, making sure to remain close to the patient
Speech
4 Assess the patient’s speech
Eyes
5 Assess eye movements for evidence of nystagmus and impaired smooth pursuit
6 Assess for dysmetric saccades
Upper limbs
7 Assess for dysmetria and intention tremor using the finger-to-nose test
8 Assess for evidence of dysdiadochokinesia
9 Assess co-ordination using heel-to-shin test
What is the Dix-Hallpike test
he Dix-Hallpike test is a diagnostic manoeuvre used to identify Benign paroxsymal positional vertigo
explain the Dix Hallpike test
- Ask the patient to sit upright on the examination couch.
- Adjust the patient’s position so that when supine, their head will hang over the edge of the bed, allowing for head extension below the horizontal plane.
- Position yourself standing behind the patient.
- Turn the patient’s head 45º to one side (i.e. left or right) – if the patient has suggested turning their head to a particular side appears to trigger the symptoms, you should try this side first.
- Whilst supporting the neck, move the patient from their sitting position to a supine position in one brisk smooth motion, ensuring their head hangs over the bed 30º below the horizontal plane. Ask the patient to keep their eyes open throughout this process.
- Inspect the patient’s eyes carefully for evidence of nystagmus for at least 30 seconds.
- If no nystagmus is observed on the assessment of the first side (i.e. left or right), the test is then complete for that side and you should carefully help the patient sit back up.
- In the case of a negative Dix-Hallpike test on the first side, after a short break, the test should be repeated on the other side, turning the patient’s head in the opposite direction during step 4. If no nystagmus is observed on assessment of the other side, the patient should be sat up and an alternative diagnosis to BPPV should be considered.
- If the test is positive, the characteristics of the patient’s nystagmus should be observed (see details below) and you should then consider performing the Epley manoeuvre.
Conduct the Epley manoeuvre test
- The Epley manoeuvre typically follows on from a positive Dix-Hallpike test, so we will assume the patient is still positioned lying flat, with the head hanging over the end of the bed, turned 45º away from the midline towards the affected side.
- Turn the patient’s head 90º to the contralateral side, approximately 45º past the midline, still maintaining neck extension over the bed. Keep the patient in this position for 30 seconds.
- Whilst maintaining the position of the patient’s head, ask the patient to roll onto their shoulder (on the side their head is currently turned towards).
- Once the patient is on their side, rotate the patient’s head so that they are looking directly towards the floor. Maintain this position for 30 seconds to a minute.
- Sit the patient up sideways, whilst maintaining head rotation.
- Once the patient is sitting upright, the head can be re-aligned to the midline and the neck can be flexed so that the patient is facing downwards (chin to chest). Maintain this position for 30 seconds.
