Neuro Dx Flashcards
L5 NR Evaluation
Disc Level (L4)
MM:
- foot dorsiflexion: tibialis anterior and extensor hallicus longus
- big toe dorsiflexion: extensor hallicus longus (deep fibular/peroneal nn)
- toes 2,3,4 dorsiflexion: extensor digitorum longus&brevis (deep f/p)
- hip and pelvis abduction: gluteus medius & minimus (superior gluteal)
Reflex: none
Sensation: lateral leg, dorsum of foot and middle three toes
L4-L5-S1 Dermatome Evaluation
L4 right: L4 left
L5 right: L5 left
S1 right: S1 left
L4 right: L5 right
L5 right: S1 right
L4 left: L5 left
L5 left: S1 left
Jendrassik Maneuver
AKA Reinforcement Test
pt hooks hands/feet together and pulls on clenched hands or feet at the moment the reflex is performed
Uvular/Palateal Reflex
Raising of the uvula upon phonation or touching with a tongue depressor
Interscapular Reflex
Drawing inward of scapula when skin or interscapular space is irritated
Abdominal Reflex
Umbilicus deviation to stroked side.
Absence is only normal if bilateral (Beevor Sign)
Plantar Reflex
Plantarflexion (curling) of toes upon stroking sole of foot
Fakuda Step Test
pt marches in place, eyes closed, for 50 steps
( + ) a turning to one side
( i ) vestibular lesion on the side of rotation
Barognosis
Ask pt to identify difference between two same sized objects of different weight
Evaluating integrity of somatosensory cortex
Schaefer Sign
Squeezing of achilles tendon to elicit Babinski’s (alternative)
Ankle Clonus
Continued involuntary contraction (sustained plantar flexion) of foot upon quick
forcible dorsiflexion of the foot
Pallesthesia of foot
Place handle of vibrating 128Hz fork on joint line of lower extremity
Utilize 3 distal interphalangeal joints, if abnormal, continue to evaulate proximally until normal finding is achieved at base of 5th metatarsal, or medial and lateral malleoli.
Ask pt to identify when he or she feels vibration and when dr has stopped the vibration
( + ) inability to identify
( i ) dorsal column involvment
C4-C5-C6 Dermatome Eval
C4 right: C4 left
C5 right: C5 left
C6 right: C6 left
C4 right: C5 right
C5 right: C6 right
C4 left: C5 left
C5 left: C6 left
Fajersztajn Test
AKA Well-Leg-Raising Test of Fajersztajn
AKA Cross-over Sign
pt supine, dr performs SLR on UNAFFECTED leg to 75* or until produces pain down affected leg
if NO PAIN, examiner dorsiflexes foot
( + ) pain down affected leg (cross-over sign)
( i ) medial disc protrusion
( + ) decrease in pain down affected leg
( i ) lateral disc protrusion
Extraocular Movements
(Cardinal fields)
Evaluating CN III, IV, VI
(oculomotor, trochlear, abducens)
observe pts eyes for normal conjugate/parallel movements of eyes and nystagmus as you have them follow finger or pencil while making wide “H” in the air
(CN4/IV) Trochlear = down and in
(CN6/VI) Abducens = lateral
(CN3/III) Oculomotor = all others
Apraxia
Following complex motor commands,
“pretend to comb your hair”, “pretend to brush your teeth”
Diadochokinesia:
Patting Test/Supination-Pronation Test
Coordination - testing cerebellum
Dysmetria:
Heel-shin/Index Finger Test
coordination - testing cerbellum
Direct Light Reflex
Ipsilateral pupillary constriction when light is shined in the eye
A: Optic
IC: Midbrain
E: Oculomotor (ipsilateral)
Indirect Light Reflex
Contralateral pupillary constriction when light is shined in the eye
A: Optic
IC: Midbrain
E: Oculomotor (contralateral)
Glabella AKA McCarthy
Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge (glabella)
Test Visual Acuity
screen by reading print
screen with shapes and/or colors
Evaluate optic nerve CN II
Evaluate Facial Nerve ( CN VII)
Ask pt about change sin taste sensations sweet, salty andsour in anterior two thirds of tongue
Inspect face:
- raise eyebrows
- close eyes tightly
- show teeth
- puff out cheeks
- smile
- frown
Evaluate Vestibulo-Cochlear Nerve
Finger Rub/Whisper test - sensory cochlear portion
assess hearing by rubbing fingers together near the EAM , find maximal distance sound can be heard
Rinne Test
tuning fork to mastoid bone for bone conduction, begin counting.
pt tells you when sound isno longer heard, then move to EAM without touching pt
Normal: air conduction 2x as long as bone
Conduction Deafness/Sensorineural deafness
Evaluate Hypoglossal Nerve
Inspect tongue for:
atrophy, fasciculations, deviation
Have pt stick out tongue and test bilateral with tongue depressor, or use tongue in cheek method
unilateral paralysis = protruded tongue deviates to involved side
Fromet Paper Sign
( + ) The patient is seen to flex the thumb thereby recruiting the median nerve to compensate for apparent weakness
( i ) Ulnar nerve paralysis (weakness or palsy of the adductor pollicus muscle)
L’Hermitte Sign
pt sitting or supine, examiner passively flexes patient’s head to the chest
( + ) Electric shock-like sensations down the spine and/or through extremities.
( i ) Dural irritation, severe spinal cord injury or degeneration.
Turyn
( + ) Pain in the gluteal region or radiating sciatic pain.
( i ) Sciatic radiculopathy
LIndner Sign
pt supine, examiner flexes patient’s head toward the chest.
( + ) Pain along sciatic distribution or sharp, diffuse pain (leg)
( i ) Sciatic radiculopathy
Roo’s/EAST
( + ) ischemic pain, heaviness of the arms, or numbness and tingling of the hand.
( i ) Thoracic outlet syndrome on side involved
(Evan’s considers this test to be most
accurate for TOS evaluation)
Adson’s
( + ) Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
( i ) Compression of the neurovascular bundle by scalenus anticus or cervical rib.
Halstead
( + ) Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
( i) Compression of the neurovascular bundle by scalenus anticus or cervical rib.
Costoclavicular/Eden’s
( + ) pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
( i ) compression of the neurovascular bundle between the clavicle and 1st rib.
Hyperabduction/Wright’s
( + ) pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
( i ) compression of the axillary artery by pectoralis minor or coracoid process, Thoracic outlet syndrome.
