neuro exam sensory and coord

Question 1

somatic sensory pathways

Answer 1

Trigeminal lemniscus pathway(THALAMIC):
touch & pressure from the head (face) & neck region

Medial lemniscus pathway transmits (DORSAL COLUMN) :
touch & pressure, from rest of the body

Antero-lateral/ spinal lemniscus pathway:
pain & temperature from the body

Question 2

hyper/hypoalgia

Question 2

allodynia

Question 2

testing light touch

Answer 2

LIGHT TOUCH:
Use a Wisp of cotton wool
Touch lightly – don’t drag
Compare both sides / symmetrical areas
Avoid calloused skin

call out dermatome after stimulation in osce

Question 3

hyp/hypoanaest

Question 4

Sensory testing – General points

Answer 4

patient co-operation is absolutely necessary
Always explain & demonstrate to the patient first
Patient close eyes during actual testing of sensation
Sensory testing quickly fatigues many patients & then may be unreliable

Pay special attention to areas with:
a) Symptoms such as numbness or pain
b) Motor or reflex abnormalities suggesting a lesion of the spinal cord or peripheral nerves
c) Trophic changes such as altered sweating, atrophy or ulceration

Question 5

4 modalities are of sensory system examined

Answer 5

1) LIGHT TOUCH - Use a wisp of cotton wool

2) PAIN - Use a sharp straight (unused) pin (not an injection needle)

3) VIBRATION - Use a 128 Hz tuning fork

4) PROPRIORECEPTION - Joint position sense

Question 6

testing sharp pain sensation

Answer 6

Use a new pin, & occasionally substitute the blunt end
(discard in sharps after use)
“ Is this sharp or blunt?”
“ Does this feel the same as this?”

Question 7

single periph nerve pattern sense loss

Answer 7

due to periph nerve inj or entrapment if >2 isolated neuropathies

Question 7

test for temp sensation

Answer 7

May be omitted if pain sensation is normal
Two test tubes - Hot & cold H2O

Question 8

periph polyneuropathy

Answer 8

gloved or stocking distribution
length dependant

Question 8

dermatomal pattern of sesniory loss

Answer 8

due to nerve root or spinal cord lesion

Question 9

hemi sesnory pattern of loss

Answer 9

one side of the face or body has sesnory loss

Question 10

stereogenssi

Answer 10

ability to id obj by feeling

Question 10

finger gnosia

Answer 10

naming finger being rouched

Question 10

two pt discrimination

Answer 10

<5mm on finger pads

Question 11

Finger agnosia

Answer 11

naming fingers touched

Question 12

Graphesthesia

Answer 12

number/letter identification

Question 13

test fir titubation

Answer 13

obs pt seated ask pt tp lift their head up if lyioong down
observe to head bobbing

Question 14

TEST FOR NYSTAGMUS

Answer 14

Involuntary “to & fro” movements of eyes
Jerk (quick & slow) or pendular
Test by asking patient to follow an object with the eyes
horizontal is main portiomn

Question 14

TEST SPEECH

Answer 14

Assess spontaneous speech
Speech may be slurred speech due to errors in timing, i.e.
incoordination of muscles controlling/involved in speech,
words broken down to individual syllables
Ask patient to say: (repetitively + fast)
ma…..ma…..ma….ma Labial
ta….ta…..ta….ta….ta Tongue
la….la….la….la….la Tongue
ga….ga….ga….ga Palate
Listen for: Slurring, scanning (separation of syllables), staccato Irregularities

Question 15

LOWER LIMB CO-ORDINATION

Answer 15

TONE & REFLEXES – refer motor examination for hpoton and pendular retglexes

HEEL-SHIN TEST for dysmetria & intention tremour

FOOT TAPPING (or HEEL TAPPING) TEST for dysdiadochokinesia

Question 15

UPPER LIMB CO-ORDINATION

Answer 15

TEST FOR ARM DRIFT –
due to various causes
TEST FOR REBOUND PHENOMENON
from hypotonia

FINGER-NOSE TEST -
look for intention tremor &
past-pointing or dysmetria

DYSDIADOCHOKINESIS –
difficulty with repetitively performed
alternating movements

Question 16

TEST TRUNCAL CO-ORDINATION & GAIT

Answer 16

Ask patient to fold his arms & sit up

Patient seated - observe if head/body are swaying - titubation/ truncal ataxia

Observe gait - ask patient to turn around suddenly - look for staggering/irregular gait

Heel to toe walking - observe for loss of balance/ does patient fall to one side?

Question 17

romberg test

Answer 17

Patient stands with feet together + eyes open
Examiner stands close to patient to support him if necessary,
then instructs patient to close eyes for 20-30 seconds
Note the ability to maintain an upright posture
(normally only minimal swaying occurs)
The Romberg test is positive
when unsteadiness increases with eye closure
(it indicates loss of proprioceptive sensation)

present in sensory ataxia
not cerebellar atxia

Question 18

Features of a Cerebellar Lesion

Answer 18

disease occur on the same side as the lesion (ipsilateral)
Speech – cerebellar speech is jerky, explosive & loud
Nystagmus – worse on looking towards lesion’s side
Upper limbs
Arm drift & Rebound due to hypotonia
Intention tremor
Past pointing or dysmetria
Dysdiadochokinesis
Trunk
Titubation
Truncal ataxia with midline lesions
Lower limbs
romberg negative
Hypotonia
Pendular knee jerks
Incoordination on heel-shin test
(note : if this is aggravated by eye closure, it suggests posterior column loss)
Loss of rhythmicity with foot tapping test
Gait
Broad-based ataxic gait
Unsteady with eyes open
Falls towards the side of the lesion
Difficulty with heel-toe walking
especially with midline lesion

Question 19

cerebellar lesion TA2R2NISH2D2

Answer 19

see slides