NEURO EXAMINATION - CN Exam Flashcards
UMN Lesion Signs
HYPERTONIA
HYPERREFLEXIA = upgoing plantars
WEAKNESS
LMN Lesion Signs
Muscle Fasciculation
HYPOTONIA
HYPOREFLEXIA
ATROPHY
CN1 Exam
Olfactory = smell
CN2 Exam
Optic Nerve
- SNELLEN CHART (acuity): test one eye whilst other covered
- PUPIL RESPONSE (afferent II, efferent III): distal focus, hand along their nose
- ipsilateral constriction
- contralateral constriction (consensual reflex)
- repeat w/ other - VISUAL FIELDS (peripheral vision)
- 1m apart, cover opposite eye (mirror)
- start from periphery coming in from opposite side = high, middle, low
- then coming in from same side = high, middle, low
- repeat for other eye - Visual Inattention (awareness on one side of visual field - hemisphere problem)
- midline, wiggling fingers while pt looks at face - ACCOMMODATION (checks bilateral constriction of close-up)
- from far and move closer to nose (fast)
Causes of decreased visual acuity
Refractive errors Cataracts Corneal Scarring Mac. Degen. Optic Neuritis
Visual Field Defects
Bitemporal Hemianopia (outer halves gone) d/t chiasm compression = pit. adenoma
Homonymous Hemianopia (same side of visual field in both eyes) = posterior to optic chiasm?, stroke?, SOL? Abscess?
Scotama (absent/reduced vision surrounded by areas of normal vision) d/t MS, Diabetic maculopathy, Glaucoma
Monocular Vision Loss (loss in one eye) d/t retinal detachment, central retinal artery occlusion, ant ischaemic optic neuropathy, MS, GCArteritis
Causes of visual inattention
Stroke
Summary of CN Ssens/Motor
S ome (olfactory) S ay (optic) M oney (oculomotor) M atters (trochlear) B ut (trigeminal) M y (abducens) B rother (facial) S ays (vestibulococh) B ig (glossopharyngeal) B rains (vagus) M atter (accessory M ore (hypoglossal)
CN III, IV, VI
OCULOMOTOR
TROCHLEAR
ABDUCENS
inspection of eye in H pattern, motor nerves
III = SR, IR, MR, IO, Levator Palpebrae Superiorsis PALSY = unopposed action of LR and SO = DOWN and OUT (inferiolaterally)
IV = SO PALSY = vertical diplopia, eye no longer pulled downwards
VI = LR PALSY = unopposed adduction = convergent squint, horizontal diplopia
Causes of nystagmus (III, IV, VI check)
MS (abduction issues = LR6)
Vestibular lesions = acute - nystagmus away from lesion; chronic - towards side of lesion
Cerebellar lesions = nystagmus towards effected side
Midbrain lesions = upwards nystagmus
CN V
Trigeminal Nerve
*sensory
V1 Opthalmic
V2 Maxillary
V3 Mandibular
*V3 motor
- temporalis
- masseter
*jaw jerk reflex
* corneal reflex
CN VII
Facial Nerve
- sensory = sense of taste (anterior 2/3)
- motor
- hearing changes = stapedius
- facial symmetry: forehead, nasolabial, mouth angles
facial expressions
- surprised
- scrunch eyes
- blow out cheeks
- act really happy
- pretend to whistle
Facial Nerve Palsy
Commonly Bell’s Palsy
*LMN = ipsilateral weakness
*UMN = upper facial sparing = STROKE
CN VIII
Vestibulocochlear
?changes in hearing
- Whisper Test
- Rinne’s Test: 512hz
- bone conduction
- air conduction
normally: air>bone RINNES +
sensorineural: air>one RINNES +
conductive deafness: bone>air RINNES -
- Weber’s Test
normal = equal
sensorineural = louder on normal ear
conductive = localises to affected ear - Vestibular = Turning Test
- marching on spot
CN IX CNX
Glossopharyngeal (posterior 1/3)
Vagus
? issues with swallowing, changes to voice or cough
- say ahh = uvula deviations (to unaffected side)
uvula elevation symmetry
bovine cough if vagus lesion - swallow test
- Gag reflex
