Neuro Screening

Question 1

What are the six basic functions that need to be tested in a neurological screening?

Answer 1

Mental status, Motor function, Sensory function, Reflexes, Cerebellar function, and Cranial nerve function

Question 2

What are the functions of the frontal lobe?

Answer 2

drives emotions, affect, motivations, and self-awareness

Question 3

What are the things we need to evaluate in a mental status evaluation? (hint: there’s an acronym for this)

Answer 3

JOMAC: Judgement, Orientation, Memory, Affect/mood, Concentration

Question 4

JOMAC: How do we evaluate judgement?

Answer 4

Ask patient what they would do in a situation. For example, finding keys in a parking lot. Look for a reasonable response.

Question 5

JOMAC: How do we evaluate orientation?

Answer 5

Need to check that the patient is oriented to person (knows who they are), place, and time.

Ox3 means oriented to all three. You loose them in the reverse order to above (ie time, then place, then person). If lost, specify Ox2, Ox1, or disoriented.

Question 6

JOMAC: How do we evaluate memory?

Answer 6

Evaluate short term memory. Ask patient to remember three things (eg watch, ring, pen), and have them repeat those immediately. In 5 minutes, ask them to repeat the same set.

Question 7

JOMAC: How do we evaluate affect/mood?

Answer 7

Judge patient’s emotional state based on questions asked during the interview

Question 8

JOMAC: How do we evaluate concentration?

Answer 8

Ask patient to count backwards from 100 by 7s or 3s. Or have the patient spell the word “world” backwards. Make it something they have to actually concentrate on doing.

Question 9

What do we need to evaluate when assessing motor function?

Answer 9

Strength and muscle tone. Be sure to check for symmetry in these things, evaluating in upwards, downwards, left, and right directions.

Question 10

How do we assess muscle strength?

Answer 10

Ask patient to move against your resistance

Question 11

How do we assess muscle tone?

Answer 11

Move patient’s limb while they relax. Increased tone and resulting resistance is called spasticity. Low tone (limpness) is muscle flaccidity.

Question 12

How and where do we evaluate sensory function?

Answer 12

Evaluate pain sensation (“sharp”), vs crude touch (“dull”). Evaluate temperature (hot vs cold) if the patient fails the pain sensation test. Also evaluate proprioception, vibration sense, and fine touch.

Start with extremities. Evaluate ulnar, radial, and median nerve (between bases of thumb and index). Evaluate lateral and medial plantar (big and pinky toe). Evaluate calcaneal (heel).

Proprioception should be tested on index and pinky fingers, as well as big and pinky toes. Test proprioception by moving a finger up and down while holding the sides.

Test vibration with a vibrating and non-vibrating tuning fork

Tap twice to give patient an opportunity to really evaluate the nature of the touch (pain vs dull).

For all these tests, make sure the patient has closed eyes.

Question 13

Where do fibers cross the spinal chord for pain, crude touch, and temperature?

Answer 13

All cross immediately at the level of the extremity. As a result, spinal chord lesions that are above a limb will affect the contralateral limb.

Question 14

Where do fibers cross the spinal chord for vibratory sense, proprioception, and fine touch?

Answer 14

Fibers do not cross until they reach the thalamus. Therefore, spinal lesions effect ipsilateral limbs.

Question 15

Why is testing vibratory sense important?

Answer 15

It is often the first sense to be lost in diabetic neuropathy.

Question 16

How do we test deep tendon reflexes?

Answer 16

This is the hammer test! Divert patient’s attention to relax muscle. Tap tendon briefly and directly. If tendon difficult to see (eg biceps), place thumb over tendon and strike your thumb. Be sure to test symmetry.

Question 17

Which deep tendons do we assess?

Answer 17

Biceps (C5, C6) - anterior elbow. Triceps (C6, C7) - posterior elbow. Patellar (L2-4) - knee. Achilles (S1) - posterior foot above heel.

Question 18

What is the Jendrassic maneuver

Answer 18

The patient clenches their teeth and hooks their index fingers together and pulls apart. The achilles deep tendon reflex is then assessed. Somehow this makes the reflex stronger. How did they come up with this thing?

Question 19

Describe the 0-4+ grading system for reflexes

Answer 19

0: no response
1+: Sluggish or diminished
2+: Active or expected response
3+: More brisk than expected, slightly hyperactive
4+: Brisk, hyperactive, with intermittent or transient clonus

Question 20

List some reasons for decreased reflexes

Answer 20

Lower motor neuron lesions, including peripheral neuropathy (eg DM, alcoholism), nerve trauma, hypothyroidism, and Adies syndrome.

Question 21

List some reasons for increased reflexes

Answer 21

Upper motor neuron lesions, including brain and spinal chord injury, stroke, hyperthyroid, and MS

Question 22

How and why do we assess glabellar reflex?

Answer 22

Gently tap the patient between the eyebrows repeatedly. Ask them not to blink. A normal patient will be able to suppress the blink after one or two blinks. A patient with Parkinson’s may not be able to (Myerson sign). It may also be lost in dementia. A negative glabellar is a normal recording.

Question 23

What functions does the cerebellum have?

Answer 23

Adis motor cortex in integration of voluntary movement. Processes sensory information. Uses vestibular information to control posture, balance, and gait.

Disorders of the cerebellum result in awkwardness of intentional movements.

Question 24

What can we do to test the cerebellum?

Answer 24

Coordination: have patient alternate between touching their nose and your moving finger. Also have them touch their own nose with their eyes closed.

Rapid alternating movement: have patient flip hand between palm-up and palm-down in as quickly as possible.

Gait: examine heel-to-toe walking. “Cerebellar gait” is as if drunk. Sensory ataxia (as in DM or MS) is wide-based, with patient looking at the ground. Parkinson has short, shuffling, hesitating gait with difficulty starting and stopping.