Neuroexam topics Flashcards
4 objectives of focused neuro-exam
To determine:
- Etiology
- Appropriate diagnostic testing
- Working diagnosis
- Proper treatment
What is the most important feature of consciousness?
Wakefullness
What can be gained by assessing the nature in which a pt recollects events of his/her history
Insight about alterations in memory or judgment
Six components of MMSE
- Orientation
- Registration
- Attention and calculation
- Recall
- Language
- Visual spatial
What is assessed by clock drawing test
Executive function
Four orientation parameters in order from last to be lost
- Person
- Place
- Time
- Situation (e.g., Why are you here)
Taste and sensation to back of mouth
Vagus
Secretomotor to submandibular glands for salivation
Facial via submandibular ganglion
Secretomotor to lacrimal glands
Facial via pterygopalatine ganglion
Taste to anterior 2/3 of tongue
Facial via chorda tympani nerve
Sensation of anterior 2/3 of tongue
Trigeminal V3 mandibular division
Taste and sensation from posterior 1/3 of tongue
Glossopharyngeal
Four most common causes of CN IV palsy
- Head trauma (acute palsy with spontaneous recovery)
- Congenital dysfunction (chronic requiring surgery)
- Peripheral lesion from trauma or disease
- Contralateral lesion to CN IV nucleus of brainstem
Findings in abducens palsy
Diplopia
Esotropia (convergent squint on fixation to distant objects)
Abduction of affected eye with forward gaze
Classically pts turn head toward affected eye to correct vision
What may an abducens palsy signify?
Increased ICP
Differentiating conductive from sensorineural deafness in Weber’s
CA-US
- Conductive localizes to Affected ear
- Unaffected ear localized in Sensorineural
Differentiating conductive from sensorineural in Rinne’s
- Conductive: bone conduction > air conduction
- Sensorineural: impairment of both bone and air conduction
Motor exam C5
- Deltoid: shoulder abduction
- Biceps: elbow flexion
Motor exam C6
-Wrist extensors: cock up wrist
Motor exam C7
-Triceps: elbow extension
Motor exam C8
-Flexor digitorum profundus (grip): squeeze hand
Motor exam T1
-Hand intrinsics (interosseous muscles): abduct fingers
Motor exam L2
-Iliopsoas: hip flexion
Motor exam L3
-Quadriceps: knee extension
Motor exam L4
-Tibialis anterior: dorsiflexion
Motor exam L5
-Extensor hallucis longus: dorsiflex great toe
Motor exam S1
-Gastrocnemius: plantarflexion
Inspection of muscle groups
- First (often overlooked) step in motor exam
- Observe for wasting fasciculation, movement disorder, disordered posture, tremor
What does pronator drift signify
- UMN weakness
- If UMN weakness present, then supination will be weaker than pronation in the upper extremity leading to pronation of affected arm
