Neurologic Examination Flashcards
General signs
Cognition
- memory(new and old)
- higher functions(mathematical problems, similarities and differences, interpret proverbs)
- judgement
- new memory test(write down 5 cities cited)
History
- chief complaint
- past medical history
- family history
- social history
Dysarthria
difficulty talking
- flaccid = nasally, soft palate is floppy, consonants distorted, speak in short phases
- cerebellar(ataxic) = scanning speech
- spastic = poor respiration, hoarseness, hard to get words out, slow
- hypokinetic = parkinson’s, poor articulation, progressively less clear, speaking very fast
dysphonia
hoarseness
- usually due to upper respiratory problem
- can occur when laryngeal nerve is affected
broca’s aphasia
- frontal lobe damage
- motor or expressive aphasia
- fluency of language is lost(not cohesive)
- pt’s know that they are speaking incorrectly
Wernicke’s aphasia
- parietal lobe damage
- sensory or receptive aphasia
- can talk fluently, but does not make sense
Global aphasia
Broca’s and Wernicke’s
nuchal rigidity
menengitis sign
skin check
- cafe-au-lait spots = brownish spots emerge suddenly
- butterfly rash on face = evidence of lupus
- tufts of hair = in spinal cord region(spina bifida occulta)
- evidence of trauma
gait assessment
- hemiparetic(stroke)
- ataxic(cerebellar problem)
- shuffling(PD)
- steppage(stroke; peripheral neuropathy)
- no dorsiflexion(increased hip flexion) - spastic/scissor(CP)
- adductor and IR’s increased tone - antalgic(pain syndrome)
- limping
CN 1
olfactory
- test with something that has a significant odor
- sometimes uses smell to wake up since direct connection to cerebral cortex
CN 2
optic
- acuity = acute vision
- visual fields
- scotomas = little blind spots in visual field
- blindness
- hemianopsia
- quadrantopsia = 1/4 of visual field lost
fundoscopic examination
looking at disk and blood vessels
papilloedema
increase in intracranial pressure
- pushing disk out
- decrease in blood vessels
- normal color of disk is yellow-white
- if Snow White, optic neuritis
CN 3
occulomotor
- dysfunction could mean intracranial pressure pushing uncus into midbrain
- if cut, could move eye laterally and “in and down”, pupils dilated, cannot lift eyelid
occulomotor complex
adductor = MR abductor = LR elevators = IO and SR depressors = SO and IR - recti work best when eye is abducted - obliques work best when eye is adducted
pupil reactions
constriction(parasypathetics)
- light
- accomodation = as object gets closer, pupil gets smaller
abnormal pupils
- fixed and dilated
- argyle robertson pupil = irregular small pupil, that doesn’t react to light(possible cause is syphillis of CNS)
- adies pupil = slightly larger than normal
- affected by ciliary ganglion dysfunction
- doesn’t react light, but accomodates
pupil dilation
sympathetics, not in CN 3
Horner’s syndrome
- miosis = pupil constriction
- ptosis = droopy eyelid
- anhydrosis = trouble sweating(dry eyes)
- enophthalmos = eye is more sunken in
saccadic eye movements
rapid jumps of eyes to look at new objects
CN 5
sensory
motor = muscles of mastication
CN 7
facial
- motor to face
- sensory = anterior 2/3 of tongue
facial nerve lesion
central lesion = contralateral weakness on lower part
peripheral lesion = ipsilateral weakness of face(upper and lower)
CN 8
vestibulocochlear
- balance control
- gaze control
- Doll’s eye = eye lids move opposite of head(lay down–>eyes close, sit up–>eyes open)
Calorics
CN 8
- cold water = eyes deviate to the same side
- warm water = eyes deviate to the opposite side
nystagmus
- normal response to cold and warm water calorics
- normal response if spin someone
- abnormal if occurs during smooth pursuit test
- abnormal if occurs spontaneously
whisper test
stand behind patient, say two syllable words
- cochlear
Weber test
- do if whisper test is abnormal
- place tuning fork on vertex of cranium
- pt should hear tuning fork equally in both ears
Rinne test
- screens one ear at a time
- compares air and bone conduction
- place stem on mastoid
- when sound no longer heard place by ear
CN 9 & 10
glossopharyngeal and vagus
- gag reflex
- uvula movement = moves to opposite side of lesion
CN 11
spinal accessory
- trapezius
- SCM
CN 12
hypoglossal
- tongue protrusion = deviates to weaker side
cerebellar signs
- finger to nose
- heel to shin
- gait = wider based gait
- dysmetria
- dysdiadochokinesia
- intention tremor = action tremor that occurs as person is doing something
sensation
- touch = cotton ball
- vibration
- position sense = mirror test, up and down
- pain = pin prick
- parietal lobe function(2-point discrimination, stereognosis, graphesthesia)
cremaster reflex
stroke inner thigh, testicle on same side should elevate
abdominal reflex
stroke abdominal and umbilicus should deviate towards umbilicus
fasciculations
bag of worms
- tiny muscle contractions
- sign of acute deinnervation
tremors
- resting = 3 cycles per second(“pill rolling” tremor)
- essential = benign tremor(non-specific, familial)
- not associated with neurologic condition - intention = occurs when doing something(intending to)
- cerebellum over corrects actions
choreiform
- Huntington’s chorea
- hereditary
- dementia
- Sydenham’s chorea
- rhematic fever
hemiballism
subthalamus
- flailing of entire limb
athetosis
globus pallidus
- slow writhing movements
dystonia
affects consistent attitude of posture
motor system weakness
- neuropathic: distal(foot/ankle, hand)
- myopathic: proximal(hips, scapula/humeral)
- pyramidal(corticospinal tract)
- UE extensors
- LE flexors
