Neurological Exam Flashcards
What is a neurological exam?
series of tests conducted by a neurologist to evaluate the integrity of the nervous system
What are the reasons for a neurological exam? (8)
- Differential diagnosis
- Monitor disease progression
- Clarify impact of injury/disease
- Determine rehabilitation needs
- Capacity for ADLs, work, study
- Surgical candidacy
- Triaging
- Legal
What is the aim of neurological exam?
Lesion localization - level & lateralization
- 5 divisions of brain
- internal capsule
- spinal cord
- cranial nerves
- neuromuscular junction
- muscle
What are the 6 common components of a neurological exam?
- Patient history
- Cranial nerves
- Motor system
- Somatosensory
- Coordination
- Mental Status
What is CRANIAL NERVE I? How do you test for CRANIAL NERVE I?
Olfactory (smell)
Identify familiar smells 1 nostril at a time, compare strength of smell
What does it mean when CRANIAL NERVE I is “unilaterally abnormal”? What area is damaged?
smell is bad on 1 side, olfactory bulb or tracts
What does it mean when CRANIAL NERVE I is “bilaterally abnormal”? What area is damaged?
smell is bad on both sides, ethmoid ridge via impact -> CSF leakage
What is CRANIAL NERVE II? How do you test for CRANIAL NERVE II?
Optic (vision)
- Snellen chart/near card (read letters)
- Visual field confrontation (can u see my finger?)
- Pupillary light reflexes (shine light & see speed/duration pupil change)
What are possible causes of increased intercranial pressure (cranial nerve ii)?
- Traumatic Brain Injury (TBI)
- Brain Tumour
- Encephalitis (inflammation)
- High blood pressure
- Bleeding
What is CRANIAL NERVE III, IV, VI? How do you test for CRANIAL NERVE III, IV, VI?
control eye position via paired muscles that move/hold eye
follow object/light without moving head
What is a result to damage to cranial nerves III, IV, VI?
gaze palsy, weakness/loss of certain eye movements
What is CRANIAL NERVE V? How do you test for CRANIAL NERVE V?
motor (activation of muscles) & sensory (detection of location)
direction of location of object, sharp vs dull, hot vs cold
What is a result of damage to CRANIAL NERVE V? What are causes & treatments?
Trigeminal neuralgia - severe chronic pain condition, electric shock to 1 side of face triggered by light touch
What is CRANIAL NERVE VII? How do you test for CRANIAL NERVE VII?
facial (expressions)
test for asymmetry & strength
What is a result of damage to cranial nerve VII?
Bell’s palsy - paralysis of facial nerve causing weakness on 1 side of face
What is CRANIAL NERVE VIII? How do you test for CRANIAL NERVE VIII?
Vestibulocochlear (hearing)
whisper test, hearing w/ tuning fork touching & not touching skull bone
What is damaged if there is bilateral hearing loss? (CRANIAL NERVE VIII)
more central damage
What is CRANIAL NERVE IX and X? How do you test for CRANIAL NERVE IX and X?
glassopharyngeal & vagus (voice, swallowing, gag reflex cough)
What is CRANIAL NERVE CI? How do you test for CRANIAL NERVE XI?
Accessory - shrugging of shoulders, head resistance - look for weakness & location
What is CRANIAL NERVE XII? How do you test for CRANIAL NERVE XII?
Hypoglossal - stick out tongue, lateral movement - look for direction deviation & strength
Where do UPPER motor neurons originate from & what used?
Motor cortex/brain stem, use glutamate
Where do LOWER motor neurons originate from & what used?
Spinal cord/brain stem, innervate muscles/glands, use acetylcholine
What does UPPER motor neuron damage lead to?
weakness, spasticity (abnormal muscle tightness), hyperreflexia, retained primitive reflexes
What does LOWER motor neuron damage lead to?
weakness, hypotonia (low tone), hyporeflexia, atrophy (physically small muscles), fasciculations (twitching)
