Neurological Exam

Question 1

How do you test for olfactory nerve function?

Answer 1

Use of an aromatic substance like ginger or coffee

Question 2

Discuss optic nerve testing.

Answer 2

Acuity, color, pupil function, visual fields and fundoscopic examination. Visual field analysis helps determine if there is a problem in the eye, optic nerve, chiasm etc.

Question 3

Discuss Oculomotor, trochlear and abducens nerve testing

Answer 3

Horizontal diplopia implies a problem with lateral or medial recti. Vertical diplopia implies a lesion of superior or inferior oblique muscles.

Question 4

Match the cranial nerve to the eye muscles

Answer 4

Lateral rectus = Cranial nerve 6
Superior oblique = Cranial nerve 4
All others = Cranial nerve 3

Question 5

Discuss the Trigeminal nerve

Answer 5

1. Facial sensation
2. Tongue sensation (not taste)
3. Muscles of mastication

Question 6

Describe Facial nerve testing in regards to UMN vs LMN

Answer 6

UMN lesions spares the superior face. LMN lesions involves the entire ipsilateral side of the face.

Question 7

Describe the localization of cranial nerve lesions

Answer 7

1. 1st and 2nd cranial nerves are extensions of brain.
2. All others are peripheral nerves
3. Midbrain = 3rd and 4th
4. Pons = 5th thru 8th
5. Medulla = 9th thru 12th

Question 8

Discuss Brainstem lesions

Answer 8

Usually cause crossed signs; The cranial nerve abnormality is ipsilateral to the lesion and the body abnormality is contralateral to the lesion.

Question 9

Describe Motor function loss

Answer 9

1. Weakness in both legs associated with spasticity implies spinal cord lesion.
2. Involvement of face, arm and leg imply lesion in opposite hemisphere

Question 10

How do you differentiate between UMN and LMN lesions?

Answer 10

UMN has spasticity, hyperreflexia and extensor toe sign.

LMN has flaccidity, atrophy and hyporeflexia

Question 11

Describe the implications of Tremors.

Answer 11

A resting tremor implies basal ganglion/substantia nigra defect.
Intention tremor implies vestibulo-cerebellar lesion.

Question 12

Describe the pathway for heat, cold, pain and touch

Answer 12

Crosses spinal cord immediately and then to the thalamus

Question 13

Describe the pathway for motion, vibration, and position

Answer 13

Goes up the entire spinal cord before crossing at the lower medulla.

Question 14

Discuss reflex testing

Answer 14

Achilles reflex = S1
Patellar reflex = L2-L4
Biceps reflex = C5-C6
Triceps reflex = C7

Question 15

Discuss the toe sign

Answer 15

Babinski manuever should cause the big toe to plantar flex after age 1. Extensor toe sign implies UMN lesion of pyramidal system supplying that foot.