Neurological Exam

Question 1

Components of a neural exam

Answer 1

Level of consciousness, orientation, attention/concentration, calculation, language, speech, memory, fund of knowledge

Question 2

Fundoscopic Exam

Answer 2

Blurring of disk margins - loss of venous pulsations - color of optic nerve head

Question 3

Testing CN 5

Answer 3

Cotton, pin, or tuning fork (temp), to compare side to side. Abnormality is ipsilateral - cotton wisp from the side (w/ CN VII) - bite down, open the jaw

Question 4

Testing CN 7

Answer 4

Observe at rest for palpebral fissures and nasolabial folds - eye squeeze to bury eyelashes - smile, puff cheeks - peripheral vs. central facial weakness (forehead is spared in a central lesion)

Question 5

Testing CN 10

Answer 5

Palate elevation (not uvula), gag (usually only in coma), swallow, listen for horseness or breathiness

Question 6

Testing CN 11

Answer 6

Turn head against resistance at chin (head to the right tests the left SCM/CN 11)

Question 7

Testing CN 12

Answer 7

Listen for slurring (la la la), observe at reset for fasciculations, observe w/ protrusion and movement for deviation to one side (will deviate to the weak side)

Question 8

Strength grading system

Answer 8

0 (no movement) - 5 (cannot overcome)

Question 9

Romberg Test

Answer 9

Identifies sensory abnormalities. Positive test possibly due to feet numbness.

Question 10

Reflex Dermatomes, Grading, Results:

Biceps - Brachioradialis - Triceps - Knees - Ankles

Answer 10

Graded 4-0
Biceps C5-6 
Brachioradialis C6-7 
Triceps C7-8 
Knees L3-4 
Ankles S1-2
Results: hyporeflexive indicate problem at the root, radiculopathy, or neuropathy. Hyperflexive indicate brain or spinal cord lesion.

Question 11

How does gait and station reflect neural state?

Answer 11

Walk at a regular pace, on heels, on toes, and tandem gait:
Wide based, ataxic – cerebellar
Wide based, slapping – neuropathy
Shuffling, stooped, multisteps to turn, fenestrating – parkinsonian/basal ganglia
Spastic – upper motor neuron
Circumducting – proximal weakness/myopathy
Steppage – distal weakness
Antalgic – painful
Astasia abasia – bizarre