Neurological Exam (Cranium) Flashcards
When taking a neurological history what are the 6 key changes to look for?
- Fits, faints or funny turns
- Sensory changes
- Speech and swallowing changes
- Cognition and Mood
- Bladder and bowel changes
- Headaches
What is included in fits faints and funny turns?
- seizures
2. loss of consciousness
If there is a fit, faint or funny turn what questions should be asked?
- Any evidence of pre-warning / preceding symptoms
- any witnesses to the event
- what the recovery period was like after regaining consciousness
Why is it important to know the occupation of the patient?
occupation / hobby where a sudden syncopal episode would be especially dangerous e.g. diving / swimming / driving
What can sensory changes include?
- hearing
- taste
- smell
- numbness
- tingling
- vision (including diplopia)
- weakness
- balance
What are the red flags of headaches?
- abrupt severe onset (“thunderclap”)
- age of onset > 50
- progressive severity / worsening frequency
- significant change in pattern of headache
- worsening of symptoms with posture or straining / coughing, neurological symptoms or focal neurological signs, confusion
- reduced consciousness
- meningism
- previous or family history of malignancy
What are some risk factors that are important for inquire about for developing neurological symptoms?
- Immunocompromise
- head injury / recent trauma
- drug and alcohol use
- anticoagulation
- pregnancy
- previous history of cancer
What is the position of a patient in the neurological exam?
patient should be sitting up
What is the exposure of a patient in the neurological exam?
examine the neck upwards
What must you always ask at the start of an exam?
Check is patient is in any pain
What features are you looking for in a general inspection
- Squint
- Ptosis
- Facial droop
- Asymmetric / abnormal eye position
- Proptosis
- Pupils
How do you test for the olfactory nerve (I)?
- Ask the patient if they have noticed any change in smell
2. If Yes: test olfaction using scented bottles to test each nostril separately
What are the 4 components for testing for the optic nerve (II)?
- Visual acuity (Snellen chart)
- Visual fields and inattention
- Reflexes (accommodation reaction, pupillary light reaction including swinging light reflex).
- Fundoscopy
What cranial nerves do the reflexes test?
optic nerve and occuolomotor nerve
What are the possible field defects when testing for the optic nerve?
- Unilateral blindness
- Bitemporal hemianopia
- Homonymous hemianopia
What can be used to test the blindspot and to assess colour vision?
- CV: Ishihara plates
- B:hatpin
What is used in fundoscopy?
- Red reflex
2. Fundus - Disc (Contour, Colour, Central Cup), Vessels, Periphery, Macula/Fovea)
What should you ask for when testing Oculomotor (III), Trochlear (IV), Abducens (VI) nerves ?
- keep the patient’s head still 2. ask them if they have any double vision
- Also test for nystagmus
What would 3 nerve palsy show?
- complete ptosis
- dilated pupil
- eye turned down and out
What would 4th nerve palsy show?
downwards diplopia
What would 6th nerve palsy show?
failure to abduct eye
What function does the trigeminal nerve have (V)?
mixed sensory and motor
How do you test trigeminal nerve?
- ask the patient to clench their teeth while you feel over the masseter and temporalis muscles
- ask the patient to open their jaw against resistance
What reflexes can also be tested with the trigeminal nerve?
- jaw jerk
- corneal
What function foes the facial nerve have (VII)?
mixed sensory and motor
What is the sensory function of the facial nerve?
taste sensation to anterior 2/3 of tongue
How do you test the motor function of the facial nerve?
- raising eyebrows
- closing eyes
- puff out cheeks
- show teeth/smile
If there is facial muscle weakness how do you tell if it is UMN or LMN defect?
-UMN: relative sparing of the upper 1/3rd of the face due to the bilateral representation of muscles that move the upper 1/3rd of the face in the cerebral cortex
How do you test the vestibulocochlear nerve (VIII)?
ask about hearing and balance
What is the gross assessment to test for the vestibulocochlear nerve (VIII)?
rubbing your fingers next to each ear in turn and asking if there is a difference
What is the sensitive assessment to test for the vestibulocochlear nerve (VIII)?
Rinne’s and Weber’s tests
How do you test for the glossopharyngeal nerve (IX)?
look for deviation of the uvula
How do you test for vagus nerve (X)?
swallow💦💦💦💦💦
How does the gag reflex test both of vagus and glossopharyngeal nerve?
sensory limb of this reflex comes from the glossopharyngeal nerve and the motor limb is the vagus nerve
What muscles do you test the motor function of to test the accessory nerve (XI)?
sternocloidmastoid and trapezius muscle
How do you test the motor function of the trapezius muscle?
ask the patient to raise their shoulders against resistance
How do you test the motor function of the sternocloidmastoid muscle?
ask the patient to turn their head against resistance
How do you test for the hypoglossal nerve (XII)?
- Inspect the tongue for wasting, fasciculation and deviation
- assess the patient’s tongue movement and speech.
What do you say to the patient after the exam?
- thank the patient
- assist in covering them up
- wash your hands
What would you say to examiner after exam?
- Take a full history
2. Conduct a neurological examination of the upper and lower limbs
