Neurological Examination Flashcards
What are the three main components of the approach to neurological diagnosis?
- History
- Examination
- Investigations
What are the two main questions to consider when making a neurological diagnosis?
- Where is the lesion?
- What is the lesion?
What is the primary purpose of examining patients?
To localise pathology within the nervous system
For what other reasons might we examine patients?
▪️Evaluate function
▪️Monitor change
▪️Identify avenues for treatment
▪️Promote patient understanding
▪️Helpful if complaint is made
▪️Ritual
What is a myelopathy?
Abnormality/disease of the spinal cord
What is a radiculopathy?
Abnormality/disease of the nerve roots (leaving spinal cord in PNS)
Multiple = polyradiculopathy
What is plexopathy?
Abnormality/disease of the plexus
(bundles of nerves, either brachial or lumbar)
What is myopathy?
Abnormality/disease of the muscles
Examination should be….
Tailored to the clinical scenario
What are the three main elements of a standard neurological examination?
- Higher mental function
- Cranial nerves
- Motor and sensory examination of the limbs (including gait)
How many pairs of cranial nerves do we have?
12
What is the first cranial nerve (I)?
Olfactory nerve
When might be test the olfactory nerve and how?
▪️Rarely formally tested
▪️Might be relevant post-head injury or in patients with suspected PD as could be prodromal
▪️Formal test = UPSIT
What is the second cranial nerve (II)?
Optic nerve
How is visual acuity measured and what is the normal result?
▪️Snellen chart (opticians)
▪️6/6 - row 6 from 6 metres away
What elements of optic nerve function can we measure?
▪️Visual acuity
▪️Visual fields
▪️Pupillary reflexes (light, accommodation)
▪️Colour vision
▪️Fundoscopy - examination of fundus/retina
What is accommodation?
Pupils restrict when focuses on something close up
What is a healthy pupillary reflect to light?
They constrict
What can you infer about the location of a lesion if someone has complete loss of vision is one whole field (e.g. right)?
The problem is either in the eyes itself or early on in the optic nerve
(just behind the eye, after the optic chiasm)
What are the two main signs to look for when conducting a fundoscooy to look at the optic disk?
▪️Papilloedema (swelling of optic nerve head)
▪️Optic atrophy
What conditions might you see optic atrophy in?
Multiple sclerosis - optic nerve looks whiter and brighter where previously inflamed
What might papilloedema suggest?
Raised intracranial pressure
What are cranial nerves III, IV, and VI important for?
Eye movement
What two eye movements do you check for during exam?
▪️Pursuit movements (following finger)
▪️Saccadic movements (moving quickly to meet a target)