Neurological examination Flashcards
what are the types of lesions
hereditary or congenital
acquired - traumatic, infective, neoplastic, degenerative, inflammatory, immune-mediated, vascular or functional
what does the Glasgow coma scale test
test eye opening response, motor response, verbal response, pupil response
score out of 15
what is the definition of a coma using the GCS
score of 8, lowest possible score is 3 which is no response for everything
how is cognitive function assessed
and what is tested
cognitive function test (MMSE, MoCA, ACE-3)
these test memory, attention, orientation, verbal fluency, language, visuospatial, change in behaviour or personality
overview of cranial nerve exam
inspection
look for symmetry, posture, involuntary movements
facial asymmetry
lack of facial expression
drooling saliva
speech - any problems with expression, articulation or phonation
olfactory nerve assessment
tests CN1
not formally assessed
ask about problems with sense of smell
asl about taste at same time which test CN7/9
optic nerve assessment
CN2
test vision
use Snellen chart (letter chart in opticians)
reading, finger counting, perception to light, visual fields, pupillary response to light, visualisation of optic disc
oculomotor, trochlear and abducens nerve assesments
CN3,4 and 6
eye movements (figure of H to test eye movement extremes)
double vision (issue with abducens, failure of one eye to abduct)
smooth pursuit or nystagmus
dilated pupil suggests issue with CN3
trigeminal nerve assessment
CN5
sensation to face (ophthalmic, maxillary and mandibular branches)
muscles of mastication (clench teeth, keep jaw open)
facial nerve assessment
CN7
muscles of facial expression
look for any asymmetry ( raise eyebrows, screw up eyes, puff out cheeks, smile)
vestibulocochlear nerve assessment
CN8
hearing and balance
whisper number in each ear whilst masking sound in other
Rinne’s and Weber’s test
glossopharyngeal and vagus nerve assessment
CN9 and 10
controls pharynx, breathing and phonation
look at back of throat
get them to cough
accessory nerve assessment
CN11
trapezius, sternocleidomastoid
shoulder shrug and turn head to each side
hypoglossal nerve assessment
CN12
look at tongue muscle bulk, is it deviated to one side
wiggle tongue from side to side
smooth movement or slow/spastic
neurological limb exams
inspection
tone
power
reflexes
coordination
sensation
gait