Neurological Examination Flashcards
what is a neurological examination?
- series of tests conducted by a neurologist to evaluate the integrity of the nervous system for many reasons
- Ex. Post-trauma/stroke, suspected neurodegenerative changes, following exposure to a neurotoxic agent
localization of neurological exam (where could damage have occurred?)
- Cerebral Hemisphere (Telencephalon)
- Internal Capsule
- Brainstem (Where? Diencephalon, Mesencephalon, Metencephalon, or Myelencephalon?)
- Spinal Cord
- Cranial Nerves
- Neuromuscular Junction
- Muscle
common components to know before conducting neurological exam
- patient history
- Cranial nerve function
- Motor function (ex. Reflex)
- Somatosensory function
- Coordination
- Mental status
components to know: patient history
- Age, education, and handedness -> right-handed people have language centers in left part of brain
- Past medical history
- Use of medication and/or recreational drugs
- Family medical history
- Disease process
components to know -> patient history -> disease process
- Temporal profile: sudden vs. Gradual; acute vs. Chronic
- Change over time: static, improvement, worsening
- Identify triggers/relievers of symptoms
- Gauge severity of symptoms
cranial nerves
- All are peripheral (“peripheral damage” refers to cranial nerves; “central damage” refers to brain stem)
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
- “Oh, Only Officers Try To Allow For Very Good Vacations And Holidays”
- “Some Say Money Matters, But My Brother Says Big Brains Matter More”
cranial nerves: olfactory
- sensory
- smell
cranial nerves: optic
- sensory
- vision
cranial nerves: oculomotor
- motor
- eye/eyelid movement
cranial nerves: trochlear
- motor
- eye movement
cranial nerves: trigeminal
- both
- facial sensation, jaw muscles
cranial nerves: abducens
- motor
- eye movement
cranial nerves: facial
- both
- taste from anterior tongue, muscles of facial expression
cranial nerves: vestibulocochlear
- sensory
- sound, balance
cranial nerves: glossopharyngeal
- both
- taste from posterior tongue, muscles of pharynx
cranial nerves: vagus
- both
- ear canal sensation, motor control of heart, lungs, viscera, larynx, etc.
cranial nerves: accessory
- motor
- movement of muscles of head rotation and shoulder shrug
olfactory nerve: test, what it’s assessing, what dysfunction could look like
- Test: smell stuff with eyes closed
- Assessing: Ethmoid ridge and TBI
- Damage: mild head injury can damage/shear nerves
optic nerve: test, what it’s assessing, what dysfunction could look like
- Test: Standard visual acuity test (Snellen chart), visual field confrontation, pupillary light reflex
- Assessing: whether visual info sent to both sides of brain
- Damage: Papilledema and intracranial pressure
Oculomotor, Trochlear, Abducens: test, what they’re assessing, what dysfunction could look like
- Test: follow object/light without moving head
- Assessing: gaze restrictions
- Damage: issues caused by lesions
trigeminal: tests/assessment
- Facial somatosensation (sharp vs. Light tip)
- Palpating jaw, checking for motor function
facial: test/assessment
Looking for facial asymmetries (ex. Bell’s Palsy)
vestibulocochlear: test/assessment
- Auditory perception
- Balance
- Vestibular senses (labyrinth)
glossopharyngeal and vagus: test/assessment
- Swallowing and voice
- Gag reflex
accessory: test/assessment
- Shrugging of shoulders
- Head resistance
hypoglossal: test/assessment
Stick out the tongue, lateral movement
motor function: what to examine, what damage looks like
- Key features to examine:
- Gross appearance of muscle
- Muscle tone, strength
- Upper vs. lower motor lesions: Effect on reflexes (ex. Babinsky reflex)
Mental Status Exam (MSE) -> what does it measure?
- Attention and orientation
- Language
- Memory
- Visuospatial function
- Executive functions
MSE: attention and orientation -> tests
- Observe the patient’s alertness
- Spelling a word backwards
- Counting backwards from 20
- Auditory vigilance
- Current whereabouts, time
MSE: attention and orientation -> regions involved
- Focal cortical or subcortical regions
- Origin may be diffuse (ex. Toxin)
MSE: attention and orientation -> problems
- Contralateral neglect = failure to attend to left side of the world (perception is there, but attention is not)
- Anosognosia = failure of individual to self-report that they have a disorder; understanding the world by literally not having the ability to acknowledge the disorder (medication can help with this)
MSE: language -> tests/what you’re looking for
- Fluency
- Naming
- Repetition
- Prosody
- Comprehension
- Reading
- Writing
- Praxis (ability to carry out a motor ability you know when it’s requested)
- Language problems
MSE: language -> language problems
- Aphasia: problems with language production and/or comprehension
- Alexia: problems with reading
- Agraphia: problems with writing
- Apraxia: problems with praxis
MSE: language -> regions involved
focal or diffuse damage to the left hemisphere language network
MSE: memory -> tests/looking for what
- Digit span (increasing digits you have to memorize, magic number = 7)
- Pointing span (increasing pointing to corners of room, memorizing order)
- Verbal, visual object learning
- Past public/personal events
- Factual knowledge
MSE: memory -> regions involved
medial temporal structures (eg. Hippocampus), thalamus, basal forebrain, prefrontal cortex
MSE: visuospatial functions -> tests/looking for what
- Line cancellation
- Copy of geometric designs
- Judgment of line orientation
- Object/face/colour recognition
- visuospatial problems
MSE: visuospatial functions -> visuospatial problems
- Prosopagnosia: failure to recognize faces
- Constructional apraxia: difficulty putting pieces of an object together
- Dressing apraxia: difficulty getting dressed
MSE: visuospatial functions -> regions involved
right hemisphere’s attention network; temporal lobe
MSE: executive functions -> tests/looking for what
- Judgment (presenting situation, making judgment calls based on it)
- Verbal fluency (“think of as many words starting with the letter F as you can”)
- Luria 3-step
- Drawing loops, alternating patterns
- Oral trail-making test
MSE: executive functions -> regions involved
prefrontal cortex and/or associated projections
cranial nerves: hypoglossal
Movement of tongue muscles (speech, swallowing)
Halstead-Reitain Neuropsychological Test Battery vs. Syndrome Analysis Scheme
- HRNTB: quantitative approach, used in USA; battery of different tests used to examine deficits associated with brain lesions
- SAS: qualitative approach, used in USSR; theory-based, hypothesizes relationship of cause and lesion, interviews/examines patients
Luria’s major contribution to neuropsychology
- Clinical approach he developed
- main points: psychological systems represent functional processes, individualized/case analysis is best method of clinical research, analysis of errors is most important observation when testing a patient
- note: “testing” = specific set of tests used; “approach” = clinical use of tests
