Neurological Examination : Sensation Flashcards
In which order do you conduct a neurological examination ?
Higher cerebral function
Cranial nerve
Posture and gait
Motor function
Sensation
Reflex
Coordination & diadochokinesis
Specific test
What is the purpose of the sensory examination ?
Verify whether there is a sensory impairment and at what level.
Need good knowledge of topography and functional anatomy of areas innervated by peripheral nerve.
Of what is composed epicritic sensation ?
Epicritic = gnostic : fine touch, vibration, sense of motion, proprioception and rombergs test, sense of posture.
Information runs through homoloteral canal via the dorsal funiculi to the medulla oblongata where they cross.
==> dorsal column tract
Of what is composed protopathic sensation ?
Protopathic = spinothalamic sensation, it includes : pain, temperature and crude touch sensation.
The information are called vital and cross first when arrived in the spinal column then go to the thalamus via the contralateral spinothalamic tract.
Of what is composed cortical sensory function ?
It includes tactile attention, stereognosis, 2 point discrimination test.
What are the general rules of a sensory examination ?
- doctor explain the procedure clearly while patient has aye open and demonstrate the test in area where there shouldn’t be any sensation loss.
- apply stimulus with no particular rythme and change the site of touch, occasionally administer fake stimuli.
- compare left/right and examine different dermatoses
- inspect for : scars, brush, trauma injury
- assess : color, hair distribution (could be a sign of autonomic dysfunction)
How do you examine pain/crude touch sensation ?
Break a cotton bud to produce a sharp and blunt points
Let the patient (eye closed) experience the difference between the 2 sensation
- at a spot where you dont expect a sensation loss
Gradually move towards affected area
- patient should let you know when the painful sensation decrease
What do you do in case of diabetic poly neuropathy suspicion ?
Use the Semmes-Weinstein monofilament test.
Indicated when : increased pain, inability to feel pain or extreme sensitivity to touch.
How do you assess temperature sensation ?
Only do on indication.
Closed eyes patient need to distinguish between hot ne cold.
How do you examine fine touch sensation ?
Repeatedly touch patient lightly with wad of cotton wool.
- no stroking motion
Patient should describe the sensation : numb, dull, tingling,….
How do you examine vibration sensation ?
- use a 128 Hz tuning fork
Strike the fork on your knee (generally)
Demonstrate the sensation on the sternum or other bones with probable intact vibration sense.
Proceed to do it on the inter phalange all joint of the hand then the one of foot of the metatarsophalangeal joint.
- patient say whether or not they feel the vibration
Stop the vibration with your hand but maintain contact with the skin.
- ask the patient if they still feel the vibration to see if they truly felt it
If the patient did not feel vibration go more proximal.
How do you examine the sense of position ?
Patient eyes closed, place their hand or ankle in a certain position. Ask them to replicate it with the opposite side.
How do you examine the sense of motion/proprioception ?
Using Romberg’s test. OR
Touch patient middle finger at the distal phalanx while immobilising the proximal phalanx.
Move distal phalanx slowly up and down.
- ask patient if they feel the movement, if not move proximal
Do the same for the great toe.
How do you test tactile attention ?
Apply tactile stimulus successively on one side then the other at the same location.
- patient should recognise both stimuli
Apply tactile stimuli simultaneously
- patient only feel one ? => extinction phenomenon
How do you test stereognosis ?
Place objet in patient hand and they need to identify it.
OR
Write number on their skin and they need to identify it => graphesthesia
