Neurology exams Flashcards
List some of the goals of neurological exams
Finding where the impairment is
Levels and lateralization
How and why do we check patient history?
Examineing age, education, handedness, medical/family history
can point the examiner towards potential hereditary conditions
Cranial nerve 1
Olfactory
How to test olfactory?
identifying familiar smells one nostril at a time
unilaterally abnormal: possible structural brain lesion to olfactory bulb/tracts
bilaterally abnormal: anosmia = loss of smell
Cranial nerve 2
Optic
How to test optic?
Typical vision test for each eye separately
poor vision can be due to increased intracranial pressure
Cranial nerves 3,4,6
Control eye position.
Oculomotor, trochlear, abucens
How to test oculomotor, trochlear, adbucens?
Testing eye movements
Gaze palsy = weakness or loss of certain eye movements
Cranial nerve 5
Trigeminal nerve (activation when biting down on side of face)
How to test trigeminal nerve?
Testing biting down
Trigeminal neuralgia: chronic sharp pains to one side of face, triggered by light touch or spontaneous
caused by pressure on trigeminal nerve by blood vessel, tumour, or stroke
Cranial nerve 7
Facial nerve
How to test facial nerve?
Tests for aysymmetry and strength: raising eyebrows, smiling, puffing out cheeks
Bell’s palsy: paralysis of facial nerve, causing weakness on one side of face
Cranial nerve 8
Vestibulococlear (hearing)
How to test vestibulococlear?
whisper test, tuning fork, touching bone
If unilateral hearing loss, peripheral lesion. If bilateral, more central damage
Cranial nerve 9, 10
Glossopharyneal, Vagus
How to test glossopharyngeal, vagus?
Assessing voice, swallowing, gag reflex, and cough
Pseudobulbar palsy = bilateral central lesions
Bulbar palsy = bilateral peripheral lesions
Cranial nerve 11
Accessory
how to test accessory?
Shrugging of shoulders, head resistance, weakness and location
Cranial nerve 12
hypoglossal
How to test hypoglossal?
Sticking out tongue, lateral movent. Looking for direction deviation and strength
What to check in motor systems?
Muscle tone, strength, outwards appearance
Upper motor neurons
originate in motor cortex or brainstem using glutamate
Lesions here: weakness, spasticity, hypereflexia, retained primitive reflexes
Lower motor neurons
Orinate in spinal cord or brainstem, innervate muscle or glands and use acetylcholine
Lesions here: wealmess, hypotonia (low tone), hyporeflexia, atrophy, fasciculations
How to test Somatosensory?
Body sensations such as temperature, pain, vibration, proprioception
Astereogenesis?
inability to recognize object by touch
Agraphesthesia?
Inability to recognize letters/numbers by touch, point to sensory cortex of parietal lobe
How to test coordination?
Quick alternating movements, point-point movements, standing/sitting, gait (manner of walking)
Dysdiadochokinesia
inability to do quick alternating movements
Dysmetria
impairment performing accurate movements
points to cerebellar damage
Where do abnormalities in coordination point to?
Ethanol innebriation
Cerebellar damage
Romberg’s test?
Balance with eyes open and closed
Protonator drift?
Rotation and vertical motion of arm
points to damage to pyramidal tract
How to test mental status?
Mental status exams such as the MoCA
What is the MoCA
Strict rules to give scores, several different types of mental exams
Tests orientation, language, short-term memory, attention, abstraction, executive function, animal naming, clock-drawing
People given score based off their performance to assess cognitive impairment
General components of mental status exams
Level of consciousness, attention and orientation, language, memory, visuospatial function, executive functions
Level of consciousness
Awake/asleep, level of stimulus needed to wake
Attention and orientation
observing patient’s alertness, spelling word backwards, counting backwards from 20, etc.
cortical/subcoritcal regions
Language
Naming body parts and reading, writing, simple phrases
fluency, comprehension, prosody
focal or diffuse damage to left hemisphere language network
Memory
remembering words, digits
medial temporal structures, prefrontal cortex, left parietal lobe
Visuospatial function
line cancellation, copying geometric designs, judging line orientations
rigt hemispehere attention network
executive functions
judgement tests, verbal fluency, Luria’s 3 step test, drawing clocks based on given time
prefrontal cortex and associated projections
