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CNS Examination . Hadeel Khadawardi , teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al- Qura University. CNS examination consists of: High Cortical Function Cranial Nerves Motor Coordination Sensory . High Cortical Functions. Handedness Consciousness

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CNS Examination

HadeelKhadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University

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CNS examination consists of:

High Cortical Function

Cranial Nerves

Motor

Coordination

Sensory

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High Cortical Functions

Handedness

Consciousness

Orientation

Memory

Speech

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Handedness

  • Shake patient hand and ask if he or she Rt. or Lt. handed to assess for the likely dominant hemisphere.
  • 94% of people are Rt. handed.
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2. Consciousness

  • Levels of consciousness
  • Alertness
  • Lethargy
  • Obtundation
  • Stupor
  • Coma
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3. Orientation

  • Time
  • Place
  • Person
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4. Memory

  • Remote (long) memory: Birthdays,…
  • Recent (short) memory: event of the day, …
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5. Speech

  • Dysphasia:dominant higher center disorder in the use of symbols for communication.
  • Dysarthria: difficulty with articulation.
  • Dysphonia: altered quality of the voice.

Types od dysphasia;

Expressive

Receptive

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II. Optic Nerve

Visual acuity:

Is checked by using Snellen Chart.

b) Visual field:

c) Visual color:

Is checked by using Ishihara Charts.

d) Fundoscopy:

e) Light reflex:

The afferent of light reflex is by optic nerve and the efferent is by oculomotornerve.

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III, IV, VI. Oculomotor, trochlear & abducentNerves

Inspect the eyes for ptosis, shape and size of pupils.

Eye movement;

ask the patient to follow your finger in H shape

comment on:

Failure of eye movement

Diplopia

Nystagmus

c) Light reflex

d) Accommodation

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V. Trigeminal Nerve

Motor; (Muscle of mastication)

Temporalis

Masseter

Pterygoids

b) Sensory;

Access for fine touch and pin break in the 3 divisions ( ophthalmic, maxillary, mandibular).

c) Corneal reflex;

The afferent of corneal reflex is by trigeminal nerve and the efferent is by facial nerve.

d) Jaw reflex;

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VII. Facial Nerve

  • Inspection
  • Forehead wrinkles
  • Angle of the eye
  • Corner of the mouth
  • Loss of nasolabial fold
  • Dropping of saliva
  • Motor
  • Frontalis muscle
  • Orbicularis oculi
  • Buccinator muscle
  • Orbicularis oris
  • Sensory
  • Anterior 2/3 of the tongue.
  • Corneal reflex

How would differentiate b/w UMNL & LMNL of VII nerve?

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VIII. Vestibulocochlear Nerve

  • Whispering
  • Rinnes test
  • Webers test
  • IX, X. Glossopharyngeal & Vagus Nerves
  • Inspection of uvula.
  • Difficulty of swallowing
  • Ask the patient to say ‘Ah’
  • Gag reflex
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XI. Accessory Nerve

Trapezius muscle

Sternomastoid muscle

XII. Hypoglossal Nerve

Inspect the tongue

Ask the patient to protrude his/her tongue

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Motor

Motor

Exposure & Inspection

Tone

Power

Reflex

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Inspection

  • Skin (rash, scar, ulcer,…)
  • Muscle (wasting, fasciculation)
  • Deformity
  • Abnormal movement
  • Drift (For Upper Limb Only)
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Tone

  • For upper & lower limbs
  • Examine each joint
  • Start from distal to proximal
  • Always compare both sides

What are the types of hypertonia?

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Power

  • For upper & lower limbs
  • Examine each joint
  • Always compare both sides

What are the grading of power?

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Reflex

  • Patient should be comfortable and relaxed
  • Expose the tested muscle
  • Strike the tendon, not the muscle belly
  • Observe the muscle contraction
  • Reflex of upper limb:
  • Brachioradialis reflex (C5,C6)
  • Biceps reflex (C5,C6)
  • Triceps reflex (C7,C8)
  • Reflex of lower limb:
  • Ankle reflex (S1,S2)
  • Knee reflex (L3,L4)
  • Planter reflex (S1,S2)
  • Clonus:
  • Ankle clonus
  • Knee clonus

What are the grading of reflex?

What is reinforcement?

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Coordination

Finger nose test

Rapidly alternative movement

Heel to shin test

Rebound

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Gait

How to differentiate b/w UMNL &LMNL ?

  • Expose both legs
  • Ask the patient to:
  • walk heel to toe
  • walk on toes
  • walk on heels
  • squat to stand
  • Romberg test

What are the types of abnormal gait?