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Neurological Exam. Duc Tran, M.D. August 2003. Neurological Exam. Mental Status Cranial Nerves Motor Sensory Reflexes Coordination Gait. Neuroaxis. Central Brain Spinal Cord Peripheral Root Plexus Nerve Neuromuscular Junction Muscle. Intracranial. Supratentorial Frontal

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neurological exam

Neurological Exam

Duc Tran, M.D.

August 2003

neurological exam1
Neurological Exam
  • Mental Status
  • Cranial Nerves
  • Motor
  • Sensory
  • Reflexes
  • Coordination
  • Gait
neuroaxis
Neuroaxis
  • Central
    • Brain
    • Spinal Cord
  • Peripheral
    • Root
    • Plexus
    • Nerve
    • Neuromuscular Junction
    • Muscle
intracranial
Intracranial
  • Supratentorial
    • Frontal
    • Parietal
    • Temporal
    • Occipital
  • Infratentorial
    • Cerebellum
    • Brainstem
supratentorial
Supratentorial
  • Aphasia - dominant
  • Aprosodias – nondominant
  • Alexia
  • Agnosia
  • Apraxia
  • Consciousness
  • Memory
  • Motor – cortical vs. subcortical
  • Personality
  • Seizures - cortical
  • Sensation - parietal
  • Vision – occipital
infratentorial
Infratentorial
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Decreased facial sensation/perioral numbness
  • Dystaxia/Ataxia
  • Dizziness/Vertigo
  • Nystagmus
  • Consciousness
  • Cross findings
cranial nerves
Cranial Nerves
  • I - Olfactory.
  • II - Optic. Vision. Pupil reflex.
  • III - Eye movement. Pupil response.
  • IV - Eye movement.
  • V - Facial sensation. Mastication.
  • VI - Eye movement.
  • VII - Facial movement.
  • VIII - Balance/Hearing.
  • IX - Taste. Sensation pharyngeal muscles.
  • X - Sensation larynx, gut. Motor to larynx, pharynx, palate.
  • XI - Motor to sternocleidomastoid/trapezius.
  • XII - Motor to tongue.
myelopathy
Myelopathy
  • Weakness
  • Reflex changes
  • Sensory loss
  • B/B dysfunction
  • Ascending Level of Dysfunction
motor neuron
UMN

Weakness

Spastic

Hyperreflexia

LMN

Weakness

Flacid

Atrophy

Fasciculations

Hyporeflexia

EMG/NCV

MotorNeuron
root radiculopathy
Root/Radiculopathy
  • Pain
  • Weakness in distribution of root
  • Sensory loss – may not be dense
  • Reflex changes – helps to localize the level
  • Rule of 7
nerve
Nerve
  • Polyneuropathy – eg. diabetes
  • Mononeuropathy – eg. CTS
  • Multiple mononeuropathies – eg. lead
polyneuropathies
Polyneuropathies
  • Weakness – distal>proximal
  • Sensory loss – distal>proximal
  • Reflex changes – distal>proximal
  • Exceptions - CIDP
mononeuropathies
Mononeuropathies
  • Cardinal movements of the thumb
    • Extension
    • Opposition
    • Adduction
  • Cardinal movements of the lower extremity
    • Hip flexion/knee extension
    • Hip adduction
    • Hip abduction/hip extension
    • Knee flexion/ankle dorsi-flexion/ankle plantar flexion/inversion/eversion.
slide30
NMJ
  • Weakness – proximal>distal
  • No sensory loss
  • No reflex changes
  • Fatigue
myopathy
Myopathy
  • Weakness – proximal>distal
  • No sensory changes
  • No reflex changes
  • Atrophy
  • Myotonia
  • Cramping