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CENTRAL NERVOUS SYSTEM :

CENTRAL NERVOUS SYSTEM :. 1.HIGHER MENTAL FUNCTIONS: 1 . APPEARANCE 2. BEHAVIOUR 11. MEMORY 3 . COGNITIVE 12. SPEECH 4 . DELUSION 5 . EMOTIONAL STATUS 6 . GAIT 7 .HALLUCINATION. 8 . ILLUSION 9 . JUDGEMENT

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CENTRAL NERVOUS SYSTEM :

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  1. CENTRAL NERVOUS SYSTEM : 1.HIGHER MENTAL FUNCTIONS: 1 . APPEARANCE 2. BEHAVIOUR 11. MEMORY 3 . COGNITIVE 12. SPEECH 4 . DELUSION 5 . EMOTIONAL STATUS 6 . GAIT 7 .HALLUCINATION. 8 . ILLUSION 9 . JUDGEMENT 10 . KNOWLEDGE( i. q)

  2. 2.SIGNS OF MENINGEAL IRRITATION: • NECK RIGIDITY • KERNIG`S SIGN • BRUDZINSKI`S SIGN 3 . CRANIAL NERVE EXAMINATION 4 . SENSORY NERVE EXAMINATION 5 . MOTOR EXAMINATION 6. GAIT

  3. CRANIAL NERVE EXAMINATION Olfactory nerve - CN I : tested easily by having the patient smell common objects such as coffee or perfume Optic nerve - CN II : • Acuity, by using the Snellen chart (near and distant vision) • Visual fields, by means of confrontation or perimetry if indicated • Color, with use of an Ishihara chart or by using common objects, such as a multicolored tie or color markers • Funduscopy

  4. Oculomotor nerve - CN III • Diplopia • Ptosis • Pupils : shape, size, direct light reflex, consensual light reflex, accomodation (distant and near) Trochlear nerve - CN IV : allows a person to view the tip of his or her nose • Downward movement is impaired Abducens nerve - CN VI : • squint (cover and uncover tests and cover – uncover test)

  5. Trigeminal nerve - CN V • Sensory : ophthalmic, maxillary, mandibular and anterior two third of the tongue • Motor : clenching of teeth (masseter and temporalis) • Corneal reflex (E: 7th and A: 5th Nerve) • Ask the patient to open the mouth (deviation on same side)

  6. Facial nerve - CN VII • Wrinkled his forehead or look up above his head • Close the eye (uprolling of the eye) • Inspect the nasolabial fold • Screw your eyes tightly shut and stop me from opening them • Blow out your cheeks with mouth closed • Taste (sweet, salt, sour and bitter) Vestibulocochlear nerve - CN VIII : • tuning fork tests (Rinne`s and Weber`s)

  7. Glossopharyngeal nerve - CN IXVagus nerve - CN X • Pharyngeal and gag reflex are unpleasant for the patient. • Assess the speech • Look the movement of the palate and uvula while the patient says ‘Aaah` Accessory nerve - CN XI : - inspect the sternocleidomastoid muscles,test the power (left : - turn the head to the right), - inspect from behind (wasting or asymmetry) and test the power (shrug the shoulder`s as you apply downward pressure)

  8. Hypoglossal nerve - CN XII • Protrude the tongue: when paralyzed on 1 side, the tongue deviates to the side of paralysis on protrusion. • Test the power (press the tongue against the inside of each cheeks in turn while you press from the outside with your finger)

  9. Motor system • Muscles :- • Bulk • Power (flexion, extension, adduction, abduction, dorsiflexion, inversion, e.t.c) • Tone • Reflexes • Coordination (finger – nose test, heel – shin test)

  10. Muscles power grading • 0 No muscles contraction visible • 1 Feeble contractions but no movement • 2 Movement with gravity eliminated • 3 Movement against gravity • 4 Movement against partial resistance • 5 Full strength Superficial reflexes • corneal, abdominal, cremasteric, and plantar (Babinski) reflexes.

  11. Deep tendon reflexes Upper limbs : • Biceps (thumb): - C5,C6 • Triceps (hold the hand): - C6,C7 • Supinator : - C5,C6 Lower limbs: • Knee jerk: -L3,L4 • Ankle jerk: - S1

  12. Sensory nerve examination Light touch (patient's eyes closed ) :- light touch with a finger, a piece of cotton wool or a piece of tissue paper Sharp touch (pinprick) :- • patient's eyes closed • With disposable pin. • hypoaesthesia (feels blunter) or hyperaesthesia (feels sharper) Temperature: touch the patient with a tuning fork Joint position sense (proprioception): Move the distal phalanx up and down Vibration sense: 128 Hz tuning fork 2-point discrimination:

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