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Neurological Exam

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

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  1. Neurological Exam Duc Tran, M.D. August 2003

  2. Neurological Exam • Mental Status • Cranial Nerves • Motor • Sensory • Reflexes • Coordination • Gait

  3. Neuroaxis • Central • Brain • Spinal Cord • Peripheral • Root • Plexus • Nerve • Neuromuscular Junction • Muscle

  4. Intracranial • Supratentorial • Frontal • Parietal • Temporal • Occipital • Infratentorial • Cerebellum • Brainstem

  5. Supratentorial • Aphasia - dominant • Aprosodias – nondominant • Alexia • Agnosia • Apraxia • Consciousness • Memory • Motor – cortical vs. subcortical • Personality • Seizures - cortical • Sensation - parietal • Vision – occipital

  6. Infratentorial • Diplopia • Dysarthria • Dysphagia • Decreased facial sensation/perioral numbness • Dystaxia/Ataxia • Dizziness/Vertigo • Nystagmus • Consciousness • Cross findings

  7. 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.

  8. Hemangiomablastoma

  9. Myelopathy • Weakness • Reflex changes • Sensory loss • B/B dysfunction • Ascending Level of Dysfunction

  10. UMN Weakness Spastic Hyperreflexia LMN Weakness Flacid Atrophy Fasciculations Hyporeflexia EMG/NCV MotorNeuron

  11. Root/Radiculopathy • Pain • Weakness in distribution of root • Sensory loss – may not be dense • Reflex changes – helps to localize the level • Rule of 7

  12. Nerve • Polyneuropathy – eg. diabetes • Mononeuropathy – eg. CTS • Multiple mononeuropathies – eg. lead

  13. Polyneuropathies • Weakness – distal>proximal • Sensory loss – distal>proximal • Reflex changes – distal>proximal • Exceptions - CIDP

  14. 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.

  15. NMJ • Weakness – proximal>distal • No sensory loss • No reflex changes • Fatigue

  16. Myopathy • Weakness – proximal>distal • No sensory changes • No reflex changes • Atrophy • Myotonia • Cramping

  17. VITAMIN DEC

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