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NEUROLOGICAL EXAMINATIONS

PROBLEM BASED LEARNING (PBL)

PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB

BACHELOR MEDICINE AND SURGERY (MBBS)

UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

WHAT IS NEUROLOGICAL EXAMINATIONS?

A series of simple questions and tests

provide crucial information about the

nervous system.

COMPONENTS

SENSORY EXAMINATION

REFLEX EXAMINATION

MENTAL STATUS EXAMINATION

COORDINATION AND GAIT EXAMINATION

MOTOR EXAMINATION

CRANIAL NERVE EXAMINATION

A) Appearance

Age Weight

Manner of dress

Grooming

B) Attitude and behaviour

Body language

Eye contact

Breathing rhytm

Body movement

c) Speech

Loudness

Rate

Quality

Spontaneity Quantity

d) Perception

Sensory experiences

External stimulus

Internal stimulus

TEST EXAMPLE :GCS

TEST EXAMPLE : AMTS

TEST EXAMPLE : MMSE

2) Reflex examination

Tendon reflex

Superficial reflex

Pathological reflex

A)Tendon reflex

Biceps Triceps

Brachioradialis Knee jerk

Ankle jerk

B)Superficial reflex

Abdominal reflex

Cremestericreflex

C)Pathological reflex

Plantar reflex

3) Sensory examination

Vibration testing

Light touch treshold

Temperature Cortical

sensation

graphesthesia

Cranial nerve mnemonics (function)

Olfactory Oh Some

Optic Oh Say

Oculomotor Oh Marry

Trochlear To Money

Trigeminal Take But

Abducent A My

Facial Family Brother

Vestibulocochlear Vacation! Says

Glossopharyngeal Go Big

Vagus Vegas Brain

Accessory And Matter

Hypoglossal Hawaii Most

I Olfactory nerve

Normal

Perceive scent with

either nostril

Abnormal response

unilateral

Structural brain lesion

Local brain lesion

bilateral

Rhinitis // damage to

CP

II Optic nerve

Visual acquity

DistantSnellen

chart(10/20 feet)

NearNear vision

card (14inches)

Visual field

Peripheral

Wiggling fingers

Counting fingers

White pin

Central Red pin

fundoscopy ophthalmoscope

Pupillary light reflex

Observe

Ptosis

irregular

Size of pupils

V Trigerminal

nerve

VI VII VIII sensory

Light touch

Cotton wisp

Corneal reflex

Pain & temperatur

e

P-disposable

pin

T- cold tuning fork

VIII Motor

Supplies muscle of

mastication

Jaw-jerk reflex

VII Facial nerve

Taste

Salty,Bitter,Sour,sweet

Muscle of facial

expression

Observe for asymmetry //

involuntary facial mvmnt

Normal

Asymmetry but no muscle

weakness

Abnormal

Lower motor neuron lesion

Upper motor neuron lesion

VII Vestibulocochlearnerve

Hearing

Rinne test

perceive the sound of the tuning fork in

front of the ear

Hearing loss

Conductive

Bone > air

Sensorineural

Air > bone

Weber test

Hear equally from both ears

Conductive

lateralizes the sound to the affected ear

Sensorineuralbest heard by

the non-involved ear.

Vestibular

Observe for nystagmus

IX Glossopharyngealnerve

X Vagus nerve

swallowing, phonation,

guttural and palatal

articulation

Observe palate movement

Palate elevate symmetrically

Unilateral palate weakness, palate

fails to elevate on the weak side

XI Spinal Accessory Nerve

• The spinal accessory supplies the trapezius and sternocleidomastoidmuscles.

• observe for– atrophy or asymmetry of the

muscles.

– quickness of shoulder shrug

XII Hypoglossal Nerve

• The hypoglossal nerve is motor to the tongue.

• Normal Response:– the tongue should be able to

protrude relatively straight. Minimal degrees of deviation (i.e. only millimeters) affecting only the tip are insignificant.

• Abnormal Response:– with tongue weakness, the

tongue deviates towards the weak side.

Motor Examination

Motor examination

Abnormal Involuntary Movements, Posture

and Bulk

Compare left to right,proximal to distal

observe for asymmetry, atrophy

or hypertrophy.

observe for abnormal involuntary movements

Tone

Spasticity

rigidity

Power

power or strength is tested by comparing the patient’s strength

against your own.

MRC Scale

Grade Description

0 no contraction

1 flicker or trace of contraction

2 active movement with gravity eliminated

3 active movement against gravity

4* active movement against gravity and resistance

5 normal power

Coordination & Gait

Coordination

• To perform tasks of co-ordination one requires normal motor, sensory, and cerebellar systems. Lesions affecting any of these areas could give rise to abnormal tests of co-ordination.

• Examine – Upper extremities

– Lower extremities

Gait

• observe the patient walk.

• if there is a subtle abnormality this may be made more obvious by asking the patient to run.

• ask the patient to perform tandem gait by walking heel to toe (eyes open).