what are the main components of the neurologic exam?
- Mental Status - level of alertness, appropriateness of responses, orientation to time and place.
- cranial nerves
- Motor systems - muscle strength test, gait, and coordination testing
- Sensory - pinprick, light touch, vibratory, proprioception
- Reflexes - deep tendon reflexes and plantar response (babinski)
What are the components of mental status exam?
- level of alertness
- appropriateness to response
- orientation to time and place
- congruency of mood
For each of the following types of disease, state whether the onset and progression of neurologic signs and symptoms are abrupt, progressive or episodic. A. Cerebral hemorrhages B. Vascular diseases C. Infections D. Head trauma E. Neoplasms F. Degenerative diseases like PD, AD G. Demyelinating diseases like MS
A through D all have abrupt or apoplectic onset
E and F are progressive
G -intermittent, relapsing episodes
Whats the proper way to test CN I?
Have patient close one nostril and sniff through the other.
How is CN II tested?
- Test visual acuity with a Snellen eye chart- pt stands 20ft from chart
- Insect the fundi - locate optic disc, check for papilledema, pallor or atrophy. inspect retina for hemorrhages, exudates, spontaneous nervous pulsation, hypertensive vascular changes, trace the arteries and veins peripherally
- Visual field test - pt in front of examiner, one eye covered during testing, patient to count fingers held up testing all 4 quadrants, also test blink response to lateral threat
- Color vision
- pupillary light reflex (tests CN II and III)
What nerves are tested during cardinal signs of gaze testing?
CN III, IV, and VI
What are you checking for when testing CN III
- eyelid for ptosis
- pupil shape and symmetry
- reactivity to light and accomodation
How is CN V tested?
- facial sensation in forehead, cheek, chin to pinprick, light touch, and hot/cold
- check motor function: check lateral jaw movements (lateral pteryoids), jaw clenching( temporal and masseter muscles)
- Check corneal reflex - (tests CN V and VII) - lightly touch cotton wisp to cornea which should result in contraction of the obbicularis oculi muscle
In the corneal blink reflex
Afferent = Trigeminal Efferent = Facial
When wide opening of the mouth, patient’s chin deviates to right. This is known as _
Right trigeminal palsy
How is CN VII tested?
- Motor - facial expressions, eye and mouth closure. Widened palpebral fissure and nasolabial fold indicative of weakness
- Sensory - taste for salty, sweet and bitter substances to anterior 2/3 of tongue
- Parasympathetic - secretion of saliva and tears
When testing for CN VIII, before proceeding to do Weber or Rinne test, what tests are usually performed to check for hearing loss?
Check for loss of hearing by whisper test or finger rub in each ear, if present then do Weber and Rinne test
For the Weber test, after striking the tuning fork, where is it placed, and what is being tested?
on the middle of the forehead, diminished tone in the affected ear indicates sensorineural loss. A louder tone in the affected ear indicates conductive deafnesss (disease in the ossicles int he middle ear)
How is the Rinne test performed and what does it test?
Confirms the presence of conduction of deafness in the affected ear. Strike a tuning fork and place it on the mastoid process.
Strike tuning fork and place on mastoid process. When the tone is gone, place it over the external auditory meatus, the patient should hear the tone again, if not, conduction deafness is present
What is the motor and sensory components of CN IX. How is CN IX tested?
Motor: innervates stylopharyngeus muscle which elevates and widens the pharynx on swallowing
Sensory - taste to the posterior 1/3 of the tongue, sensation to the palate and pharynx, skin of the external ear
Test: gag reflex - touch posterior pharynx with cotton tipped applicator should illicit a gag response
CN X innervates the larynx and all the muscles of the pharynx except
Stylopharyngeus
How is CN X tested?
- test by listening to voice for hoarseness
- check gag reflex
Lesions of IX results in
- loss of gag reflex
- loss of sensation in pharynx and posterior 1/3 of tongue
- slight dysphagia
Lesion of X results in
- dysphonia
- dysphagia
- dyspnea
- loss of gag or cough reflex
How is CN XI tested?
CN XI innervates trap and SCM.
SCM: test by having pt turn head against mild resistance. contraction of the left SCM turns head to the right
Trap: pt shrug shoulders against resistance
CN XII innervates all intrinsic muscles of the tongue except
palatoglossus (CNX)
How is XII tested?
pt protude tongue and push tongue into opposite cheek
CN XII lesion results in
tongue deviation to the weak side and inability to push tongue to the opposite cheek
List the following with the corresponding nerve root A. shoulder shrug - trapezius B. Shoulder abduction- deltoid C. Elbow flexion D. Elbow Extension E. Wrist flexion/extension F. Hand grip G. Finger abduction H. Opposition of the thumb I. Hip Flexion J. Hip Extension K. Hip Adduction L. Hip Abduction M. Knee Flexion N. Knee Extension O. Ankle plantar flexion P. Ankle dorsiflexion
A. CN XI B. C5 C. C5-6 D. C6-8 E. C6-7 F. C7-C8 T1 G. C8-T1 H. C8-T1 I. L2-4 J. S1 K. L2-4 L. L4-S1 M. L4-S2 N. L2-L4 O. s1 P. L4, L5
