The Neurological Examination and Methods of Assessment

1
The Neurological Examination and Methods of
Assessment

• Alvin V. Terry Jr., Ph.D.
• Associate Professor

UGA College of Pharmacy and MCG Alzheimers
Research Center
Lecture 1
2
Domains

• History of Present Illness
• Mental Status
• Cranial Nerves
• Motor Function
• Reflexes

3
Domains Continued

• Sensory Function
• Gait

4
History

• Chief Complaint
• Time Course
• Distribution of Symptoms
• Additional Questions

5
Mental Status

• Speech
• Alertness
• Memory
• Abstract Reasoning
• Ability to Follow Commands

6
Cranial Nerves
Source Web Path The Internet Pathology
Laboratory for Medical Education
7
I Olfactory Nerve

• Odors tested through one Nostril
• oil of cloves
• methyl salicylate
• vanilla

8
II Optic Nerve
Tests of visual acuity, visual fields and
internal eye structure
9
Papilledema
Normal
Severe
Source Lingsley, Robert E (2000). Conscience
text of neuroscience (2nd ed.)
10

• III Oculomotor
• Pupil size, shape and equality
• Pupillary reflex
• ability to follow moving objects
• IV Trochlear
• ability to follow moving objects
• VI Abducens
• ability to move each eye laterally

Usually Tested Together
11
V Trigeminal Nerve
Testing the corneal reflex
Testing the jaw jerk
12
VII Facial Nerve
Testing for weakness of the face
13
VIII Acoustic Nerve
Tests of hearing, bone conduction and equilibrium
14

• IX Glossopharyngeal
• X Vagus
• Gag reflex
• Patient asked to speak and cough
• Posterior 1/3 of tongue tested for taste

Usually Tested Together
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XI Accessory Nerve
Examination of the sternocleido- mastoid muscle
Testing the trapezius muscle
16
XII Hypoglossal Nerve
Testing for deviation of the tongue
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Motor Function

• Strength
• Coordination
• Tremors
• Atrophy
• Fasiculations

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Strength
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Finger to nose test
Coordination
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Coordination and Balance
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Reflexes

• Biceps
• Triceps
• Tendon Reflexes
• Plantar Response
• Cutaneous Reflexes

22
Source Lingsley, Robert E (2000). Conscience
text of neuroscience (2nd ed.)
23
Sensory Function

• Asymmetry to Pin Prick
• Vibration
• Temperature

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Gait

• Walking
• Standing

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Imaging Planes
Axial
Coronal
Sagittal
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Computerized Axial Tomography (CAT)
Source Mosby Clinical Neurology CD Atlas
27
Magnetic Resonance Imaging (MRI)
Sagittal
Coronal
Axial
Source Mosby Clinical Neurology CD Atlas
28
Magnetic Resonance Angiography
Source Mosby Clinical Neurology CD Atlas
29
Digital Subtraction Angiography
Intracranial
Vertebrobasilar
Source Mosby Clinical Neurology CD Atlas
30
Carotid Doppler
Duplex Scan of the Carotid Bifurcation
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Transcranial Doppler
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Electroencephalography
Source Mosby Clinical Neurology CD Atlas
33
(No Transcript)
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Lumbar Puncture
CSF Pressure Measurement (with manometer)
Source Mosby Clinical Neurology CD Atlas
35
Single Photon Emission Computed Tomography
(SPECT)
Axial
Sagittal
Source NIH/NIA
36
Positron Emission Tomography (PET)
Source NIH/NIA