The Neurologic Examination

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The Neurologic Examination

• Dr. Heidi Barnes
• Neurology Resident

2
Anatomic Localization

• Every anatomic location has unique clinical signs
• Neurology examination tests for those clinical
  signs
• You must perform and interpret the examination
  properly to have it help!

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Rostral to the Foramen Magnum

• Cerebrum/telencephalon
• Thalmus/diencephalon
• Midbrain/mesencephalon
• Pons/metencephalon
• Medulla oblongata/myelencephalon
• Cerebellum/part of metencephalon

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Lesion Localization

• Telencephalon/Diencephalon
• Mentation changes depression, dementia, stupor,
  coma
• Seizures (ALWAYS!!!)
• Basal Ganglia LIMITED (cerebrospinal tracts)
  motor to limbs.
• Horse lips, face
• Dog Upper forelimbs
• Cat Complete forelimbs
• Human/Chimp hands
• Circling toward lesion, NO head tilt!
• Blindness intact PLR, no menace

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Localization for the Brainstem

• I. Olfactory
• II. Optic
• III. Oculomotor
• IV. Trochlear
• V. Trigeminal
• VI. Abducens

• VII. Facial
• VIII. Vesibulocochlear
• IX. Glossopharingeal
• X. Vagus
• XI. Spinal Accessory
• XII. Hypoglossal

Motor tracts (red nucleus, reticulospinal tracts)
cross in midbrain.
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Cranial Nerve Evaluation

• Ear/lip/eye twitch V and VII
• Temporal/masseter muscle V
• Gag IX and X
• Trapezius muscle XI
• Tongue movement XII

• Menace II and VII
• PLR II and III (parasympathetic part)
• Strabismus
• Static III, IV, VI
• Positional VIII
• Nystagmus VIII

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Spinal Cord Localization

• Divided into cord segments based on the anatomic
  action
• Upper motor neuron cell body originating rostral
  to the foramen magnum
• Lower motor neuron cell body originating in the
  spinal cord

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Spinal Cord Segments

• C1-C5 Upper Motor Neuron all 4 limbs

• C6-T2 Lower Motor Neuron front limbs
• Upper Motor Neuron pelvic limbs

• T3-L3 Upper Motor Neuron pelvic limbs

• L4-S3 Lower Motor Neuron pelvic limbs

L4-S3
C1-C5
T3-L3
C6-T2
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Postural Reactions Upper Motor Neuron Function

• Hopping, placing, conscious proprioception
• Need lower motor neurons intact
• BUT also uses white matter of spinal cord

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Reflex Arch- Lower Motor Neuron Function
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Spinal Reflexes Thoracic Limb

• Biceps brachii musculocutaneous
• Triceps radial nerve
• Extensor Carpi radialis radial nerve
• Withdrawal axillary median/ulnar
  musculocutaneous radial

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Spinal Reflexes Pelvic Limb

• Patellar Femoral (L4-5)
• Sciatic Sciatic (L6-S2)
• Cranial tibial peroneal (L6-7)
• Gastrocnemius tibial (L7-S1)
• Withdrawal Sciatic (L6-S2)

Withdrawal is not conscious!!
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Practice Makes Perfect