The neurologicexamination

The Neurologic Examination Steven A. Glyman MD July 8, 2008 July 8, 2008 July 8, 2008

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A proper neurologic examination begins with a careful clinical history.

http://www.cbu.edu/~mcondren/IRM/Stop-Look-Listen-sign-IRM-7-7-07.jpg

You must do a minimum basic examination on every patient but you don’t need to do every test

A mechanic does not need to use every tool on every project

The history guides the neurologic examination

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The Neurologic Exam often can be completed during the clinical history ,[object Object],[object Object],[object Object],The Technique of the Neurologic Examination by William DeMyer Fifth Edition 2004 McGraw Hill Publisher

The history and preliminary observations focus attention on specific symptoms, motor or sensory systems, cranial nerves,or cerebral functions. If the history suggests a spinal lesion, then carefully test each dermatome for a sensory level. If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia The Technique of the Neurologic Examination by William DeMyer Fifth Edition 2004 McGraw Hill Publisher

The Technique of the Neurologic Examination by William DeMyer McGraw Hill 2004

http://www.ptup.org/files/2007-SJ-Monterey-Tour/TheWholeEnchilada.jpg

The Neurologic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mental Status Exam ,[object Object],[object Object]

Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /

Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

http://www.mrc-cbu.cam.ac.uk/research/rehabilitation/research.html

Mental Status Exam ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve1 Olfaction Olfaction ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

http://commons.wikimedia.org/wiki/Image:Head_olfactory_nerve.jpg http://www.braininjury.com/images/cranialnerveinjury.jpg

Cranial Nerve 2 Optic Nerve Optic Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

http://www.merck.com/media/mmhe2/figures/MMHE_20_235_01_eps.gif http://arapaho.nsuok.edu/~fulk/Images/Img0013.JPG

Cranial Nerve 2 and 3 Pupillary responses Pupillary responses ,[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

Pupillary Size is determined by the light input, sympathetic and parasympathetic tone Text http://www.psych.ndsu.nodak.edu/mccourt/Psy460/Central%20visual%20pathways/pupillary%20light%20reflex.gif http://www.abdn.ac.uk/~opt065/Web%20pages%20only/drh-g085.gif

Cranial Nerve 3,4,6 Extraocular Movements Extraocular Movements ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve 5 Facial Sensation and Muscles of Mastication Facial Sensation and Muscles of Mastication ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

http://www.healthatoz.com/healthatoz/Atoz/images/ency/00044039.jpg http://www.dalcross.com/staging/_images/trigeminal.JPG

Cranial Nerve 7 Muscles of Facial Expression and Taste Muscles of Facial Expression and Taste ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve 8 Hearing and Balance Hearing and Balance ,[object Object],[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve 9 and 10 Palatal Elevation and Gag Reflex Palatal Elevation and Gag Reflex ,[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerves 5,7,9,10,12 Muscles of Articulation Muscles of Articulation ,[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve11 Sternocleidomastoid and Trapezius Muscles Sternocleidomastoid and Trapezius Muscles ,[object Object],[object Object],http://www.neuroexam.com /

Cranial Nerve12 ,[object Object],[object Object],http://www.neuroexam.com /

Motor Examination ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

Motor Examination ,[object Object],[object Object],http://www.neuroexam.com /

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MRC Scale Aids to the Examination of the Peripheral Nervous System Fourth Edition WB Saunders

Note the parkinsonian stare,masked facies,flexed posture,hypokinesia typical of extrapyramidal disorders http://www.ananova.com/news/story/sm_1417224.html

Muscle Stretch Reflexes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reflex Arcs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Plantar Response ,[object Object],http://www.neuroexam.com /

http://commons.wikimedia.org/wiki/Image:Babinski's_sign01.jpg

Coordination ,[object Object],[object Object],http://www.neuroexam.com /

Romberg test ,[object Object],http://www.neuroexam.com /

Gait ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

Primary Sensation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cortical sensation ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /

The neurologicexamination

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The neurologicexamination