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The Neurological Examination PowerPoint Presentation

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Description : Check out this medical presentation on Neurology, which is titled "The Neurological Examination", to know about Neurological Examination, Understand Afferent and Efferent Pathways for Brainstem Reflexes and Differentiate Between Upper and Lower Motor Neuron Findings.

Tags : Neurology, Neurological Examination, Afferent, Efferent Pathways, Brainstem Reflexes

Published on : Aug 23, 2021 | Views : 4980 | Downloads : 15

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Slide 1-

The Neurological Examination Objectives Organize Exam into the 6 Subsets of Function Concept of Screening Examination Understand Afferent and Efferent Pathways for Brainstem Reflexes Differentiate Between Upper and Lower Motor Neuron Findings
Slide 2-

The Neurological Examination Six Subsets of the Neuro Exam Mental Status Cranial nerves Motor Coordination Sensory Gait * Always write or present the exam in this format regardless of the order in which the information is obtained
Slide 3-

The Neurological Examination Concept of a Screening Exam Screening each of the subsets allows one to check on the entire neuroaxis (Cortex, Subcortical White Matter, Basal Ganglia/Thalamus, Brainstem, Cerebellum, Spinal Cord, Peripheral Nerves, NMJ, and Muscles) Expand evaluation of a given subset to either Answer questions generated from the History Confirm or refute expected or unexpected findings on Exam
Slide 4-

The Neurological Examination The “Complete” Neuro Exam This is never done given the amount of time and effort that it would take. The Neurological Exam is Long and Redundant Take advantage of this to confirm or refute abnormal findings
Slide 5-

The Neurological Examination Mental Status Level of Alertness Subjective view of Examiner Definition of Consciousness Terminology for Depressed Level of Consciousness Concept of Coma Delerium Degree of Orientation To what? “A and O x 4”
Slide 6-

The Neurological Examination Mental Status Concentration Serial 7’s or 3’s “WORLD” backwards Months of the Year Backwards Try to quantify degree of impairment * A and O and Concentration need to be intact for other aspects of the Mental Status Exam to have localizing value!
Slide 7-

The Neurological Examination Mental Status Memory Immediate Recall A task of concentration Short-Term Memory “3/3 objects after 5 minutes” Long-Term Memory Last thing to go
Slide 8-

The Neurological Examination Mental Status Language Aphasia vs Dysarthria Receptive Language Command Following Expressive Language Fluency Word Finding Repetition Screens for Receptive, Expressive, and Conductive Aphasias
Slide 9-

The Neurological Examination Language
Slide 10-

The Neurological Examination Mental Status Calculations, R-L confusion, finger agnosia, agraphia Gerstmann’s Syndrome (Dominant Parietal Lobe) Hemineglect Non-Dominant Parietal Lobe Delusional Thinking, Abstract Reasoning, Mood, Judgement, Fund of Knowledge, etc Important for Psychiatry Does not localize well to one region of the cortex Neurocognitive Testing required to get at more specific deficits
Slide 11-

The Neurological Examination Cranial Nerves Olfactory Nerve
Slide 12-

The Neurological Examination Cranial Nerves Olfactory Nerve Distinguish Coffee from Cinnamon Smelling Salts irritate nasal mucosa and test V2 Trigemminal Sense Disorders of Smell result from closed head injuries
Slide 13-

The Neurological Examination Cranial Nerves Optic Nerve Cranial nerve II
Slide 14-

The Neurological Examination Cranial Nerves Optic Nerve Visual Acuity Visual Fields Afferent input to Pupillary Light Reflex APD Look at the Nerve (Fundoscopic Exam) “VA equals 20/20 OU at near” “PEERLA”
Slide 15-

The Neurological Examination Cranial Nerves Trochlear Nerve c.n. IV Oculomotor Nerve Cn III Abducens Nerve Cn VI
Slide 16-

The Neurological Examination Cranial Nerves Cranial Nerves III, IV, VI Extra-Ocular Muscles Efferent limb of pupillary light reflex (III) Edinger-Westphal nucleus in tegmentum of midbrain Ptosis Oculomotor Nerve Palsy Part of Horner’s Syndrome Cardinal Directions of Gaze Efferent output for Oculocephalic Reflex Look for Nystagmus “EOMI without nystagmus”
Slide 17-

The Neurological Examination Cranial Nerves Trigeminal Nerve c.n. V
Slide 18-

The Neurological Examination Cranial Nerves Trigeminal Nerve Motor Component Opthalmic (V1), Maxillary (V2), and Mandibular (V3) Distributions All modes of Primary Sensation Modalities can be tested Afferent input for the Corneal Blink Reflex “Facial sensation intact in all distributions”
Slide 19-

The Neurological Examination Cranial Nerves Facial Nerve c.n. VII
Slide 20-

The Neurological Examination Cranial Nerves Facial Nerve Motor innervation to facial muscles UMN versus LMN Facial Weakness Efferent output to Corneal Blink Reflex Other Functions Parasympathetic input to lacrimal, sublingual, and submandibular glands, taste to anterior 2/3 of tongue, general sensation to concha of earlobe and small part of scalp, motor input to stapedius muscle “Facial motor intact”
Slide 21-

The Neurological Examination Cranial Nerves Vestibulocochlear Nerve c.n. VIII
Slide 22-

The Neurological Examination Cranial Nerves Vestibulocochlear Nerve Hearing and Balance Patients will complain of tinnitis, hearing loss, and/or vertigo Weber and Renee Test Differentiates Conductive vs Sensorineural hearing loss Afferent input to the Oculocephalic Reflex Doll’s Eye Maneuver Cold Calorics Not “COWS” “Hearing grossly intact AU”
Slide 23-

The Neurological Examination Cranial Nerves Glossopharyngeal and Vagus Nerves c.n.’s IX and X
Slide 24-

The Neurological Examination Cranial Nerves Glossopharyngeal and Vagus Nerves Afferent (IX) and Efferent (X) components for the Gag Reflex Vagus Nerve also does all parasympathetics from the neck down until the mid-transverse colon
Slide 25-

The Neurological Examination Cranial Nerves Spinal Accessory Nerve c.n. XI Trapezius strength Sternocleido- Mastoid strength
Slide 26-

The Neurological Examination Cranial Nerves Hypoglossal Nerve c.n. XII
Slide 27-

The Neurological Examination Cranial Nerves Hypoglossal Nerve Protrudes the tongue to the opposite side Tongue in cheek (strength) Hemi-atrophy and fasiculations (LMN)
Slide 28-

The Neurological Examination Motor Examination Strength Tone DTR’s Plantar Responses Involuntary Movements
Slide 29-

The Neurological Examination Motor Examination Strength
Slide 30-

The Neurological Examination Motor Examination Strength Medical Research Council Scale 5/5 = Full Strength 4/5 = Weakness with Resistance 3/5 = Can Overcome Gravity Only 2/5 = Can Move Limb without Gravity 1/5 = Can Activate Muscle without Moving Limb 0/5 = Cannot Activate Muscle
Slide 31-

The Neurological Examination Motor Examination Weakness Describe the Distribution of Weakness Upper Motor Neuron Pattern Peripheral neuropathy Pattern Myopathic Pattern
Slide 32-

The Neurological Examination Motor Examination
Slide 33-

The Neurological Examination Motor Examination Tone Tone is the resistance appreciated when moving a limb passively “Normal Tone” Hypotonia “Central Hypotonia” “Peripheral Hypotonia” Increased Tone Spasticity (Corticospinal Tract) Rigidity (Basal Ganglia, Parkinson’s Disease) Dystonia (Basal Ganglia)
Slide 34-

The Neurological Examination Motor Examination DTR’s 0/4 = Absent 1-2/4 = Normal Range 3/4 = Pathologically Brisk 4/4 = Clonus
Slide 35-

The Neurological Examination Motor Examination 2 2+ 2 3 4 4
Slide 36-

The Neurological Examination Motor Examination Involuntary Movements Hyperkinetic Movements Chorea Athetosis Tics Myoclonus Bradykinetic Movements Parkinsonism (Bradykinesia, Rigidity, Postural Instability, Resting Tremor) Dystonia
Slide 37-

The Neurological Examination Sensory Examination Primary Sensory Modalities Light Touch (Multiple Pathways) Pain/Temperature Sensation (Spinothalamic Tract) Vibration/Position Sensation (Posterior Columns) Cortical Sensory Modalities Stereognosis Graphesthesia Two-Point Discrimination Double Simultaneous Extinction
Slide 38-

The Neurological Examination Sensory Examination Primary Sensory Modalities Reflect Input from sensory receptors, sensory nerves, spinal cord, brainstem, through to the level of the Thalamus. Cortical Sensory Modalities Reflect Processing by the Somatosensory Cortex (post-central gyrus)
Slide 39-

The Neurological Examination Sensory Examination Pain and Temperature A-δ and small-unmyelinated fibres provide pain and temperature input which travels through the dorsal roots, then up and down a few segments in Lissauer’s tract then synapse with neurons in Lamina II (Substantia Gelatinosa) Second-order neurons cross midline at the anterior commissure and travel up the lateral spinothalamic tract to synapse on VPL nucleus of Thalamus
Slide 40-

The Neurological Examination Sensory Examination Joint Position and Vibration Larger myelinated A-α and A-β fibres bring sensory information concerning vibration and joint position sense up through the Fasiculus Gracilis (legs) and Fasiculus Cuneatus (arms) to synapse on the ipsilateral Nucleus Gracilis and Cuneatus respectively. Second-order neurons cross at the medial lemniscus to synapse on VPL nucleus of the Thalamus
Slide 41-

The Neurological Examination Sensory Examination
Slide 42-

The Neurological Examination Sensory Examination Pain and Temperature Pinprick (One pin per patient!) Sensation of Cold Look for Sensory Nerve or Dermatomal Distribution Vibration Sensation C-128 Hz Tuning Fork (check great toe) Joint Position Sensation Check great toe Romberg Sign
Slide 43-

The Neurological Examination Sensory Examination Higher Cortical Sensory Function Graphesthesia Stereognosis Two-Point Discrimination Double Simultaneous Extinction Gerstmann’s Syndrome (acalculia, right-left confusion, finger agnosia, agraphia) Usually seen in Dominant Parietal Lobe lesions
Slide 44-

The Neurological Examination Coordination Cerebellum Inputs Outputs
Slide 45-

The Neurological Examination Coordination Hemisphere Dysfunction Dysmetria on Finger-Nose-Finger Testing* Irregularly-Irregular Tapping Rhythm* Dysdiadochokinesis* Impaired Check* Hypotonia* Impaired Heel-Knee-Shin* Falls to Side of Lesion* Nystagmus (Variable Directions) * All Deficits are Ipsilateral to the side of the lesion
Slide 46-

The Neurological Examination Coordination Midline Dysfunction Truncal Ataxia Titubation Ataxic Speech Gait Ataxia Acute Ataxia (unsteady Gait) Chronic Ataxia (wide-based, steady Gait)
Slide 47-

The Neurological Examination Gait A normal Gait requires multiple levels of the neuroaxis to be intact Vision Strength Balance/Coordination Joint Position
Slide 48-

The Neurological Examination Gait Observe Different Aspects of Gait Arm Swing Base of Gait Heel Strike Time Spent on Each Leg Posture of Trunk Toe Walking Heel Walking Tandem Walking
Slide 49-

The Neurological Examination Gait Classical Patterns of Abnormal Gait Parkinsonism Gait Hemiparetic Gait Spastic Diplegia Gait Acute Ataxia Gait Chronic Ataxia Gait Waddling Gait (Hip Girdle Weakness) High Stepping Gait
Slide 50-

The Neurological Examination Questions?