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Neurologic Examination

Neurologic Examination. Kefah Al-Hayek, MD Assistant Prof. of Neurology J.U.S.T ABPN, ABCNP, ABEM, ABNM. Equipment Needed. Reflex Hammer 128 and 512 (or 1024) Hz Tuning Forks A Snellen Eye Chart or Pocket Vision Card Pen Light or Otoscope Wooden Handled Cotton Swabs Paper Clips.

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Neurologic Examination

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  1. Neurologic Examination Kefah Al-Hayek, MD Assistant Prof. of Neurology J.U.S.T ABPN, ABCNP, ABEM, ABNM

  2. Equipment Needed • Reflex Hammer • 128 and 512 (or 1024) Hz Tuning Forks • A Snellen Eye Chart or Pocket Vision Card • Pen Light or Otoscope • Wooden Handled Cotton Swabs • Paper Clips

  3. Neurologic Examination • Mental Status • Cranial Nerves • Motor • Reflexes • Sensory • Coordination and Gait • Special Tests

  4. Aphasia

  5. Cranial Nerves • I – Olfactory • Not Normally Tested • Suspected mass • c/o smell

  6. II - Optic • Optic Fundi • Visual Acuity • Visual Fields • Pupillary test • Light • accomodation

  7. III – Oculomotor, IV – Trochlear, VI - Abducens • Observe for Ptosis • Test Extraocular Movements

  8. V - Trigeminal Sensation Mastication Corneal reflex Jaw gerk

  9. VII - Facial • Observe for Any Facial Droop or Asymmetry • Ask Patient to do the following, note any lag, weakness, or assymetry: • Raise eyebrows [8] • Close both eyes to resistance • Smile • Frown • Show teeth • Puff out cheeks • UMN Vs LMN

  10. VIII - Acoustic • Screen Hearing • Lateralization (Weber( • Compare Air and Bone Conduction (Rinne) • Vestibular Function • Not Normally Tested

  11. IX – Glossopharyngeal • Afferent pathway for the gag reflex • X – Vagus • Efferent pathway for the gag reflex • Ask Patient to Swallow • Ask Patient to Say "Ah" • XI – Accessory • Shrug shoulders against resistance • Turn head against resistance

  12. XII - Hypoglossal • Observe the tongue as it lies in the mouth • Ask patient to: • Protrude tongue • Move tongue from side to side

  13. Motor • Observation • Involuntary Movements • Muscle Symmetry • Atrophy • Muscle Tone • Decreased (flaccid) or increased (rigid/spastic) tone

  14. Muscle Strength

  15. Reflexes • Deep Tendon Reflexes

  16. Deep Tendon Reflexes • Biceps (C5, C6) • Brachioradialis (C5, C6) • Triceps (C6, C7) • Knee (L2, L3, L4( • Ankle (S1, S2)

  17. Plantar Response (Babinski)

  18. Sensory • Pain & Temp • Vibration & position • Light Touch • Cortical sensory • Graphesthesia • Stereognosis • Two Point Discrimination

  19. Coordination • Rapid Alternating Movements • Point-to-Point Movements • F-N-F • H-K-S

  20. Romberg • Sensory ataxia • Gait • Walk across the room, turn and come back • Walk heel-to-toe in a straight line • Walk on their toes in a straight line • Walk on their heels in a straight line

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