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CNS Examination

CNS Examination . Hadeel Khadawardi , teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al- Qura University. CNS examination consists of: High Cortical Function Cranial Nerves Motor Coordination Sensory . High Cortical Functions. Handedness Consciousness

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CNS Examination

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  1. CNS Examination HadeelKhadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University

  2. CNS examination consists of: High Cortical Function Cranial Nerves Motor Coordination Sensory

  3. High Cortical Functions Handedness Consciousness Orientation Memory Speech

  4. Handedness • Shake patient hand and ask if he or she Rt. or Lt. handed to assess for the likely dominant hemisphere. • 94% of people are Rt. handed.

  5. 2. Consciousness • Levels of consciousness • Alertness • Lethargy • Obtundation • Stupor • Coma

  6. 3. Orientation • Time • Place • Person

  7. 4. Memory • Remote (long) memory: Birthdays,… • Recent (short) memory: event of the day, …

  8. 5. Speech • Dysphasia:dominant higher center disorder in the use of symbols for communication. • Dysarthria: difficulty with articulation. • Dysphonia: altered quality of the voice. Types od dysphasia; Expressive Receptive

  9. Cranial Nerves

  10. I. Olfactory Nerve

  11. II. Optic Nerve Visual acuity: Is checked by using Snellen Chart. b) Visual field: c) Visual color: Is checked by using Ishihara Charts. d) Fundoscopy: e) Light reflex: The afferent of light reflex is by optic nerve and the efferent is by oculomotornerve.

  12. III, IV, VI. Oculomotor, trochlear & abducentNerves Inspect the eyes for ptosis, shape and size of pupils. Eye movement; ask the patient to follow your finger in H shape comment on: Failure of eye movement Diplopia Nystagmus c) Light reflex d) Accommodation

  13. V. Trigeminal Nerve Motor; (Muscle of mastication) Temporalis Masseter Pterygoids b) Sensory; Access for fine touch and pin break in the 3 divisions ( ophthalmic, maxillary, mandibular). c) Corneal reflex; The afferent of corneal reflex is by trigeminal nerve and the efferent is by facial nerve. d) Jaw reflex;

  14. VII. Facial Nerve • Inspection • Forehead wrinkles • Angle of the eye • Corner of the mouth • Loss of nasolabial fold • Dropping of saliva • Motor • Frontalis muscle • Orbicularis oculi • Buccinator muscle • Orbicularis oris • Sensory • Anterior 2/3 of the tongue. • Corneal reflex How would differentiate b/w UMNL & LMNL of VII nerve?

  15. VIII. Vestibulocochlear Nerve • Whispering • Rinnes test • Webers test • IX, X. Glossopharyngeal & Vagus Nerves • Inspection of uvula. • Difficulty of swallowing • Ask the patient to say ‘Ah’ • Gag reflex

  16. XI. Accessory Nerve Trapezius muscle Sternomastoid muscle XII. Hypoglossal Nerve Inspect the tongue Ask the patient to protrude his/her tongue

  17. Motor Motor Exposure & Inspection Tone Power Reflex

  18. Inspection • Skin (rash, scar, ulcer,…) • Muscle (wasting, fasciculation) • Deformity • Abnormal movement • Drift (For Upper Limb Only)

  19. Tone • For upper & lower limbs • Examine each joint • Start from distal to proximal • Always compare both sides What are the types of hypertonia?

  20. Power • For upper & lower limbs • Examine each joint • Always compare both sides What are the grading of power?

  21. Reflex • Patient should be comfortable and relaxed • Expose the tested muscle • Strike the tendon, not the muscle belly • Observe the muscle contraction • Reflex of upper limb: • Brachioradialis reflex (C5,C6) • Biceps reflex (C5,C6) • Triceps reflex (C7,C8) • Reflex of lower limb: • Ankle reflex (S1,S2) • Knee reflex (L3,L4) • Planter reflex (S1,S2) • Clonus: • Ankle clonus • Knee clonus What are the grading of reflex? What is reinforcement?

  22. Coordination Finger nose test Rapidly alternative movement Heel to shin test Rebound

  23. Gait How to differentiate b/w UMNL &LMNL ? • Expose both legs • Ask the patient to: • walk heel to toe • walk on toes • walk on heels • squat to stand • Romberg test What are the types of abnormal gait?

  24. Thank You

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