1 / 37

CNS Examination

CNS Examination. Done by Dr/ Abdullah Mohd. Jan MBBS,Intern. Aspects of Examination. General Ex The Cranial nerves The upper limbs ( Motor + Sensory + coordenation ) The lower limbs ( Motor + Sensory + coordenation) The skull and spine for local disease

loyal
Download Presentation

CNS Examination

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CNS Examination Done by Dr/ Abdullah Mohd. Jan MBBS,Intern

  2. Aspects of Examination • General Ex • The Cranial nerves • The upper limbs ( Motor + Sensory + coordenation ) • The lower limbs ( Motor + Sensory + coordenation) • The skull and spine for local disease • The carotid arteries for bruits

  3. General Examination • Assessment of the higher centers • Speech • Neck stiffness • Abnormal movements

  4. General Examination • Assessment of the higher centers • Consciousness • Orientation ( Person , Place , Time ). • Memory • Handedness • Speech • Flow of speech • Comprehension • Repetition

  5. Neck stiffness looking for meningism ( meningitis ,SAH)

  6. Cranial Nerves Examination • you have to know how to examine all cranial nerves in detail but we will focus on the most important ones ( 3rd , 4th , 5th , 6th , 7th , 11th & 12th ) .

  7. Where CN Come From? • 3rd & 4th cranial nerves are located in the mid brain • 5th , 6th , 7th & 8th cranial nerves are located in the pons • 9th , 10th , 11th & 12th cranial nerves are located in the medulla oblongata

  8. CN III, IV, VI: Oculomotor, Trochlear, Abducent • Inspection of pupil • Light reflex • Eye Movement & nystagmus • Convergence & accomodation

  9. Look at pupils: shape, relative size, • Ptosis. • Shine light in from the side to look for pupil's light reaction.• Assess both direct and consensual responses.• Assess afferent pupillary defect by moving light in arc from pupil to pupil. 

  10. The pupils

  11. CN V: Trigeminal • Motor • Sensory • Reflex

  12. Motor:pt opens mouth, clenches teeth )pterygoids).• Palpate temporal, masseter muscles as they clench. • Jaw jerk: • Dr's finger on tip of jaw. • Grip patellar hammer halfway up shaft and tap Dr's finger lightly.

  13. Sensory Facial sensation by cotton on forehead, cheek & jaw.

  14. Corneal reflex: patient looks up and away.• Touch cotton wool to other side.• Look for blink in both eyes, ask if can sense it.• Repeat other side [ tests V sensory, VII motor].

  15. CN VII: Facial • Motor • Taste sensation

  16. CN VII: Facial • Inspectfor facial droop or asymmetry. • Facial expression muscles:pt looks up and wrinkles forehead.• looking for wrinkling loss. • Pt shuts eyes tightly: compare each side.

  17. Pt smile: compare nasolabial grooves. • Pt show teeth, puff out cheeks. • Taste sensation in the anterior 2/3 of the tongue.

  18. CN XI: Accessory • InspectionFrom behind, examine for trapezius atrophy, asymmetry. • Pt. shrugs shoulders (trapezius). • Pt. turns head against resistance: watch, palpate SCM on opposite side.

  19. CN XII: Hypoglossal • Inspect tongue in mouth for wasting, fasciculations. • Protrude tongue: unilateral deviates to affected side.

  20. Motor system don’t forget to compare both limbs • Inspection • Palpation ( muscle bulk + tenderness ) • Muscle tone • Muscle power • Reflexes

  21. Motor system • Upper limbs (compare) • Inspect for muscle wasting ( proximal & Distal ) – scars – deformity – fasciculation – skin pigmentation. • Drift test

  22. Feel the muscle bulk ( proximally & Distally ) – muscle tenderness. • Tone ( normo – hypo – hypertonia ) by passive movement of wrist and elbow joints.

  23. Power ( 0 – 5 ) by active movement at the shoulder , elbow , wrists and fingers.

  24. Reflexes ( 0 - ++++ ) Biceps ( C5,C6 ) – Triceps ( C7,C8 ) – Brachioradialis ( C5,C6 )

  25. Coordination Finger to nose test Finger to finger test Dysdiadochokinesis Rebound test

  26. Lower limbs • Inspect the gait of the patient • Expose both thighs and legs. • Inspect for muscle wasting – scars – deformity – posture -fasciculation – skin pigmentation .

  27. Feel the muscle bulk and muscles for tenderness. • Tone ( normo – hypo – hypertonia ) by passive movement of the knee and ankle joints

  28. Clonus more than 3 ankle and knee clonus • Power ( 0 – 5 ) by active movement at the hip , knee , ankle , and tarsal joints

  29. Reflexes ( 0 - ++++ ) Knee jerk ( L3,L4 ) – Ankle jerk (S1,S2 ) – Plantar reflex ( L5, S1 , S2 ) • Coordination Heal to shin test Toe finger test Foot Tapping test

  30. Sensory system • Spinothalamic pathway Pain and Temperature ( usually temperature is not tested ) • Posterior column pathway Vibration and Proprioception Romberg Sign • Light touch with cotton wool

  31. Back • Inspect for deformity – scars – neurofibromas . • Palpate for tenderness over the vertebral bodies • Do the straight leg raising test

  32. Auscultation • Auscultate over the carotid arteries looking for bruits.

  33. Thank You

More Related