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Explore various components of a neurological exam, including mental status, cranial nerves, motor function, sensory assessment, reflexes, coordination, and gait. Learn about different aspects of the neuroaxis, intracranial regions, and neuromuscular functioning.
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Neurological Exam Duc Tran, M.D. August 2003
Neurological Exam • Mental Status • Cranial Nerves • Motor • Sensory • Reflexes • Coordination • Gait
Neuroaxis • Central • Brain • Spinal Cord • Peripheral • Root • Plexus • Nerve • Neuromuscular Junction • Muscle
Intracranial • Supratentorial • Frontal • Parietal • Temporal • Occipital • Infratentorial • Cerebellum • Brainstem
Supratentorial • Aphasia - dominant • Aprosodias – nondominant • Alexia • Agnosia • Apraxia • Consciousness • Memory • Motor – cortical vs. subcortical • Personality • Seizures - cortical • Sensation - parietal • Vision – occipital
Infratentorial • Diplopia • Dysarthria • Dysphagia • Decreased facial sensation/perioral numbness • Dystaxia/Ataxia • Dizziness/Vertigo • Nystagmus • Consciousness • Cross findings
Cranial Nerves • I - Olfactory. • II - Optic. Vision. Pupil reflex. • III - Eye movement. Pupil response. • IV - Eye movement. • V - Facial sensation. Mastication. • VI - Eye movement. • VII - Facial movement. • VIII - Balance/Hearing. • IX - Taste. Sensation pharyngeal muscles. • X - Sensation larynx, gut. Motor to larynx, pharynx, palate. • XI - Motor to sternocleidomastoid/trapezius. • XII - Motor to tongue.
Myelopathy • Weakness • Reflex changes • Sensory loss • B/B dysfunction • Ascending Level of Dysfunction
UMN Weakness Spastic Hyperreflexia LMN Weakness Flacid Atrophy Fasciculations Hyporeflexia EMG/NCV MotorNeuron
Root/Radiculopathy • Pain • Weakness in distribution of root • Sensory loss – may not be dense • Reflex changes – helps to localize the level • Rule of 7
Nerve • Polyneuropathy – eg. diabetes • Mononeuropathy – eg. CTS • Multiple mononeuropathies – eg. lead
Polyneuropathies • Weakness – distal>proximal • Sensory loss – distal>proximal • Reflex changes – distal>proximal • Exceptions - CIDP
Mononeuropathies • Cardinal movements of the thumb • Extension • Opposition • Adduction • Cardinal movements of the lower extremity • Hip flexion/knee extension • Hip adduction • Hip abduction/hip extension • Knee flexion/ankle dorsi-flexion/ankle plantar flexion/inversion/eversion.
NMJ • Weakness – proximal>distal • No sensory loss • No reflex changes • Fatigue
Myopathy • Weakness – proximal>distal • No sensory changes • No reflex changes • Atrophy • Myotonia • Cramping