Neurologic Examination

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 Neurologic Examination Mental Status

Cranial Nerves Motor Reflexes Sensory Coordination and Gait Special Tests Aphasia Fluency Comprehension Repetition Motor -

+ - Sensory + - -

Conductive + + - Global -

- - Cranial Nerves I Olfactory Not Normally Tested Suspected mass c/o smell II - Optic

Optic Fundi Visual Acuity Visual Fields Pupillary test Light accomodation III Oculomotor, IV Trochlear, VI - Abducens Observe for Ptosis Test Extraocular Movements

V - Trigeminal Sensation Mastication Corneal reflex Jaw gerk 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 VIII - Acoustic Screen Hearing Lateralization (Weber( Compare Air and Bone Conduction (Rinne) Vestibular Function Not Normally Tested 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 XII - Hypoglossal Observe the tongue as it lies in the mouth

Ask patient to: Protrude tongue Move tongue from side to side Motor Observation Involuntary Movements Muscle Symmetry Atrophy Muscle Tone Decreased (flaccid) or increased

(rigid/spastic) tone Muscle Strength Grade Description 0/5 No muscle movement 1/5

Visible muscle movement, but no movement at the joint 2/5 Movement at the joint, but not against gravity 3/5 Movement against gravity, but not against added resistance

4/5 Movement against resistance, but less than normal 5/5 Normal strength Reflexes Deep Tendon Reflexes

Tendon Reflex Grading Scale Grade Description 0 Absent 1+ or + Hypoactive

2+ or ++ "Normal" 3+ or +++ Hyperactive without clonus (spread) 4+ or ++++ Hyperactive with clonus Deep Tendon Reflexes

Biceps (C5, C6) Brachioradialis (C5, C6) Triceps (C6, C7) Knee (L2, L3, L4( Ankle (S1, S2) Plantar Response (Babinski) Sensory Pain & Temp Vibration & position

Light Touch Cortical sensory Graphesthesia Stereognosis Two Point Discrimination Coordination Rapid Alternating Movements Point-to-Point Movements F-N-F H-K-S

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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