neurological examination

What is the primary purpose of performing a neurological examination?

To diagnose neurological conditions by assessing mental status, cranial nerves, motor/sensory function, coordination, and gait. Summary 1

What comparisons are important when evaluating findings during a neurological examination?

Findings should always be compared with the contralateral side, and upper limb function compared with lower limb function. Summary 2

What is a key component of any neurological examination involving patient history and observation?

The mental status examination. Mental status examination 3

Name three assessment points included in a comprehensive mental status examination.

Appearance and behavior, Sensorium and cognition, Mood and affect, Speech, Thought process/content, Perceptual disturbances, Insight/judgment. (Any 3) Mental status examination 4

What is the focus of a mental status exam in emergency settings?

Assessment of orientation and level of consciousness using standardized scales (e.g., Glasgow coma scale). Mental status examination 5

What is Aphasia?

The inability to either form or understand language not attributed to motor ability, caused by dominant hemisphere damage (usually left). Types of aphasia 6

Which type of aphasia is characterized by nonfluent, telegraphic speech with largely spared comprehension?

Broca aphasia (motor or expressive aphasia). Types of aphasia 7

Where is the typical lesion location in Broca aphasia?

Broca area (inferior frontal gyrus). Types of aphasia 8

Which type of aphasia is characterized by fluent speech lacking sense ("word salad") and impaired comprehension?

Wernicke aphasia (sensory or receptive aphasia). Types of aphasia 9

Where is the typical lesion location in Wernicke aphasia?

Wernicke area (superior temporal gyrus). Types of aphasia 10

How is Global aphasia characterized?

Severe impairment of both speech production and comprehension, often nonfluent, caused by damage to Broca/Wernicke areas and arcuate fasciculus. Types of aphasia 11

Which type of aphasia involves impaired repetition with paraphasia despite fluent speech and mostly intact comprehension?

Conduction aphasia (associative aphasia). Types of aphasia 12

Where is the typical lesion location in Conduction aphasia?

Arcuate fasciculus of the parietal lobe. Types of aphasia 13

Which type of aphasia is characterized by fluent speech with isolated difficulty finding words (anomia)?

Anomic aphasia. Types of aphasia 14

How does Transcortical Motor aphasia differ from Broca aphasia regarding repetition?

Transcortical Motor aphasia has intact repetition and comprehension, unlike Broca aphasia which has impaired repetition. Types of aphasia / Diff 15

How does Transcortical Sensory aphasia differ from Wernicke aphasia regarding repetition?

Transcortical Sensory aphasia has intact repetition, unlike Wernicke aphasia which has impaired repetition. Types of aphasia / Diff 16

What is the purpose of the cranial nerve examination?

To identify problems with the cranial nerves by physical examination. Cranial nerve exam 17

What function is tested when examining the Olfactory nerve (CN I)?

Olfaction (ability to detect and identify aroma). Cranial nerve exam 18

Name three functions tested when examining the Optic nerve (CN II).

Visual acuity, color vision, visual field, papilla (optic disc) appearance, and pupillary light reflex (afferent limb). (Any 3) Cranial nerve exam 19

What test is used to examine visual acuity?

Snellen chart. Cranial nerve exam 20

What test is used to examine color vision?

Ishihara plates. Cranial nerve exam 21

What method is commonly used to assess visual fields?

Confrontation (comparing patient's fields to examiner's) or perimetry. Cranial nerve exam 22

What examination method is used to view the optic disc (papilla) and retina?

Fundoscopic examination using an ophthalmoscope. Cranial nerve exam 23

What nerve serves as the efferent limb for the pupillary light reflex?

Oculomotor nerve (CN III). Cranial nerve reflexes 24

Name the cranial nerves tested when examining eye movement (saccades, pursuits).

Oculomotor (III), Trochlear (IV), and Abducens (VI). Cranial nerve exam 25

What Trigeminal nerve (CN V) division is involved in facial sensation testing?

V1 (ophthalmic), V2 (maxillary), and V3 (mandibular) divisions. Cranial nerve exam 26

Which muscles are tested when examining the motor function of the Trigeminal nerve (CN V)?

Muscles of mastication (e.g., masseter). Cranial nerve exam 27

Name three motor functions tested when examining the Facial nerve (CN VII).

Forehead wrinkling, closing eyes tightly, nose wrinkling, inflating cheeks, smiling. (Any 3) Cranial nerve exam 28

Which cranial nerve mediates the sense of taste from the anterior 2/3 of the tongue?

Facial nerve (CN VII). Cranial nerve exam 29

Which cranial nerve mediates hearing?

Vestibulocochlear nerve (CN VIII). Cranial nerve exam 30

What two tests are used with a tuning fork to differentiate sensorineural from conductive hearing loss?

Weber test and Rinne test. Cranial nerve exam 31

Which cranial nerves are involved in palatal movement and the gag reflex?

Glossopharyngeal nerve (CN IX) and Vagus nerve (CN X). Cranial nerve exam / Ref 32

Which muscle motor functions are tested when examining the Accessory nerve (CN XI)?

Trapezius muscle (shoulder elevation) and sternocleidomastoid muscle (head rotation). Cranial nerve exam 33

Which cranial nerve mediates motor function of the tongue muscles?

Hypoglossal nerve (CN XII). Cranial nerve exam 34

What cranial nerve is the afferent limb for the corneal reflex?

Trigeminal nerve (CN V1). Cranial nerve reflexes 35

What cranial nerve is the efferent limb for the corneal reflex, causing eye closure?

Facial nerve (CN VII). Cranial nerve reflexes 36

What reflex tests the integrity of CNs IX afferent and X efferent?

Gag reflex. Cranial nerve reflexes 37

What are the fundamental elements examined to differentiate central and peripheral motor lesions?

Muscle appearance, muscle strength (power), tone, and reflexes. Motor function 38

Which type of muscle atrophy is typically seen in lower motor neuron (LMN) lesions but absent in upper motor neuron (UMN) lesions?

Muscle atrophy. Motor function / Diff 39

What abnormal muscle movement, the involuntary contraction of muscle fascicles, can signify an LMN lesion?

Fasciculation. Motor function / Appear 40

Which type of paresis is characterized by spasticity (increased tone, hyperreflexia) and weakness?

Central paresis (UMN lesion). Motor function / Diff 41

Which type of paresis is characterized by hypotonia (decreased tone), hyporeflexia/areflexia, and weakness?

Peripheral paresis (flaccid paresis) (LMN lesion). Motor function / Diff 42

How does bladder function typically present in UMN lesions?

Detrusor hyperreflexia and detrusor/external urethral sphincter dyssynergia. Motor function / Diff 43

How does the Babinski sign typically present in UMN lesions?

Upgoing (big toe points upward while others fan out). Motor function / Diff 44

How does the Babinski sign typically present in LMN lesions?

Downgoing (toes neutral or point downward). Motor function / Diff 45

What type of muscle tone is characterized by increased, velocity-dependent resistance (clasp-knife phenomenon)?

Spasticity, characteristic of pyramidal tract (UMN) lesions. Motor function / Tone 46

What type of muscle tone is characterized by increased, velocity-independent resistance (lead-pipe, cogwheel)?

Rigidity, suggests abnormalities of the extrapyramidal system. Motor function / Tone 47

What type of muscle tone is characterized by decreased tone?

Hypotonia, can occur in PNS, LMN, or cerebellar lesions. Motor function / Tone 48

What abnormal muscle movement is an abrupt loss of muscle tone during sustained contraction ("negative myoclonus"), tested by asking the patient to hold arms extended?

Asterixis, often caused by hepatic encephalopathy. Abnormal movements 49

What abnormal movement is a subjective feeling of restlessness manifesting as the inability to stay still?

Akathisia, often caused by medications like dopamine antagonists. Abnormal movements 50

What abnormal movements are continuous, irregular, writhing movements of the extremities and trunk?

Chorea, often associated with lesions of the striatum, Huntington disease, or Sydenham chorea. Abnormal movements 51

What abnormal movement is a sustained contraction of a muscle group leading to abnormal posturing?

Dystonia. Abnormal movements 52

What type of tremor occurs when muscles are relaxed and often appears as "pill-rolling"?

Rest tremor, characteristic of Parkinson disease. Abnormal movements 53

What type of tremor occurs as the patient reaches a target during a voluntary movement?

Intention tremor, suggesting lesions or structural abnormalities affecting cerebellar hemispheres. Abnormal movements 54

What type of tremor occurs when maintaining a posture against gravity (e.g., holding hands outstretched)?

Postural tremor (e.g., essential tremor). Abnormal movements 55

What abnormal movements are recurrent sudden, involuntary, nonrhythmic motor or vocalizations?

Tics, characteristic of tic disorders (e.g., Tourette syndrome). Abnormal movements 56

How is muscle power graded?

On a scale from 0 (no contraction/complete paralysis) to 5 (normal power/full resistance). Motor function / Power 57

What special test for subtle paresis involves holding arms horizontally palms up with eyes closed?

Pronator drift test. Lowering or pronation of one arm indicates paresis. Motor function / Power 58

What special test for subtle paresis involves lying supine, raising legs to 90° hip/knee with eyes closed?

Mingazzini test. Lowering of one leg indicates subtle paresis. Motor function / Power 59

What does an increased Deep Tendon Reflex (DTR) indicate?

An upper motor neuron (UMN) issue. Reflexes / DTR 60

What does a decreased Deep Tendon Reflex (DTR) indicate?

A lower motor neuron (LMN), neuromuscular junction, or muscle issue. Reflexes / DTR 61

What maneuver can be used to elicit a DTR that is initially absent or reduced?

Reinforcing maneuvers (e.g., Jendrassik maneuver). Reflexes / DTR 62

Which nerve root is associated with the Ankle (Achilles) reflex?

S1-S2. Reflexes / DTR 63

Which nerve root is associated with the Knee (Patellar) reflex?

L2-L4. Reflexes / DTR 64

Which nerve roots are associated with the Biceps and Brachioradialis reflexes?

C5-C6. Reflexes / DTR 65

Which nerve roots are associated with the Triceps reflex?

C7-C8. Reflexes / DTR 66

What type of reflexes are elicited by skin stimulation and are polysynaptic?

Superficial reflexes. Superficial reflexes 67

Which superficial reflex, tested by stroking the abdomen, indicates nerve root damage (T6-T12) if absent?

Abdominal reflex. Superficial reflexes 68

What are Primitive reflexes?

Reflexes that are normal in newborns and infants but not in adults. Primitive reflexes 69

What does the presence of primitive reflexes in adults indicate?

Diffuse brain injury due to a lack of common inhibiting factors. Primitive reflexes 70

What does the Babinski sign indicate when present in adults?

Damage to the pyramidal tract (corticospinal tract sign). Corticospinal signs 71

Until what age is an upgoing Babinski sign considered a normal physiological response?

Up to the age of 2 years. Corticospinal signs 72

How is muscle tone defined?

Resistance of an individual muscle (or group) to passive stretching. Tone 73

What abnormal sensation is described as tingling or prickling ("pins and needles")?

Paresthesia. Sensory function 74

What abnormal sensation is an unpleasant feeling like itching or burning?

Dysesthesia. Sensory function 75

What is Allodynia, a subtype of dysesthesia?

A painful sensation triggered by a stimulus that is not ordinarily considered painful. Sensory function 76

What abnormal sensation is an exaggerated perception of sensory stimuli?

Hyperesthesia. Sensory function 77

What does the absence of vibration sense (pallhypesthesia) suggest?

Peripheral neuropathy or myelopathy. Sensory function 78

Which sensory pathway mediates light touch and proprioception?

Dorsal columns. Sensory function 79

Which sensory pathway mediates pain and temperature sensation?

Spinothalamic tract. Sensory function 80

What part of the brain are lesions most commonly found in when a patient presents with limb ataxia?

Cerebellar hemispheres. Coordination 81

What finding on the finger-to-nose or finger-to-finger test is called Dysmetria?

Inability to touch the target (tip of nose or examiner's finger). Coordination 82

If dysmetria improves when the patient performs the finger-to-nose test with eyes open, what does that indicate?

Visual compensation of dysmetria, characteristic of sensory impairment (e.g., proprioception loss). Coordination 83

What finding on the finger-to-nose test suggests an intention tremor?

The fingers will begin to shake just as they reach their nose. Coordination 84

What finding on the Heel-knee-shin test indicates limb ataxia (dysmetria)?

The heel will deviate to alternate sides while sliding down the shin. Coordination 85

What finding on the Rapid Alternating Movement test is called Dysdiadochokinesia?

Inability to perform rapidly alternating movements (agonistic-antagonistic) in a rapid, coordinated manner. Coordination 86

What gait abnormality is characterized by loss of arm swing, circumduction of the affected leg, and flexion/adduction of the arm?

Hemiplegic gait, often associated with stroke. Abnormal gait patterns 87

What gait abnormality involves dropping of the pelvis (Trendelenburg sign) or a waddling pattern?

Myopathic gait, caused by weakness of pelvic girdle muscles (e.g., myopathies). Abnormal gait patterns 88

What gait abnormality involves lifting the leg high (steppage gait) due to foot drop?

Neuropathic gait, caused by weakness of foot dorsiflexion (e.g., peroneal nerve palsy, peripheral neuropathies). Abnormal gait patterns 89

What gait abnormality is unsteady, wide-based, irregular, and uncoordinated?

Cerebellar ataxic gait, associated with cerebellar diseases or acute alcohol intoxication. Abnormal gait patterns 90

What gait abnormality is stooped, stomping, and exacerbated when the patient cannot see their feet?

Sensory ataxic gait, associated with dorsal column disorders or peripheral neuropathies, and a positive Romberg test. Abnormal gait patterns 91

What gait abnormality is characterized by small, slow, shuffling steps, sometimes accelerating, with forward leaning?

Parkinsonian gait, associated with Parkinson disease or Parkinsonism. Abnormal gait patterns 92

What gait abnormality involves an inability to lift the foot ("magnetic gait"), shuffling, and poor balance?

Gait apraxia, associated with bilateral frontal lobe disorders or cerebrovascular disease. Abnormal gait patterns 93

What gait abnormality is associated with irregular, jerky, involuntary movements in the limbs while walking?

Choreiform gait, associated with Huntington disease or Sydenham chorea. Abnormal gait patterns 94

What is the definition of Meningism?

The triad of nuchal rigidity (stiff neck), headache, and photophobia. Meningism 95

What examination maneuver for Meningism involves pain on extending the knee when the hip is flexed at 90°?

Kernig sign. Meningism 96

What examination maneuver for Meningism involves passive neck flexion provoking involuntary leg lifting?

Brudzinski sign. Meningism 97

What causes the signs of Meningism?

Inflammatory (bacterial/viral meningitis) or noninflammatory (e.g., subarachnoid hemorrhage) causes. Meningism 98

What do signs of nerve root irritation indicate?

An inflammatory and/or irritative process where the spinal nerves exit the vertebral column (suggesting spinal root compression). Signs of nerve root irrit 99

What test for nerve root irritation involves lifting an extended leg (<45°) causing pain along the lumbar roots?

Straight leg raise test (root L5-S1). Signs of nerve root irrit 100