U of U PA School Neurologic Exam

What is the standard format in order for a neurology exam? (7)

Mental status

Cranial nerves

Motor function

Reflexes

Sensory function

Coordination

Gait

What is assessed for the mental status? (9)

Level of consciousness

Orientation

Memory - long/short

Language - receptive/expressive

Knowledge

Insight

Judgment

Affect

Mood

What is assessed with a MOCA?

Orientation

Memory - long/short

Language - receptive/expressive

What can be assessed with a bedside limited exam? (5)

Orientation

-date/location/time

Basic math

Complex commands (multistep directions given at once)

Simple commands (single direction)

Draw a clock, put the time at 10 past 11

What is assessed for motor function? (4) How should that be done?

Muscle

-Bulk

-Tone

Speed

Strength

Compare side to side, isolate each muscle

How is sensory function assessed?

Proprioception/vibration - Dorsal column tract

Light touch/pin prick/temp - Spinothalamic tract

What tendon reflexes should be assessed? What is needed for a response?

Upper extremity

-Brachioradials

-Biceps (C5, C6)

-Triceps (C7)

Lower extremity

-Patellar (L4)

-Achilles (S1)

Both sensory and motor nerves required to produce a response (sensory more than motor)

In addition to standard CN testing, what reflexes should be assessed? (6)

Pupillary light reflex

Corneal reflex

Oculocephalic reflex (dolls eyes)

Oculovestibular reflex (cold water caloric)

Gag reflex

Nystagmus

What is the corneal reflex?

Patient blinks when wisp of cotton touches cornea

What is the oculocephalic reflex?

Assesses brainstem damage in comatose patient

- turn their head and the eyes should move the other way

- Positive it doesnt deviate meaning there is severe brainstem damage

What is the oculovestibular reflex?

Cold calorics: ice water is injected into the ear. The normal response is that the eyes deviate toward the ear and there is nystagmus.

No eye movement is pathological.

How should coordination be assessed?

Finger-nose-finger

Heel-knee-shin

Eye movement coordination

How should gait be assessed? (7)

Stride length

Arm swing

Turning

Gait speed

Astasia-abasia

Pull test

Romberg

What is astasia-abasia?

Inability to stand and walk, despite sparing of motor function underlying the required balance and gestures

What is the pull test?

Tug the standing patient backward at the shoulders and grades the response