31. General diagnostics of the spinal cord diseases. Spinal reflexes. Imagine diagnostics. Radiology, CT and MRI

What is the aim of a physical examination in neurological cases?

To rule out other disorders that mimic neurological symptoms

What does a complete neurological examination follow?

Physical examination

What is the purpose of a neurological examination?

To confirm a neurological condition and localise the lesion

What is mentation?

Observation of the patient's behaviour and consciousness

What do alterations in mentation indicate?

Intracranial disease

What are the different mentation states?

Normal, excitement, depression (apathy, stupor), coma

What are some abnormal postures?

Kyphosis, lordosis, scoliosis, torticollis, opisthotonus, wide-based stance, Schiff-Sherrington posture

What does kyphosis indicate?

Dorsal curvature of the spine

What does lordosis indicate?

Ventral curvature of the spine

What does scoliosis indicate?

Lateral deviation of the spine

What does torticollis indicate?

Head tilt, vestibular system or brainstem lesion

What does opisthotonus indicate?

Dorsoflexion of the head and neck

What does a wide-based stance indicate?

Vestibular or cerebellar lesion

What does Schiff-Sherrington posture indicate?

Increased forelimb tone, hindlimb paralysis, T3-L3 lesion

What is the purpose of examining cranial nerves?

To detect abnormalities in cranial nerve function and localise lesions

What are some cranial nerve tests?

Ability to see/smell, pupillary light reflex, menace response, dazzle reflex, palpebral reflex, corneal reflex, swallowing reflex

What is nystagmus?

Jerking movements of the eyeball

What do postural reactions test?

Proprioceptive and motor systems

What do abnormalities in postural reactions indicate?

Lesion in peripheral or central nervous system

What is an early indicator of spinal cord compression?

Abnormal conscious proprioception

What are some postural reaction tests?

Knuckling correction, placing response (tactile and visual), hopping reaction, hemi-walking, wheelbarrowing

What is dysmetria?

Inaccurate movement

What is the procedure for testing spinal reflexes?

Lateral recumbency, relaxation

What are some spinal reflexes tested?

Biceps, triceps, patellar, gastrocnemius, withdrawal, perineal, panniculus

Which nerve is involved in the biceps reflex?

Musculocutaneous

Which nerve is involved in the triceps reflex?

Radial

Which nerve is involved in the patellar reflex?

Femoral

Which nerves are involved in the withdrawal reflex?

C6-T2, L4-S1, L5-L6, S1-S2

Which nerve is involved in the perineal reflex?

Perineal nerve

Which nerves are involved in the panniculus reflex?

Lateral thoracic nerves

What does palpation detect in a neurological exam?

Swelling, atrophy, pain

What is nociception?

Perception of pain

What does loss of deep pain perception indicate?

Poor prognosis

How is superficial pain tested?

Cutaneous stimulation

How is deep pain tested?

Periosteal pressure (haemostats/fingernails)

What imaging techniques are used in neurological diagnosis?

Radiography, CT scan, MRI, myelography

What does radiography detect in spinal injuries?

Fractures, osteophytes, bone loss, subluxations, disc space deviations

What are the advantages of CT scan over radiography in spinal injuries?

More accurate identification of fractures and bone problems

What are the limitations of CT scan in spinal injuries?

Less useful for soft tissue damage detection

What are the advantages of MRI in spinal injuries?

Better for soft tissue damage (spinal cord, discs, ligaments, nerves)

What is myelography?

Radiography (or CT) of the spinal cord after contrast medium injection

What does myelography detect?

Spinal canal stenosis

What spinal injuries can be diagnosed with radiography?

Obvious spinal fractures, presence of osteophytes, loss of bone tissue, subluxations, intervertebral space deviations

What spinal injuries can be diagnosed with CT?

Spinal fractures, bone problems, clearer picture of damage than x-ray, less useful for soft tissue damage

What spinal injuries can be diagnosed with MRI?

Soft tissue injuries affecting the spinal cord, intervertebral discs, ligaments, nerve roots