Week 6 Lesson 41a: The Neurologic Examination

What cranial nerve is be evaluated?

Olfactory

Which cranial nerves are being evaluated?

3,4 and 6

What is the name of this test?

Patellar reflex

What nerve is being assessed when a patellar reflex is performed?

Femoral

When should you not perform a neuro exam or be very causes?

In cases of rabies

T/F: Gloves are necessary for examining any neurologic patient.

True

If there is a loss or gain of function in the nervous system, what problems will occur to manifest signs?

• Destruction of functional tissue

• Release or loss of inhibition

• Excitation or increased stimulation

Manifestation of neurological signs depends on what?

Physiologic importance of that location

Why do we have a neurologic exam form?

Neurologic abnormalities include both loss and gain of function

On the neurologic exam form what is considered normal?

+2

What is an example of an altered mental state for clinical expression of neurologic disease?

Lethargy/excitation

What is an example of involuntary movements for clinical expression of a neurologic disease?

Convulsions, tetany, tremors

What is an example of abnormal posture and gait for a clinincal expression of a neurologic disease?

Opisthotonus, ataxia

What is an example of paresis/paralysis for a clinical expression of a neurologic disease?

Weakness

What is an example of altered sensations for a clinical expression of a neurological disease?

Hyperaethesia, Hemineglect

What are the diagnostic steps when a nervous system disease is suspected?

1. History

2. PE

3. NE

4. Rads

5. CT

6. MRI

7. CSF tap

8. Electroencephalography

9. Postmortem examination

What cranial nerve is effected?

Facial (VII)

What is the function of the Facial nerve (CNVII)?

Motor to muscles of facial expression and lacrimal gland

Taste to the rostral 2/3 of tongue

What is an example of a specifc tests for eyes?

Oculophalic reflex

What nerves are assessed with the palpebral reflex?

CN V and CN VII (Trigeminal and Facial)

What is this test?

Hemiwalking

What are the 8 different types of postural reactions?

1. Hopping

2. Hemiwalking

3. Wheelbarrowing

4. Knucking

5. Extensor postural thrust

6. Tactile placing

7. Visual placing

8. Righting

What are the 6 different types of myotatic reflexes?

1. Patellar

2. Gastrocnemius

3. Cranial tibialis

4. Triceps

5. Biceps

6. Extensor Carpi Radialis

What are the two types of withdraw reflexes?

1. Thoracic limb

2. Pelvic limb

What are the two types of crossed extensor reflexes?

1. Pelvic

2. Thoracic

What is the neurologic condition that causes the masseter and temporalis muscle to be hard and the jaw to remain closed?

Masticatory muscle myositis

What is the key in the case of pain sensation?

awareness

When should you only test for deep pain?

If paralyzed (no motor)

List the clincial progression from first to go to last to go if there is a neurologic problem?

1. Proprioception

2. Ataxia

3. Voluntary motor

4. Voluntary Urination

5. Superficial pain

6. Deep pain

Why is urination and defecation important when there is a neurologic problem?

• May have to manually empty the bladder because the patient cannot do it themselves

• Evaluate anal tone for the same reason

Brainstem

Why is a distance exam important in a neurologic evaluation?

Good at identifying normal so you can identify when something is abnormal

What is it called when a patient cannot move the pupils/Mydriasis?

Internal Opthalmoplegia

What is the neurologic condition is caused by iris sphincter muscle dysfunction, atropine or atropine-like drugs, Parasympatheitc denervation (CN III or its nucleus)?

Internal Opthalmoplegia

What do we see?

Anisocoria

What is the neruological condition called where the patient cannot move the eyes?

External Opthalmoplegia

What is the neurological condition that is caused by most commonly with central lesions but also internal opthalmoplegia, Small palpebral fissures, ventrolateral strabismis, and abnormal vestibular-ocular reflexes?

External Ophthalmoplegia

What is strabismus?

Cross eyes