NEUROLOGIC EXAMINATION p2

Normal respons to babinski

 downward contraction of toes 

upgoing big toe and fanning of other toes with or without triple flexion (ankle dorsiflexion, hip and knee flexion)

Babinski sign

(+) UMN lesion

Babinski sign is normal up to how many years old

2 y/o

Tap glabella rapidly 10 times

N: lid remains open

Abn: continuous reflex blinking with or without lid closure (orbicularis oris)

Glabellar Blink or Tap

With patient’s eyes closed, tap the philtrum or press the tip of a test tube firmly compressing the upper lip against the gum

N: no response 

Abn: puckering or pursing or the lips (orbicularis oris)

Snout Reflex

Stroke patient’s hypthenar eminence 

N: no contraction of mentalis 

Abn: ipsilateral or bilateral mentalis contraction

Palmomental Reflex

Use index and middle finger to stroke patient’s palm from the hypothenar eminence towards junction of finger and thumb 

N: no response

Abn: grasping fingers

Grasp Reflex

Normal response is the umbilicus twitches towards stimulated quadrant

Abdominal (Beevor’s) Reflex

Elevation of ipsilateral testicle in relation to thigh stimulus

Cremasteric Reflex

Pricking the glans penis causes reflex contraction of the bulbocavernosus muscle, detected by pressing a finger against the perineum

Bulbocavernosus  Reflex

Pricking or scratching the perianal skin causes a quick constriction of the anal sphincter

Anocutaneous (Anal Wink) Reflex

Nerve roots of the beevor’s reflex below the umbilicus

T10-12

Nerve roots of the bulbocavernosus reflex

S2-4

Nerve roots of the Cremasteric reflex

L1-2

Nerve roots of the beevor’s reflex above the umbilicus

T8-10

Nerve roots of the anal wink reflex

S2-4

Abnormal movements in coordination disorders

Ataxia

lesion on ipsilateral cerebellar hemisphere causes?

Appendicular ataxia

 lesion on the vermis causes?

Truncal ataxia

Rapid alternating movement

dysdiadochokinesia 

Finger-to-nose test is used to test for?

dysmetria

Other tests and signs of appendicular ataxia:

• Overshoot (hypermetria)

• Finger tapping test 

• Heel-shin test 

• Foot tapping

• Ipsilateral limb intention tremor 

• Ipsilateral limb ataxia

Signs of Truncal Ataxia

• Wide-based, unsteady, drunkard-like gait 

• May have difficulty sitting up without support

Romberg Test uses which senses?

Vision, proprioception, vestibular senses

Stand with feet together, eyes closed
instability due to impaired proprioceptive and vestibular systems

Gait where patient walks in straight line while toughing the heel of one foot to toe of the other with each step

Tandem gait

Sensations

• Light touch → cotton

• Pain → pinprick 

• Temperature → cool piece of metal (i.e. tuning fork) 

  • 5-10 deg C and 40-45 deg C

• Vibration sense 

• Joint position sense 

• Two-point discrimination (using a caliper)

Which tract is responsible for light touch?

anterior spinothalamic tract

Which tract is responsible for pain sense?

lateral spinothalamic tract

Objectives of Both Light Touch and Pain

• Performed in all extremities including face and trunk

• Eyes closed

• Reproducible

• Correlate and recheck to improve objectivity

Which tract is responsible for temp sense?

lateral spinothalamic tract

Which tract is responsible for vibration sense

posterior-column medial lemniscal pathway (DCML)

Which tract is responsible for proprioception / joint sense

DCML

Which tract is responsible for two point discrimination?

DCML

Review this

Dermatome distribution of C5

Clavicles

Which nerve roots are the dermatomes for the lateral sides of upper limbs?

C5-6

Dermatome distribution of C8-T1

Medial sides of upper limbs

Nerve roots of the dermatome of digits IV and V

C8

Nerve roots of the dermatome of digit 1

C6

Nerve roots for the dermatome at the level of the nipples

T4

Nerve roots for the dermatomes of the hand

C6,7,8

Dermatome distribution of T10

umbilicus

Dermatome distribution of S2,3,4

Perineum

The inguinal region’s dermatome is supplied by which nerve root?

L1

Dermatome distribution of L4

Medial side of great toe

Nerve root of dermatome that supplies the lateral margin of foot and digit V (little toe)

S1

Dermatomes of the anterior and inner surfaces of lower limbs are supplied by which nerve roots?

L1,2,3,4

Dermatomes of the lateral and posterior surfaces of the lower limbs are supplied by which nerve roots?

L5, S1,2

What is the distribution of the dermatome with the nerve roots L4,5 and S1

Foot

Neither patient nor examiner can flex the patient’s head because of reflex spasm of nuchal (extensor) muscles

Nuchal Rigidity

Adduction and flexion of legs as head is flexed 

Neck flexion places tension on the entire cord and roots 

Flexion of legs reduces stretch on nerve root

Brudzinski

Bend knee leg raising tests; knees cannot extend due to pain

Kernig