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The Neurologic Examination Steven A. Glyman MD July 8, 2008 July 8, 2008 July 8, 2008
Resources ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
A proper neurologic examination begins with a careful clinical history.
http://www.cbu.edu/~mcondren/IRM/Stop-Look-Listen-sign-IRM-7-7-07.jpg
You must do a minimum basic examination on every patient but you don’t need to do every test
A mechanic does not need to use every tool on every project
The history guides the neurologic examination
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The Neurologic Exam often can be completed during the clinical history ,[object Object],[object Object],[object Object],The Technique of the Neurologic Examination by William DeMyer Fifth Edition 2004 McGraw Hill Publisher
The history and preliminary observations focus attention on specific symptoms, motor or sensory systems, cranial nerves,or cerebral functions.  If the history suggests a spinal lesion, then carefully test each dermatome for a sensory level.  If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia If the history suggests a cerebral lesion,emphasize tests for memory, aphasia, apraxia, and agnosia The Technique of the Neurologic Examination by William DeMyer Fifth Edition 2004 McGraw Hill Publisher
The Technique of the Neurologic Examination by William DeMyer  McGraw Hill  2004
Tools of the trade
http://www.ptup.org/files/2007-SJ-Monterey-Tour/TheWholeEnchilada.jpg
The Neurologic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mental Status Exam  ,[object Object],[object Object]
 
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
http://www.mrc-cbu.cam.ac.uk/research/rehabilitation/research.html
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
Perseveration
Mental Status Exam ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
Mental Status Exam ,[object Object],[object Object],http://www.neuroexam.com /
The Cranial Nerves
Cranial Nerve1 Olfaction Olfaction ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
http://commons.wikimedia.org/wiki/Image:Head_olfactory_nerve.jpg http://www.braininjury.com/images/cranialnerveinjury.jpg
Cranial Nerve 2 Optic Nerve Optic Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
http://www.merck.com/media/mmhe2/figures/MMHE_20_235_01_eps.gif http://arapaho.nsuok.edu/~fulk/Images/Img0013.JPG
Cranial Nerve 2 and 3 Pupillary responses Pupillary responses ,[object Object],[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
Pupillary Size is determined by the light input, sympathetic and parasympathetic tone Text http://www.psych.ndsu.nodak.edu/mccourt/Psy460/Central%20visual%20pathways/pupillary%20light%20reflex.gif http://www.abdn.ac.uk/~opt065/Web%20pages%20only/drh-g085.gif
Cranial Nerve 3,4,6 Extraocular Movements Extraocular Movements ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
Cranial Nerve 5 Facial Sensation and Muscles of Mastication Facial Sensation and Muscles of Mastication ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
http://www.healthatoz.com/healthatoz/Atoz/images/ency/00044039.jpg http://www.dalcross.com/staging/_images/trigeminal.JPG
Cranial Nerve 7 Muscles of Facial Expression and Taste  Muscles of Facial Expression and Taste  ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
 
Cranial Nerve 8  Hearing and Balance Hearing and Balance ,[object Object],[object Object],[object Object],http://www.neuroexam.com /
Cranial Nerve 9 and 10 Palatal Elevation and Gag Reflex Palatal Elevation and Gag Reflex ,[object Object],[object Object],http://www.neuroexam.com /
Cranial Nerves 5,7,9,10,12 Muscles of Articulation  Muscles of Articulation  ,[object Object],[object Object],http://www.neuroexam.com /
Cranial Nerve11 Sternocleidomastoid and Trapezius Muscles Sternocleidomastoid and Trapezius Muscles ,[object Object],[object Object],http://www.neuroexam.com /
Cranial Nerve12 ,[object Object],[object Object],http://www.neuroexam.com /
Hypoglossal Nerve Injury
Motor Examination
Motor Examination ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
Motor Examination ,[object Object],[object Object],http://www.neuroexam.com /
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MRC Scale  Aids to the Examination of the Peripheral Nervous System Fourth Edition WB Saunders
Note the parkinsonian stare,masked facies,flexed posture,hypokinesia typical of extrapyramidal disorders  http://www.ananova.com/news/story/sm_1417224.html
Muscle Stretch Reflexes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reflex Arcs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Plantar Response ,[object Object],http://www.neuroexam.com /
http://commons.wikimedia.org/wiki/Image:Babinski's_sign01.jpg
Coordination ,[object Object],[object Object],http://www.neuroexam.com /
Romberg test ,[object Object],http://www.neuroexam.com /
Gait ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
Sensory Exam ,[object Object]
Primary Sensation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cortical sensation ,[object Object],[object Object],[object Object],[object Object],http://www.neuroexam.com /
 

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The neurologicexamination