Presentation on theme: "CNS Examination Done by Dr/ Abdullah Mohd. Jan MBBS,Intern."— Presentation transcript:
CNS Examination Done by Dr/ Abdullah Mohd. Jan MBBS,Intern
Aspects of Examination 1.General Ex 2.The Cranial nerves 3.The upper limbs ( Motor + Sensory + coordenation ) 4.The lower limbs ( Motor + Sensory + coordenation) 5.The skull and spine for local disease 6.The carotid arteries for bruits
General Examination Assessment of the higher centers Speech Neck stiffness Abnormal movements
General Examination 1.Assessment of the higher centers o Consciousness o Orientation ( Person, Place, Time ). o Memory o Handedness 2.Speech o Flow of speech o Comprehension o Repetition
3.Neck stiffness looking for meningism ( meningitis,SAH)
Cranial Nerves Examination you have to know how to examine all cranial nerves in detail but we will focus on the most important ones ( 3 rd, 4 th, 5 th, 6 th, 7 th, 11 th & 12 th ).
Where CN Come From? 3 rd & 4 th cranial nerves are located in the mid brain 5 th, 6 th, 7 th & 8 th cranial nerves are located in the pons 9 th, 10 th, 11 th & 12 th cranial nerves are located in the medulla oblongata
Inspection of pupil Light reflex Eye Movement & nystagmus Convergence & accomodation CN III, IV, VI: Oculomotor, Trochlear, Abducent
Look at pupils: shape, relative size, Ptosis. Shine light in from the side to look for pupil's light reaction. Assess both direct and consensual responses. Assess afferent pupillary defect by moving light in arc from pupil to pupil.
Motor: pt opens mouth, clenches teeth )pterygoids). Palpate temporal, masseter muscles as they clench. Jaw jerk: –Dr's finger on tip of jaw. –Grip patellar hammer halfway up shaft and tap Dr's finger lightly.
Sensory Facial sensation by cotton on forehead, cheek & jaw.
Corneal reflex: patient looks up and away. Touch cotton wool to other side. Look for blink in both eyes, ask if can sense it. Repeat other side [ tests V sensory, VII motor].