Assessing your patient The neurological exam Assessing your patient

What are the components of the neurological exam Key points of the neuro exam Mental Status Language and Speech Cranial nerves (2-12) Motor Reflexes Sensory Cerebellar Gait

Assessing your patient’s mental status MENTAL STATUS EXAM: Orientation: Alert and oriented to person, place and time. Memory: Cooperative, follows commands well. Recent and remote memory normal. Attention, concentration: Attention span and concentration are normal. Language: Speech is clear and language is normal. Fund of knowledge: Aware of current events, vocabulary appropriate for patient age.

Cranial Nerves 2-12

Cranial nerve 2 Cranial Nerve 2 (Optic) Visual fields are intact to confrontation Funduscopic examination 1. Optic disc pallor 2. Optic disc edema 3. Retinal vessels are normal

Cranial Nerve 3, 4 and 6 Oculomtor (3) Pupils should be equal and reactive to light Extraocular eye movements ( superior, medial and inferior recti; inferior oblique Trochlear (4) Extraocular eye movements (superior oblique) Abducens (6) Extraocular movements (lateral rectus)

Cranial nerve 5 Trigeminal (5) Facial sensation No weakness of the masticatory muscles

Cranial nerve 7 Facial (7) Observe for facial weakness

Cranial nerve 8 Vestibulocochlear AKA Auditory (8) Hearing Vestibular function

Cranial nerves 9 and 10 Glossopharyngeal (9) Taste Check the that the Uvula is midline Vagus (10) Phonation Check to make sure the palate elevates symmetrically

Cranial nerve 11 Spinal accessory Normal sternocleidomastoid and trapezius strength

Cranial nerve 12 Hypoglossal (12) Tongue is midline No atrophy or fasciculation

Motor exam Muscle strength Check for symmetry bilaterally Look for pronation and drift Grading muscle strength 5/5 Full Strength 4/5 can resist opposition to some extent, but do not exhibit full strength 3/5 can move against gravity 2/5 can move with gravity elimination 1/5 can see muscle contraction but no movement 0/5 no movement

Motor exam Cont. Muscle Tone Look for increased or decreased tone in both upper and lower extremities Check for symmetry ( more on the left vs more on the right)

Reflexes Reflexes symmetric bilaterally Plantar response flexor bilaterally Grading Reflexes 0 Absent 1+ Hyporeflexic 2+ Normal 3+ Brisk, without clonus 4+ Brisk, with clonus

Coordination Intact finger to nose Heal to shin Check rapid alternating movements Assess for tremor Resting Action

Sensation Check that sensation is intact to… Light touch Pinprick Vibration Check for symmetry bilaterally Romberg test

Gait Check for gait abnormalities - Casual - Heel - Tandem

Other considerations for your neuro exam Medications (Could they be effecting your exam) Epilepsy medications Blood pressure medications Mood stabilizing medications