The Neurological Examination and Methods of Assessment Alvin V. Terry Jr., Ph.D. Associate Professor UGA College of Pharmacy and MCG Alzheimer’s Research Center Lecture 1

Domains History of Present Illness Mental Status Cranial Nerves Motor Function Reflexes

Domains Continued Sensory Function Gait

History Chief Complaint Time Course Distribution of Symptoms Additional Questions

Mental Status Speech Alertness Memory Abstract Reasoning Ability to Follow Commands

Source: Web Path®: The Internet Pathology Laboratory Cranial Nerves Source: Web Path®: The Internet Pathology Laboratory for Medical Education

I: Olfactory Nerve Odors tested through one Nostril oil of cloves methyl salicylate vanilla

acuity, visual fields and internal eye structure II: Optic Nerve Tests of visual acuity, visual fields and internal eye structure

Papilledema Normal Severe Source: Lingsley, Robert E (2000). Conscience text of neuroscience (2nd ed.)

* Usually Tested Together III: Oculomotor Pupil size, shape and equality Pupillary reflex ability to follow moving objects IV: Trochlear VI: Abducens ability to move each eye laterally * Usually Tested Together

V: Trigeminal Nerve Testing the corneal reflex Testing the jaw jerk

Testing for weakness of the face VII: Facial Nerve Testing for weakness of the face

Tests of hearing, bone conduction VIII: Acoustic Nerve Tests of hearing, bone conduction and equilibrium

* Usually Tested Together IX: Glossopharyngeal X: Vagus Gag reflex Patient asked to speak and cough Posterior 1/3 of tongue tested for taste * Usually Tested Together

XI: Accessory Nerve Examination of the Testing the sternocleido- mastoid muscle Testing the trapezius muscle

XII: Hypoglossal Nerve Testing for deviation of the tongue

Motor Function Strength Coordination Tremors Atrophy Fasiculations

Strength

Finger to nose test Coordination

Coordination and Balance

Reflexes Biceps Triceps Tendon Reflexes Plantar Response Cutaneous Reflexes

Source: Lingsley, Robert E (2000) Source: Lingsley, Robert E (2000). Conscience text of neuroscience (2nd ed.)

Sensory Function Asymmetry to Pin Prick Vibration Temperature

Gait Walking Standing

Imaging Planes Axial Coronal Sagittal

Computerized Axial Tomography (CAT) Source: Mosby Clinical Neurology CD Atlas

Magnetic Resonance Imaging (MRI) Coronal Axial Sagittal Source: Mosby Clinical Neurology CD Atlas

Magnetic Resonance Angiography Source: Mosby Clinical Neurology CD Atlas

Digital Subtraction Angiography Intracranial Vertebrobasilar Source: Mosby Clinical Neurology CD Atlas

Duplex Scan of the Carotid Bifurcation Doppler Duplex Scan of the Carotid Bifurcation

Transcranial Doppler

Electroencephalography Source: Mosby Clinical Neurology CD Atlas

Lumbar Puncture CSF Pressure Measurement (with manometer) Source: Mosby Clinical Neurology CD Atlas

Single Photon Emission Computed Tomography (SPECT) Axial Sagittal Source: NIH/NIA

Positron Emission Tomography (PET) Source: NIH/NIA