Neurological History and Exam 07 9775 1663 Neurological History and Exam

Peculiarities Where is the lesion=localization What is the lesion=differential diagnosis What is the etiology of the lesion

Chief Complaint Time factor Location factor Associations Time of onset Mode of onset Change over time (progression) If episodic: duration, recurrence Location factor Right/left, Upper/lower, Crossed Associations

Past History Family History Social History

Neurological Symptoms Headache Changes in the level of consciousness Weakness Sensory changes Abnormal movements Memory and behavioral changes Falls

Headache Description and history taking Possible etiologies Checklist for pain Possible etiologies Primary Secondary Red flags in the history of headache

Level of Consciousness Seizures Classification Temporal progression Possible etiologies Syncope Breath holding spells Mass effect and increased intracranial pressure

Weakness / Sensory Change Onset Distribution Progression Associated symptoms Etiologies

Abnormal Movements Shaking movements of the hands Slow writhing movements Ballistic proximal movements Sudden jerks

Memory and Confusion Baseline of the patient History of trauma, incontinence, gait problem, anticoagulation, abnormal movements, language deficit, systemic disease. Onset of the change Specific manifestation Living environment Possible etiologies

Falls Loss of consciousness: seizure, syncope Transient ischemic attacks Third ventricular and posterior fossa tumors Motor and sensory impairment of the lower limbs: neuromuscular disorders myelopathy cerebral and cerebellar disorders basal ganglionic diseases - Neuropathy.

Neurological Exam

Neurologic Exam General observations Neck and cervical spine Cranial nerves Motor system Sensory system Coordination Cortical function

General Observations Level of consciousness Facial appearance Gait Speech Language Involuntary movements Hand writing Neck and spine movements

Gait Hemiparetic Spastic Foot drop Parkinsonian Cerebellar Apraxic

Speech Disorder of articulation, motor weakness myasthenia gravis motor neuron disease multiple lacunes parkinsonism cerebellar lesions Recurrent laryngeal nerve palsy

Language (Aphasia) Broca’s Wernicke’s Conduction aphasia Global aphasia

Language Spontaneous speech Naming objects Comprehension Repetition of spoken words Reading aloud Handwriting

Involuntary movements - Tremor Chorea: Athetosis Dystonia Myoclonus Hemiballismus Orofacial-lingual dyskinesia Tics

Chorea repetitive, brief, irregular, somewhat rapid involuntary movements that start in one part of the body and move abruptly, unpredictably, and often continuously to another part

Athetosis a continuous stream of slow, flowing, writhing involuntary movements.

Hemiballismus a type of chorea, usually involving violent, involuntary flinging of one arm and/or one leg.

Dystonia characterized by long-lasting (sustained) involuntary muscle contractions that may force into abnormal positions—for example, causing the entire body, the trunk, limbs, or neck to twist.

Neurologic Exam General observations Neck and cervical spine Cranial nerves Motor system Sensory system Coordination Cortical function

Cranial Nerves Olfactory nerve Optic Nerve visual acuity pupillary reflexes visual fields color vision fundoscopy

Cranial Nerves Oculomotor, Trochlear, Abducent nerves Trigeminal nerve sensory motor corneal reflex jaw jerk

Cranial Nerves Facial nerve Vestibulocochlear nerve Glossopharyngeal and Vagus nerves Accessory nerve Hypoglossal nerve

Neurologic Exam General observations Neck and cervical spine Cranial nerves Motor system Sensory system Coordination Cortical function

Motor System Inspection and palpation of muscle groups Assessment of tone Testing of power Deep tendon reflexes and plantar responses Superficial and Pathological reflexes

Neurologic Exam General observations Neck and cervical spine Cranial nerves Motor system Sensory system Coordination Cortical function

Sensory System Pattern and distribution peripheral neuropathy mononeuropathy radiculopathy myelopathy hemispheric

Sensory System Modalties pain temperature light touch vibration positin

Neurologic Exam General observations Neck and cervical spine Cranial nerves Motor system Sensory system Coordination Cortical function

Coordination Finger-Nose-Finger test Heel-Shin test Rapid alternating movements Stance and gait

Cortical Function Point localization Streiognosis Graphaesthesia Sensory inattention Calculating skills Constructional apraxia