Neurologic Examination Kefah Al-Hayek, MD Assistant Prof. of Neurology J.U.S.T ABPN, ABCNP, ABEM, ABNM

Equipment Needed Reflex Hammer 128 and 512 (or 1024) Hz Tuning Forks A Snellen Eye Chart or Pocket Vision Card Pen Light or Otoscope Wooden Handled Cotton Swabs Paper Clips

Neurologic Examination Mental Status Cranial Nerves Motor Reflexes Sensory Coordination and Gait Special Tests

Aphasia Repetition Comprehension Fluency - + Motor Sensory Conductive Global

Cranial Nerves I – Olfactory Not Normally Tested Suspected mass c/o smell

II - Optic Optic Fundi Visual Acuity Visual Fields Pupillary test Light accomodation

III – Oculomotor, IV – Trochlear, VI - Abducens Observe for Ptosis Test Extraocular Movements

Sensation Mastication Corneal reflex Jaw gerk V - Trigeminal Sensation Mastication Corneal reflex Jaw gerk

VII - Facial Observe for Any Facial Droop or Asymmetry Ask Patient to do the following, note any lag, weakness, or assymetry: Raise eyebrows [8] Close both eyes to resistance Smile Frown Show teeth Puff out cheeks UMN Vs LMN

VIII - Acoustic Screen Hearing Lateralization (Weber( Compare Air and Bone Conduction (Rinne) Vestibular Function Not Normally Tested

IX – Glossopharyngeal X – Vagus XI – Accessory Afferent pathway for the gag reflex X – Vagus Efferent pathway for the gag reflex Ask Patient to Swallow Ask Patient to Say "Ah" XI – Accessory Shrug shoulders against resistance Turn head against resistance

XII - Hypoglossal Observe the tongue as it lies in the mouth Ask patient to: Protrude tongue Move tongue from side to side

Motor Observation Muscle Tone Involuntary Movements Muscle Symmetry Atrophy Muscle Tone Decreased (flaccid) or increased (rigid/spastic) tone

Muscle Strength Description Grade No muscle movement 0/5 Visible muscle movement, but no movement at the joint 1/5 Movement at the joint, but not against gravity 2/5 Movement against gravity, but not against added resistance 3/5 Movement against resistance, but less than normal 4/5 Normal strength 5/5

Reflexes Deep Tendon Reflexes Tendon Reflex Grading Scale Description Grade Absent Hypoactive 1+ or + "Normal" 2+ or ++ Hyperactive without clonus (spread) 3+ or +++ Hyperactive with clonus 4+ or ++++

Deep Tendon Reflexes Biceps (C5, C6) Brachioradialis (C5, C6) Triceps (C6, C7) Knee (L2, L3, L4( Ankle (S1, S2)

Plantar Response (Babinski)

Sensory Pain & Temp Vibration & position Light Touch Cortical sensory Graphesthesia Stereognosis Two Point Discrimination

Coordination Rapid Alternating Movements Point-to-Point Movements F-N-F H-K-S

Romberg Gait Sensory ataxia Walk across the room, turn and come back Walk heel-to-toe in a straight line Walk on their toes in a straight line Walk on their heels in a straight line