Neurological Exam Duc Tran, M.D. August 2003

Neurological Exam Mental Status Cranial Nerves Motor Sensory Reflexes Coordination Gait

Neuroaxis Central Peripheral Brain Spinal Cord Root Plexus Nerve Neuromuscular Junction Muscle

Intracranial Supratentorial Infratentorial Frontal Parietal Temporal Occipital Infratentorial Cerebellum Brainstem

Supratentorial Aphasia - dominant Aprosodias – nondominant Alexia Agnosia Apraxia Consciousness Memory Motor – cortical vs. subcortical Personality Seizures - cortical Sensation - parietal Vision – occipital

Infratentorial Diplopia Dysarthria Dysphagia Decreased facial sensation/perioral numbness Dystaxia/Ataxia Dizziness/Vertigo Nystagmus Consciousness Cross findings

Cranial Nerves I - Olfactory. II - Optic. Vision. Pupil reflex. III - Eye movement. Pupil response. IV - Eye movement. V - Facial sensation. Mastication. VI - Eye movement. VII - Facial movement. VIII - Balance/Hearing. IX - Taste. Sensation pharyngeal muscles. X - Sensation larynx, gut. Motor to larynx, pharynx, palate. XI - Motor to sternocleidomastoid/trapezius. XII - Motor to tongue.

Hemangiomablastoma

Myelopathy Weakness Reflex changes Sensory loss B/B dysfunction Ascending Level of Dysfunction

Motor Neuron UMN LMN Weakness Spastic Hyperreflexia Weakness Flacid Atrophy Fasciculations Hyporeflexia EMG/NCV

Root/Radiculopathy Pain Weakness in distribution of root Sensory loss – may not be dense Reflex changes – helps to localize the level Rule of 7

Nerve Polyneuropathy – eg. diabetes Mononeuropathy – eg. CTS Multiple mononeuropathies – eg. lead

Polyneuropathies Weakness – distal>proximal Sensory loss – distal>proximal Reflex changes – distal>proximal Exceptions - CIDP

Mononeuropathies Cardinal movements of the thumb Extension Opposition Adduction Cardinal movements of the lower extremity Hip flexion/knee extension Hip adduction Hip abduction/hip extension Knee flexion/ankle dorsi-flexion/ankle plantar flexion/inversion/eversion.

NMJ Weakness – proximal>distal No sensory loss No reflex changes Fatigue

Myopathy Weakness – proximal>distal No sensory changes No reflex changes Atrophy Myotonia Cramping

VITAMIN DEC