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5 components of basic neuro exam

1. General assessment (mental status)
2. Cranial nerves (II-XII)
3. Motor systems
4. Sensory systems
5. Reflexes


4 things you are testing in your general assessment during basic neuro exam

1. Level of alertness
2. Appropriateness of responses
3. Orientation to person, place, and time
4. Congruency of mood


Location of cranial nerves

Telencephalon = 1

Diencephalon = 2

Midbrain = 3-4

Pons = 5

Pontomedullary junction = 6-8

Medulla = 9-12


Olfactory n. testing

Use familiar/non-irritating odors, have pt occlude one nostril and identify odor on each side


Conditions that cause loss of sense of smell

Sinus conditions
Head trauma
Cocaine use
Parkinson’s disease


Optic n. testing

Visual acuity w/ snellen chart

Visual fields by confrontation (wiggling fingers at edge of VF)

Light reaction (check for direct and consensual reaction)


Visual acuity result indicating pt is legally blind



Light reaction actually checks what 2 CNs?

CN II sensory
CN III constriction


CN III, IV, and VI testing

Cardinal signs of gaze

Near reaction (accommodation)

Also checking for nystagmus and/or ptosis


Trigeminal n. testing

Sensory: test forehead, cheeks, and jaw bilaterally with pinprick and cotton wisp. If pain sensation not intact, check temperature using hot/cold test tube

Motor: test temporalis+masseter with teeth clenching, lateral pterygoid with jaw movement side to side


Unilateral weakness of jaw musculature indicates what type of lesion

CNS pontine lesion


Bilateral weakness of jaw musculature indicates what type of lesion?

Cerebral hemispheric disease d/t bilateral cortical innervation


CNS patterns of stroke

Facial and body sensory loss on same side but from contralateral cortical or thalamic lesion

Ipsilateral face but contralateral body sensory loss in brainstem


Isolated facial sensory loss may indicate what condition

Trigeminal neuralgia


Facial n. testing

Motor: mm. of facial expression: raise eyebrows, frown, close both eyes tight, show upper and lower teeth, smile, puff out both cheeks

Sensory: taste for salty, sweet, sour, and bitter substances on anterior 2/3 tongue

Parasympathetic: secretion of saliva and tears


During facial n. testing, a widened ____ ____ and _____ ____ are indicative of weakness

Palpebral fissure; nasolabial fold


What condition affects both upper and lower face, loss of taste, hyperacusis, and increased/decreased tearing as a result of facial n. damage?

Bell’s palsy


A central lesion affecting the facial n. typically affects which part of the face?

Lower face


Vestibulocochlear n. testing

Whisper test

Weber/Rinne test

Balance testing (typically done with cerebellar testing)


Glossopharyngeal n. testing

Motor: voluntary m. for swallowing+phonation

Sensory: sensation of nasopharynx, gag reflex and taste for posterior 1/3 tongue

Parasympathetic: secretion of salivary glands and carotid reflex


Vagus n. testing

Inspect palate+uvula for symmetry
Observe for difficulties swallowing (water test)
Test for gag reflex
Check for hoarseness of voice


Spinal accessory n. testing

Shoulder shrug
Head turn against resistance


General observations for motor system

Body position and gait
Involuntary movement - tremors, tics, or fasciculations
Muscle bulk - wasting, atrophy
Muscle tone - muscle resistance to passive stretch


Testing major muscle groups of upper extremity

Shoulder shrug - CN XI
Elbow flexion (C5,6) and extension (C6-8)
Wrist flexion and extension (C6,7)
Hand grip (C7,8, T1)
Finger abduction (C8, T1)
Thumb opposition (C8, T1)


Testing major muscle groups of lower extremity

Hip flexion (L2-4) and extension (S1)
Hip adduction (L2-4) and abduction (L4-S1)
Knee flexion (L4-S2) and extension (L2-4)
Ankle plantarflexion (S1) and dorsiflexion (L4-5)


Gait observation

Casual -observe posture, balance, arm swinging, leg movement, look for ataxia

Tandem - heel-to-toe in straight line

Toe walk/heel walk - may reveal distal weakness in legs


Inability to heel-walk is a sensitive test for damage to what tract?

CST damage


Cerebellar tests and what abnormal test is

Rapid alternating movements (abnormal=dysdiadokinesia)

Finger-to-nose (abnormal=tremor)

Heel-to-shin (tests position sense)


Sensory testing utilizes dermatomes and what 3 methods of testing for spinothalamic tract, posterior columns, and both pathways at once?

Spinothalamic testing = pain and temp of dermatomes

Posterior columns = proprioception and vibration

Both pathways = light touch


What is the romberg test

Test of position sense/proprioception (posterior columns)

Pt stands with feet together and eyes open, pt closes eyes for 30-60 seconds without support, doc notes pt ability to maintain upright posture without excessive swaying