INT - Neurological examination Flashcards
(37 cards)
NEUROLOGICAL EXAMINATION:
- Ask
- Watch
- Touch
- Pain
WATCH:
• Inspection (without move)
◦body posture
◦head position
◦eye position, -movement
◦consciousness
WATCH:
• Inspection (on move)
◦walk
◦turn
◦sit-stand
TOUCH:
- palpation (symmetry, muscle atrophy, crepitation, fracture)
- postural reactions, spinal reflexes
- cranial nerves
- sensitivity of the skin and mucous membranes
- manipulation
PAIN:
• Pain sensation
◦superfitial
◦deep pain
DISEASE PROCESSES:
DAMNITV
DISEASE PROCESSES:
What is DAMNITV
D. Degenerative eg lipofuscinosis - difficult to diagnose
A. Anomalous eg hydrocephalus
M. Metabolic eg hepatic encephalopathy
N. Neoplastic eg tumor
I. Inflammatory eg steroid-responsive meningitis-arteritis
I. Infectious eg bacterial, viral
I. Idiopathic eg idiopathic vestibular syndrome
T. Toxic eg ethylene glycol toxicity
V. Vascular eg ischemia, bleeding
PHYSICAL EXAMINATION - HEAD/SKULL
- Shape (symmetrical - asymmetrical changes)
- Mobility
- Ears (drooping or pointing
- Signs of pain by palpation
MENTAL STATE - INAPPROPRIATE MENTAL FUNCTION
• Reduced:
◦Depressed, obtunded, dull, blunt, indolent: lowering or decrease of functional activity
◦Somnolentia: drowsiness
◦Delirium: mental disturbance (hallucinations, illusions, restlesness, incoherence)
◦Dementia: organic loss of intellectual function
MENTAL STATE - INAPPROPRIATE MENTAL FUNCTION
• Increased:
◦Exitatio: excitement
◦Aggressive: attacking
◦Furor: rage
OTHER FORMS OF CONVULSIONS NOT NECESSARILY CONNECTED TO CNS
- Tetanus: sustained tonic contraction of muscles without twitching
- Tetany: violent muscle twitching over the whole body
- Tremor: regular, rhythmic trembling (oscillation) of muscles
- Tic: repetitive contractions of one muscle
- Myoclonus: rhythmic contraction of one muscle group
- Fibrillation: uncoordinated twitching of individual muscle fibres
EXAMINATION OF PROPRIOCEPTION: POSTURAL REACTIONS
• Wheelbarrowing test
• Hopping tests
◦On one leg
◦Hemihopping
• Knuckling-over test
• Placing reactions
◦Tactile
◦Visual
• Extensor postural thrust reactionATAXIA
• Classification by
• Classification by signs: • Classification by anatomical origin: ◦Cortical: ◦Cerebellar: ◦Vestibular: ◦Spinal (proprioceptive):
ATAXIA
• Classification by signs:
◦Static: signs in standing position (as well)
◦Locomotive: signs during movement only
◦Intentional: tremor of the head when fine adjustment is demanded
ATAXIA
• Classification by anatomical origin:
◦Cortical:
‣ circling, lateral head turn, behavior changes, altered mental state
◦Cerebellar:
‣ wide-based stance, dysmetria-hypermetria, (nystagmus)
◦Vestibular:
‣ ipsilateral head tilt leans to the affected side, nystagmus
◦Spinal (proprioceptive):
‣ paresis/paralysis (muscle weakness) frequent
‣ Hindlimbs are always affected
PARESIS, PARALYSIS/PLEGIA:
• Diagnostic methods
◦Inspection ◦Palpation ◦Evaluation of muscle tone ◦Atony ◦Hypotony (reduced muscular tone ◦Hypertony (increased muscular tone)
CLASSIFICATION OF PARALYSIS:
• by
- by severity
- by affected limbs
- by muscle tone
- by origin, related to neuron nucleus
CLASSIFICATION OF PARALYSIS:
• by severity
◦paresis = partial loss of strength ◦paralysis/plegia = complete loss of strength
CLASSIFICATION OF PARALYSIS:
• by affected limbs
◦monoparalysis (-plegia, -paresis): one limb
◦tetraparalysis (-plegia, -paresis): all limbs
◦paraparalysis (-plegia, -paresis): rear/hind limbs
◦hemiparalysis (-plegia, -paresis): ipsilateral limbs
CLASSIFICATION OF PARALYSIS:
• by muscle tone
◦spastic, rigid
◦atonic, flaccid
CLASSIFICATION OF PARALYSIS:
• by origin, related to neuron nucleus
◦UMN (upper motor neuron): above the nucleus
◦LMN (lower motor neuron): in or below the nucleus
EXAMINATION OF CRANIAL NERVES: #1
N. Olfactorius I - Smelling
• Patho:
Hyposomia (partial loss) & Anosomia (complete loss of smell)
• Tests: Use strong stimuli objects/materials
• EXCLUDE VISION (avoid to stimulate Opticus) & DON’T IRRITATE NASAL MUCOSA (which stimulates Trigeminus)
EXAMINATION OF CRANIAL NERVES: #2
N. Opticus II - Vision
• Patho: Amaurosis (blindness)
• Tests: Falling cotton test, pupillary light reaction direct & indirect (+Occulomotorius), threat/menace
reflex (+Facial)
• AVOID AIR CURRENT (which stimulates Trigeminus) & TOUCHING SENSORY HAIR (which
stimulates Trigeminus)
EXAMINATION OF CRANIAL NERVES: #3
N. Occulomotorius III - Pupils constriction
• Patho: Anisocoria (uneven size of pupils), Mydriasis (dilatation), Miosis (constriction)
• Horner’s syndrome: Loss of sympathetic innervation
◦Ipsilateral miosis (on affected side),
◦Ipsilateral ptosis (upper eyelid slagging down slightly
◦Enophtalmus (sunken eye)
◦Prolapse of 3rd eyelid
