Neurological Exam Flashcards by Natasha Martin

Q

What are the components of a NEUROLOGICAL EXAMINATION

A

Mental State
Speech 
Cranial Nerves
Examination of Limbs &amp; Trunk:
- posture
- wasting
- tone
- power
- reflexes
- sensation
- coordination &amp; gait

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Q

BICEPS JERK

Major segmental innervation & peripheral nerve

A

C5(6)

Musculocutaneous nerve

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Q

SUPINATOR JERK

Major segmental innervation & peripheral nerve

A

C5/6

Radial nerve

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Q

TRICEPS JERK

Major segmental innervation & peripheral nerve

A

C7(8)

Radial nerve

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Q

FLEXOR FINGER JERK

Major segmental innervation & peripheral nerve

A

C6-T1

Median and Ulnar n.

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Q

KNEE JERK

Major segmental innervation & peripheral nerve

A

L3/4

Femoral

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Q

ANKLE JERK

Major segmental innervation & peripheral nerve

A

S1(2)

Medial popliteal and sciatic n.

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Q

TRAPEZIUS

Nerve and major root supply of muscle

A

C3/4

Spinal accessory n.

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Q

RHOMBOIDS

Nerve and major root supply of muscle

A

C4/5

Brachial plexus

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Q

SERRATUS ANTERIOR

Nerve and major root supply of muscle

A

C5 C6 C7

Brachial plexus

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Q

PECTORALIS MAJOR

Nerve and major root supply of muscle

A

Clavicular C5/6
Sternal C6, C7, C8

Brachial plexus

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Q

SUPRASPINATUS

Nerve and major root supply of muscle

A

C5/6

Brachial plexus

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Q

INFRASPINATUS

Nerve and major root supply of muscle

A

C5/6

Brachial plexus

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Q

LATISSIMUS DORSI

Nerve and major root supply of muscle

A

C6, C7, C8

Brachial plexus

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Q

TERES MAJOR

Nerve and major root supply of muscle

A

C5, C6, C7

Brachial plexus

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Q

DELTOID

Nerve and major root supply of muscle

A

C5/6

Axillary n.

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Q

BICEPS

Nerve and major root supply of muscle

A

C5/6

Musculocutaneous n.

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Q

BRACHIALIS

Nerve and major root supply of muscle

A

C5/6

Musculocutaneous n.

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Q

TRICEPS

Nerve and major root supply of muscle

A

Long head/lateral head/medial head
C6, C7, C8
Radial n.

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Q

BRACHIORADIALIS

Nerve and major root supply of muscle

A

C5/6

Radial n.

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Q

EXTENSOR CARPI RADIALIS LONGUS

Nerve and major root supply of muscle

A

C5/6

Radial n.

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Q

SUPINATOR

Nerve and major root supply of muscle

A

C6/7

Posterior interosseous n.

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Q

EXTENSOR CARPI ULNARIS

Nerve and major root supply of muscle

A

C7/8

Posterior interosseous n.

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Q

FLEXOR DIGITORUM SUPERFICIALIS

Nerve and major root supply of muscle

A

C7, C8, T1

Posterior interosseous n.

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ABDUCTOR POLLICIS BREVIS | Nerve and major root supply of muscle

C7/8 | Posterior interossesous n.

EXTENSOR POLLICIS BREVIS | Nerve and major root supply of muscle

C7/8 | Posterior interossesous n.

EXTENSOR INDICIS | Nerve and major root supply of muscle

C7/8 | Posterior interossesous n.

PRONATOR TERES | Nerve and major root supply of muscle

C6/7 | Median n.

FLEXOR CARPI RADIALIS | Nerve and major root supply of muscle

C6/7 | Median n.

FLEXOR DIGITORUM SUPERFICIALIS | Nerve and major root supply of muscle

C6, C7, C8 | Median n.

ABDUCTOR POLLICIS BREVIS | Nerve and major root supply of muscle

C8, T1 | Median n.

FLEXOR POLLICIS BREVIS | Nerve and major root supply of muscle

C8, T1 | Median n.

OPPONENS POLLICIS | Nerve and major root supply of muscle

C8, T1 | Median n.

LUMBRICALS I and II | Nerve and major root supply of muscle

C8, T1 | Median n.

FLEXOR DIGITORUM PROFUNDUS I and II | Nerve and major root supply of muscle

C7/8 | Anterior interosseous n.

FLEXOR POLLICIS LONGUS | Nerve and major root supply of muscle

C7/8 | Anterior interosseous n.

FLEXOR CARPI ULNARIS | Nerve and major root supply of muscle

C7, C8, T1 | Ulnar n.

FLEXOR DIGITORUM PROFUNDUS III and IV | Nerve and major root supply of muscle

C7/8 | Ulnar n.

HYPOTHENAR MUSCLES | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

ADDUCTOR POLLICIS | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

FLEXOR POLLICIS BREVIS | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

PALMAR INTEROSSEI | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

DORSAL INTEROSSEI | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

LUMBRICALS III and IV | Nerve and major root supply of muscle

C8, T1 | Ulnar n.

ILIOPSOAS | Nerve and major root supply of muscle

L1, L2, L3 | Femoral n.

QUADRICEPS FEMORIS | Nerve and major root supply of muscle

L1, L2, L3 Femoral n. Recuts femoris Vastus medius Vastus lateralis Vastus intermedius

ADDUCTOR LONGUS | Nerve and major root supply of muscle

L2, L3, L4 | Obturator n.

ADDUCTOR MAGNUS | Nerve and major root supply of muscle

L2, L3, L4 | Obturator n.

GLUTEUS MEDIUS and MINIMUS | Nerve and major root supply of muscle

L4, L5, S1 | Superior gluteal n.

TENSOR FASCIA LATAE | Nerve and major root supply of muscle

L4, L5, S1 | Superior gluteal n.

GLUTEUS MAXIMUS | Nerve and major root supply of muscle

L5, S1, S2 | Inferior gluteal n.

SEMITENDINOSUS | Nerve and major root supply of muscle

L5, S1, S2 | Sciatic and tibial n.

BICEPS FEMORIS | Nerve and major root supply of muscle

L5, S1, S2 | Sciatic and tibial n.

SEMIMEMBRANOSUS | Nerve and major root supply of muscle

L5, S1, S2 | Sciatic and tibial n.

GASTROCNEMIUS and SOLEUS | Nerve and major root supply of muscle

S1/2 | Sciatic and tibial n.

TIBIALIS POSTERIOR | Nerve and major root supply of muscle

L4/5 | Sciatic and tibial n.

FLEXOR DIGITORUM LONGUS | Nerve and major root supply of muscle

L5, S1, S2 | Sciatic and tibial n.

FLEXOR HALLUCIS LONGUS | Nerve and major root supply of muscle

L5, S1, S2 | Sciatic and tibial n.

SMALL MUSCLES OF FOOT | Nerve and major root supply of muscle

S1/2 | Sciatic and tibial n.

TIBIALIS ANTERIOR | Nerve and major root supply of muscle

L4/5 | Sciatic and common peroneal n.

EXTENSOR DIGITORUM LONGUS | Nerve and major root supply of muscle

L5, S1 | Sciatic and common peroneal n.

EXTENSOR HALLUCIS LONGUS | Nerve and major root supply of muscle

L5, S1 | Sciatic and common peroneal n.

EXTENSOR DIGITORUM BREVIS | Nerve and major root supply of muscle

L5, S1 | Sciatic and common peroneal n.

PERONEUS BREVIS | Nerve and major root supply of muscle

L5, S1 | Sciatic and common peroneal n.

PERONEUS LONGUS | Nerve and major root supply of muscle

L5, S1 | Sciatic and common peroneal n.

DYSARTHRIA

Dysarthria is due to impaired coordination of the lips, palate, tongue and larynx and may result from extrapyramidal, brainstem or cerebellar le- sions. The volume and content of the speech will be normal but the enunciation will be distorted

SPASTIC DYSARTHRIA

This is due to bilateral upper motor neurone disease due to pseudobulbar palsy, motor neurone disease or brainstem tumours.

ATAXIC DYSARTHRIA

This is due to incoordination of the muscles of speech; the words are often staccato or scanning and the rhythm is jerky. This type of dysarthria is seen in cerebellopontine angle tumours, cerebellar lesions, multiple sclerosis and phenytoin toxicity.

RIGID DYSARTHRIA

This is characteristic of Parkinson’s disease. In severe cases the phenomenon of palilalia is seen.

EXPRESSIVE DYSPHAGIA

This is due to a lesion affecting either Broca’s area in the lower part of the precentral gyrus or the left posterior temporoparietal region. If the latter region is affected the patient may have a nominal dysphasia, in which the ability to name objects is lost but the ability to speak is retained.

RECEPTIVE DYSPHAGIA

This results from lesions in Wernicke’s area, which is the posterior part of the superior temporal gyrus and the adjacent pari- etal lobe.

ALEXIA

Inability to understand written speech. Alexia with agraphia (inability to write) is due to a lesion in the left angular gyrus often accompanied by nominal dysphasia, acalculia, hemianopia and visual agnosia

GERTSMANN SYNDROME

consists of finger agnosia for both the patient’s own finger and the examiner’s finger, acalculia, right/left disorientation and agraphia without alexia. It is found in lesions of the dominant hemisphere in the region of the angular gyrus.

Common causes of ANOSMIA

Olfactory nerve lesions from head injury, tumours involving the floor of the anterior cranial fossa - olfactory groove meningiomas

Examination of OLFACTORY NERVE

It is important to use non-irritant substances when testing olfaction, as irritating compounds (e.g. ammonia) will cause irritation of the nasal mucosa. The stimulus is then perceived by the general sensory fibres of the trigeminal nerve.

Examination of OPTIC NERVE

Visual acuity Colour vision Fundoscopy Pupillary light reflex

Foraml assessment of VISUAL FIELDS

Bjerrum screen | Goldmann perimeter

Pattern of visual field loss and anatomical site of lesion

Total visual loss - optic nerve lesion Altitudinous hemianopia - partial lesion of the optic nerve due to trauma or vascular accident Homonymous hemianopia - lesion of the optic tract, radiation or calcarine cortex Bitemporal hemianopia - optic chiasm lesion e.g. pituitary tumour, craniopharyngioma or suprasellar meningioma

FUNDOSCOPIC EXAMINATION

Optic disc Vessels Retina A pale optic disc is due to optic atrophy which may be either primary, as a result of an optic nerve lesion caused by compression or demyelination, or consecutive, which follows severe swelling of the disc. Papilloedema is due to raised intracranial pressure and is evident by: • blurring of the disc margins • filling in of the optic cup • swelling and engorgement of retinal veins, with loss of normal pulsation of the veins • haemorrhages around the disc margin (if severe)

Examination of OCCULOMOTOR, TROCHLEAR and ABDUCENS nerves

Position of Eyelid Pupils - size, shape, equality: direct/consensual Extraocular movements

PTOSIS

Due to paralysis of the levator palpebrae superioris as a result of a 3rd cranial nerve lesion or due to weakness of the tarsal muscle due to a sympathetic lesion (Horner’s syndrome).

MIOSIS

Unilateral constricted pupil oftenindicates a lesion in the sympathetic supply tothe pupillary dilator muscle.

HORNER'S SYNDROME

Horner’s syndrome, in its complete state, consists of miosis, ptosis, enophthalmos and dryness and warmth of half of the face. Due to a lesion of the sympathetic supply such as results from an intracavernous carotid artery aneurysm, or a Pancoast’s tumour of the apex of the lung.

MYRDRIASIS

Dilated pupil secondary to paralysis of the parasympathetic fibres originating from the Edinger-Westphalia nucleus in the midbrain. - Seen in CN III palsy Causes: enlarging PCA aneurysm, tentorial herniation from raised ICP with herniated uncus of the temporal lobe compressing the CN III

ARGYLL-ROBERTSON pupil

Small, irregular pupil not reacting to light Reacting to accommodation but responding poorly to mydriatics Usually caused by syphilis.

HOLMES-ADIE pupil

Myotopic pupil Usually occurs in young woman and presents as unilateral dilatation of one pupil with failure to react to light. In the complete syndrome the knee and ankle jerks are absent.

LATERAL RECTUS

CN VI moves the eye horizontally outwards.

MEDIAL RECTUS

CN III moves the eye horizontally inwards.

SUPERIOR RECTUS

CN III elevatest eh eye when it is turned outwards.

INFERIOR OBLIQUE

CN III elevates the eye when it is turned inwards.

INFERIOR RECTUS

CN III depresses the eye when it is turned outwards.

SUPERIOR OBLIQUE

CN IV derpesses the eye when it is turned inwards

Impaired CONJUGATE OCCULAR EYE MOVEMENT

The centre control of conjugate lateral gaze is situated in the posterior frontal lobe, with input from the occipital lobe. Final common pathway for controlling conjugate movement is the brainstem - median longitudinal bundle Frontal lobe lesion causes contralateral paralysis of conjugate gaze (i.e. eyes deviated towards lesion) Lesion of brainstem causes ipsilateral paralysis of conjugate gaze (i.e. eyes deviated away from lesion)