Neuro Exam

Mental Status

  • conscious, unconscious, coma, yawning, sweating, intubated, sedated

  • Awake: alert

  • Stuperous: drunk but still awake

  • Obtunded: passed out, responds to stimuli

  • Coma: passed out, not responsive

  • Cadence: response time/rhythm

  • Orientation: AOX3 not helpful, ask about hobbies, recent news

  • Hallucination: ask if bothered or acts on them

  • Calculations: how many quarters in $2.25

CN

CN2

  • visual acuity

  • visual fields: which side moves with hands

  • Fundoscopy: look for papilledema. Right side, right eye, right hand with scope, left hand on shoulder. Turn light to 30%

CN3

  • direct, consensual response, convergence

CN 3, 4, 5

  • saccades: smooth eye movementents

    • length: how far can go before stop and start again

    • velocity: how quickly

  • decreased length and velocity in Huntington

Double vs Blurry Vision

  • Double vision: focused, not aligned

  • blurry vision: not focused

CN 5

  • open mouth: lateral pterygoid

  • if there's lesion, jaw will be pulled to side of lesion

  • blink reflex: wet cotton, bed sheet edges

CN 7

  • LMN: nerve, forehead wrinkled

  • UMN: brain problem, forehead smooth

CN 9/10

  • check both palate sides with Qtip

  • top of uvula deviates away from lesion

  • don't have to check gag reflex on everyone

CN 11

  • tongue out, look faor fasciculus

Motor

  • look for atrophy, fasciculus, strength, bradkinesia

  • Motor exam:

    • 0: no strength

    • 1: no range

    • 2: full range. Weaker than gravity. Can't lift, can't hold

    • 3: equal to gravity. Can't lift but can hold up to gravity

    • 4: stronger than gravity, not normal

    • 5: normal

  • spasticity vs rigidity: spasticity in stroke. Rigidity just stiff

  • protonator drift: protonates + falling arm

  • finger nose finger: fully extend arm. If tremorous, touch chin

  • heel shin: laying down most official. Heel on shin, go down, move back to shin.

  • Romberg: needs visual correction, feet sensation, cerebellar correction

    • primary: sensation disrupted, B12, DM

    • secondar: CNS

  • DTR

    • 0: nothing

    • 2: normal

    • 4: clonus, repeated sustained beats

  • Babinski: back to front

Sensory

  • light touch: use fingers on both sides, ask which side touched. Pt close eyes

  • pin prick: Q tip in halves

  • temperature: use tuning fork

  • vibration: start at. foot, big toe, count to 11. If not present, check maleolus, knee, thumb, wrist, elbow, shoulder

  • Graphesthesia: face same as patient, write letter/number

  • stereognosia: things in hand

  • 2 point: Q tip, same time

  • join position: grab big toe/thumb, move up/down

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