Central Nervous System examination. MENTAL STATUS CRANIAL NERVES MOTOR EXAM STRENGTH GAIT...
Preview:
Citation preview
- Slide 1
- Central Nervous System examination
- Slide 2
- MENTAL STATUS CRANIAL NERVES MOTOR EXAM STRENGTH GAIT
CEREBELLAR REFLEXES SENSATION
- Slide 3
- Awake and alert Agitated Lethargic Arousable with Voice Gentle
stimulation Painful/vigorous stimulation Comatose
- Slide 4
- PERSON PLACE TIME
- Slide 5
- FLUENCY NAMING REPETITION READING WRITING COMPREHENSION
Aphasia
- Slide 6
- IMMEDIATE REMOTE - Name 3 OBJECTS and ask to repeat HISTORICAL
EVENTS PERSONAL EVENTS
- Slide 7
- CALCULATION ABSTRACTION SIMILARITIES/DIFFERENCES JUDGEMENT
PERSONALITY/BEHAVIOR
- Slide 8
- How and what part of the nervous system are we checking? Light
touch Pinprick Temperature Vibration Joint position sense Checking
a level Romberg- correct positioning!
- Slide 9
- VIBRATION 128 hz tuning fork JOINT POSITION SENSE PIN PRICK
TEMPERATURE Start distally and move proximally
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Grading system 0: absent 1+: hyporeflexia 2+: normal 3+: brisk,
without clonus 4+: brisk, with clonus
- Slide 14
- BICEPS BRACHIORADIALIS TRICEPS KNEE ANKLE
- Slide 15
- Planar reflex(S1) Normal- On stroking the lateral border of the
sole there is flexion of the big toe and other toes.
- Slide 16
- Extensor plantar response Babiniski sign Dorsiflexion of the
big toe and ankle joint and fanning of the other toes.
- Slide 17
- I - OLFACTORY DONT USE A NOXIOUS STIMULUS COFFEE, LEMON EXTRACT
II - OPTIC VISUAL ACUITY VISUAL FIELDS FUNDOSCOPIC EXAM
- Slide 18
- III/IV/VI OCULMOTOR, TROCHLEAR, ABDUCENS PUPILLARY RESPONSE EYE
MOVEMENTS 9 CARDINAL POSITIONS OBSERVE LIDS FOR PTOSIS V -
TRIGEMINAL MOTOR - JAW STRENGTH SENS - ALL 3 DIVISIONS
- Slide 19
- VII - FACIAL OBSERVE FOR FACIAL ASYMMETRY FOREHEAD WRINKLING,
EYELID CLOSURE, WHISTLE/PUCKER VIII - VESTIBULAR ACUITY RINNE,
WEBER
- Slide 20
- IX/X - GLOSSOPHARYNGEAL, VAGUS GAG XI - SPINAL ACCESSORY
STERNOCLEIDOMASTOID M. TRAPEZIUS MUSCLE XII - HYPOGLOSSAL TONGUE
STRENGTH RIGHT XII THRUSTS TONGUE TO LEFT
- Slide 21
- ATROPHY FASCIULATIONS
- Slide 22
- TREMOR REST WITH ARMS OUTSTRETCHED INTENTION CHOREA ATHETOSIS
ABNORMAL POSTURES
- Slide 23
- RAPID ALTERNATING MOVEMENTS FINGER TO FINGER TO NOSE TESTING
HEEL TO SHIN GAIT TANDEM
- Slide 24
- Stand with feet together - assure patient stable - have them
close eyes Romberg is positive if they do worse with eyes closed
Measures Cerebellar function Frequently poor balance with eyes open
and closed Proprioception Frequently do worse with eyes closed
Vestibular system
- Slide 25
- Tone Muscle bulk Strength: check agonist/antagonist pairs
Abnormal movements Motor
- Slide 26
- Slide 27
- STRENGTH GRADED 0 - 5 0 - NO MOVEMENT 1 - FLICKER 2 - MOVEMENT
WITH GRAVITY REMOVED 3 - MOVEMENT AGAINST GRAVITY 4 - MOVEMENT
AGAINST RESISTANCE 5 - NORMAL STRENGTH
- Slide 28
- UPPER AND LOWER EXTREMITIES DISTAL AND PROXIMAL MUSCLES GRIP
STRENGTH IS A POOR SCREENING TOOL FOR STRENGTH SUBTLE WEAKNESS TOE
WALK, HEEL WALK OUT OF CHAIR DEEP KNEE BEND
- Slide 29
- INCREASED, (Hypertonia) COGWHEEL rigidity CLASP KNIFE
spasticity DECREASED, (Hypotonic)
- Slide 30
- Slide 31
- 1. Ask the subject if he/she has a subjective olfactory
problem. 2. Check for rash, deformity of nose. 3. One nostril is
occluded while examining the other. Use pleasant odor substances
like tea or rose water. Dont use irritating substances
- Slide 32
- There are three main aspects to this nerve: visual acuity,
visual fields, and fundi opticus. 1. Examine visual acuity: 2.
Examine visual fields: 3. Look into the fundi:
- Slide 33
- CN III Oculomotor: Eyelid and eyeball movement CN IV Trochlear:
Innervates superior oblique Turns eye downward and laterally CN VI
Abducens: Turns eye laterally Cranial Nerves III, IV and VI supply
the muscles of eye movement and are tested as a unit.
- Slide 34
- 1. Appearance of eyes: 2. Eyeball movement: 3. Look at pupils:
4. Test pupillary light reaction: 5. Pupillary reaction to
convergence and accommodation reflex:
- Slide 35
- Functions: Chewing Face & mouth touch & pain 1. Facial
sensation: 1) Use sterile sharp item on forehead, cheek and jaw. 2)
If abnormal, then test temperature [water-heated/cooled tuning
fork], light touch [cotton].
- Slide 36
- 2. Motor: Subject opens mouth, clenches teeth. 1) Palpate
temporal, masseter muscles as they clench. 2) Subject opens mouth;
assess the symmetry of the mouth.
- Slide 37
- 3. Corneal reflex: Ask the patient looks up and straight. 1)
Touch cotton wool to the sclera on the other side. 2) Look for
blink in both eyes, ask if subject can sense it. 3) Repeat on the
other side.
- Slide 38
- 4. Test jaw jerk: 1) Examiner places finger on tip of jaw. 2)
Grip patellar hammer halfway up shaft and tap examiner s finger
lightly. 3) Usually nothing happens, or just a slight closure
- Slide 39
- Functions: controls most facial expressions, secretion of tears
& saliva, taste 1. Muscles of facial expression: 2. Check the
sense of taste:
- Slide 40
- Slide 41
- Functions: hearing; equilibrium sensation Auditory acuity 1.
Rinne test: 2. Weber test: Vestibular function:
- Slide 42
- Slide 43
- CN IX Glossopharyngeal: taste senses carotid blood pressure CN
X Vagus: senses aortic blood pressure slows heart rate stimulates
digestive organs taste
- Slide 44
- Slide 45
- 1. Sternocleidomastoid Press a hand against the patient's jaw
and have the patient rotate the head against resistance. Pressing
against the right jaw tests the left sternocleidomastoid and vice
versa. 2. Trapezius Have the patient shrug shoulders against
resistance and assess weakness.
- Slide 46
- 1. Listen to articulation. 2. Inspect tongue in mouth for
wasting, fasciculations. 3. Protrude tongue: deviates to affected
side.
- Slide 47
- TREMORS They are regular rhythmic movements. STATIC TREMOR
1.parkinsonism 2.senile POSTRUAL TREMORS Anxiety Familial
Hyperthyroidsm
- Slide 48
- Some useful tests for detection of deficiencies in motor
function of the palate, pharynx, and larynx are described below.
Sensory function needs to be checked if one suspects cranial
neuropathy or a brain stem lesion. 1. Palatal Elevation 2. Gag
reflex (afferent IX, efferent X) 3. Sensory function 4. Voice
Quality 5. Taste test see CN VII
- Slide 49
- INTENTION TREMORS Cerebellar Severe parkinsonism HYSTERICAL
TREMORS
- Slide 50
- Quick jerky irregular brief movements. Causes Infections
Hereditary Endocrine Collagen disorders Liver disease like Wilson
disease Myoclonus Muscular contractions
- Slide 51
- Grading of level of coma Grade -0 Fully conscious
Grade1-Drowsy,but responds to verbal commands Grade 2-Unconscious
but responds to minimal pain Grade3-unconscious but responds to
deep pain Grade4- Unconscious with no response to pain
- Slide 52
- Slide 53
- Slide 54
- The sum of these values is calculated. The minimum GCS is 3
(deep coma) The maximum is 15 GCS 11-15 good prognosis GCS 5-10
intermediate GCS 3-4 poor prognosis
- Slide 55
- RAPID ALTERNATING MOVEMENTS FINGER TO FINGER TO NOSE TESTING
HEEL TO SHIN GAIT TANDEM
- Slide 56
- Stand with feet together - assure patient stable - have them
close eyes Romberg is positive if they do worse with eyes closed
Measures Cerebellar function Frequently poor balance with eyes open
and closed Proprioception Frequently do worse with eyes closed
Vestibular system
- Slide 57
- Meningeal signs Neck stiffness- Causes Meningitis Subarchonoid
hemorrhage Cervical spondylosis
- Slide 58
- Kernigs sign With the hip flexed the knee is extended. Normally
it can be done upto 135 degree. In meningitis it is restricted due
to spasm of the hamstrings.
- Slide 59
- Brudzinskis sign Neck sign Leg sign