Neurologic Examination.ppt

Neurologic Examination.ppt

• 1.
  The Neuro Exam Yes,you really do have to wake them up and do this Last Updated by Lindsay Pagano Summer 2013
• 2.
  What are thecomponents and how do I document them? Neuro: • Mental Status • Language, Speech • Cranial Nerves • Motor • Reflexes • Sensory • Cerebellar • Gait
• 3.
  What are wechecking and how? Mental Status • What? – Level of alertness, awareness – Degree of interaction – Orientation – Following commands – Older children: naming objects, simple calculations, extinction, neglect, fund of knowledge – Difference from baseline • How?
• 4.
  Language, Speech • Language –comprehension – spontaneous, fluent – appropriate content – other things you can check: repetition, naming objects, reading, writing • Speech – prosody – volume – rate – dysarthria
• 5.
  Cranial Nerves • CN1: Olfactory…yeah, we don’t check that either • CN 2: Optic – Visual acuity – Visual fields – Fundus • CN 3: Oculomotor – Pupil reactivity to light (direct and consensual) and accomadation – Extraocular eye movements (superior, medial and inferior recti; inferior oblique) • CN 4: Trochlear – Extraocular eye movements (superior oblique) • CN 5: Trigeminal – Muscles of mastication – Facial sensation (V1, 2, 3 divisions) • CN 6: Abducens – Extraocular eye movements (lateral rectus)
• 6.
  Cranial Nerves, continued •CN 7: Facial – Facial muscles – Taste (anterior 2/3) • CN 8: Vestibulocochlear – Hearing – Vestibular function • CN 9: Glossopharyngeal – Taste (posterior 1/3) – Uvula • CN 10: Vagus – Phonation – Palate elevation • CN 11: Spinal accessory – Head turn – Shoulder shrug • CN 12: Hypoglossal – Tongue protrusion
• 7.
  Motor • Tone • Musclebulk • Strength: check agonist/antagonist pairs – Grading system • 0: no movement • 1: can see muscle contraction but no movement • 2: can move with gravity eliminated • 3: can move against gravity • 4: can resist opposition to some extent, but not full (+, - also) • 5: full strength – Pronator drift: correct position! – Orbiting • Abnormal movements
• 8.
  Reflexes • Grading system –0: absent – 1+: hyporeflexic – 2+: normal – 3+: brisk, without clonus – 4+: brisk, with clonus • More pathologic descriptors: crossed, spreading • Where to check • Clonus – Sustained – Unsustained • Other reflexes: pectoral, grasp, suck, moro, jaw jerk • Plantar response
• 9.
  Sensory • How andwhat part of the nervous system are we checking? – Light touch – Pinprick – Temperature – Vibration – Joint position sense • Checking a level • Romberg- correct positioning!
• 10.
  Cerebellar • Ataxia – Axial –Appendicular • Finger-nose-finger • Heel-knee-shin • Rapid alternating movements
• 11.
  • Casual • Toe •Heel • Tandem • What are those last 3 testing? Gait
• 12.
  Other Neuro RotationTips • Neuro exam on all patients • Report all AEDs in per dose and mg/kg/day • Know the patients primary neurologist • When applicable know the last head imaging and EEG done and the results • Make sure after their inpatient stay they have follow up and a breakthrough seizures plan/medication • In clinic, be sure to ask birth history, developmental history (gross motor, fine motor, language, social), about school performance, therapies