Common Sense Aspects of the Neurological Exam

Or Why Can’t Neurologists KISS? (Keep It Simple

Stupid)?

Common Sense Aspects of the Neurological Exam

Visual Loss From Brain Injury

• Patients may see movement even if they can count static fingers

• Don’t forget that you can get field cuts with disease of the optic chiasm or optic tract (especially in MS)

• Superior cuts suggest involvement of the contralateral temporal occipital region

• Inferior cuts suggest involvement of the contralateral parietal occipital region.

Pupillary Reflexes

Afferent Pupillary Defect (Marcus Gunn Pupil)

Eye Simulator.html.lnk

What Six Little Eye Muscles Can Do

CN VI (ABDUCENS) AND III (OCULOMOTOR) PALSIES

Directions in Nystagmus

Horizontal

Upbeating vertical

Downbeating vertical

Direction in Nystagmus

Unidirectional

Bidirectional

Horizontal Nystagmus

First Degree

Second Degree

Third Degree

Horizontal Third Degree Nystagmus

Bidirectional Nystagmus in a Patient

Eye Movement Problems With Brain Injury

Doll’s Eye Reflex

CN VII (Facial)Peripheral v Central

Do-It-Yourself Cranial Nerve Exam

CN VIII (Auditory)Weber and Rinne Tests

• Weber test = Tuning fork over middle of head to lateralize hearing loss

• Rinne=bone conduction v air conduction

CN IX and X Palsy

• Absent gag on stimulated side

• Weakness of levator of palate

• Dysphonia secondary to vocal cord paralysis

CN XI (Spinal Accessory Nerve) Palsy

• Affects SCM and trapezius

• Shoulder shrugging tests trapezius

• Forward flexion of the next tests both SCM

• Most often injured with pathology of the anterior cervical triangle

CN XII (Hypoglassal) Palsy

• Atrophy and often fasculations on the side of the palsy

• Tongue deviates towards the side of the lesion

• Beware bilateral tongue atrophy and fasciculationsALS

Thinking About Biceps Jerk

Thinking About The Triceps Jerk

Thinking About the Brachioradialis Jerk

Thinking About the Knee Jerk

…Remember even

Presidents don’t know everything