NEUROLOGIC ASSESSMENT

Mental Status

Cranial Nerve Exam

Motor Exam

Sensory Exam

Awake and alert Agitated Lethargic

Arousable with: Voice Gentle stimulation Painful/vigorous stimulation

Comatose

Fluency Naming Repetition Reading Writing Comprehension

Aphasia vs. dysarthria

Immediate
Really a measure of attention rather than

memory

Recent
3 objects at 0/3/5 minutes

Remote
Historical events

Person
Not who they are but who you are

Place
Time

Calculation Abstraction

Similarities/Differences
Judgment

Personality/Behavior

I - Olfactory
Dont use a noxious stimuli

Coffee; Lemon extract

II - Optic
Visual Acuity
Visual Fields

III/IV/VI-Oculomotor;Trochlear;Abducens
Pupillary Response Eye movements 9 cardinal positions Observe lids for ptosis

V - Trigeminal
Motor - jaw strength Sense - all 3 divisions

VII - Facial
Observe for facial asymmetry Forehead wrinkling, eyelid closure,

whistle/pucker

VIII - Vestibular/Acoustic
Acuity
Rinne, Weber

IX/X - Glossopharyngeal; Vagus

GAG

XI - Spinal Accessory
Sternocleidomastoid Muscle Trapezius Muscle

XII - Hypoglossal
Tongue strength Tongue thrusts right to left

Strength
Graded 0 - 5

- 0 No movement - 1 Flicker - 2 Movement with gravity removes - 3 Movement against gravity - 4 Movement against resistance - 5 Normal strength

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 the chair Deep knee bend

Include walking and turning Examples of abnormal gait

High steppage
Waddling

Hemiparetic
Shuffling

Muscle Tone- ranges from flaccid to taut Atonia - no muscle tone, no resistance Hypotonia-slight muscle tone, little resistance

Hypertonia- too much resistance

Spasticity- stiff, awkward movements Rigidity- tightness, inability to bend Involuntary movements tics, fasciculations (fine tremors) and tremors (resting or intentional).

Tremor
Rest With arms outstretched Intention

Chorea Athetosis Abnormal postures

Rapid Alternating Movements (RAM) Hand movements Tap finger to thumb, rapidly. Tap each finger to thumb rapidly. Pronate and supinate hands rapidly on knees Finger to nose test Eyes closed touch finger to nose alternating and increasing speed

Finger to finger test - Have pt. touch his fingertip to your fingertip, alter position.

Heel to shin test While supine or sitting,

have pt. run heel of one foot over the shin

of opposite leg

Tandem walk Heel to toe gait

Test for cerebellar dysfunction requiring the patient to stand with feet together,

eyes closed and arms extended.

Inability to maintain the position, with either significant stagger or sway, is a positive test.

Graded 0 - 4
0 No response 1+ Diminished (hypoactive) 2+ Normal 3+ Increased (may be interpreted as

normal 4+ Hyperactive (hyperreflexia)

Biceps Reflex Forearm flexes at elbow

Triceps Reflex Forearm extends at elbow

Brachioradialis Reflex Slight flexion of forearm at elbow and forearm pronation

Patellar Reflex leg extends at knee

Achilles Reflex Plantar flexion

Perform clonus testing if previous reflex testing reveals hyperactivity

Relax muscle of calf

Briskly dorsiflex foot and hold stretch

Clonus = rapid rhythmic contractions

NO CLONUS ( no movement) = normal

Abdominal - Umbilicus shifts toward stimulus

Cremasteric Testicle on same side of

stimulation rises

Babisnki (Plantar) Toes flex

Sensory Function: Perform all sensory testing with the patients eyes closed and test bilaterally.

Spinothalamic tract- pain, temp., touch Posterior (Dorsal) Columns position (proprioception), vibration and tactile discrimination (fine touch)

Vibration tuning fork to bony prominence Position (kinesthesia) Grasp toe or finger

and move it up/down or side/side.

Stereognosis place object in hand to identify (coin, paperclip). Graphesthesia trace letter or number on palm to identify.

Thank you!