Neuro Exam

～神経系の身体診察法～

Cranial nerves

1)　Olfactory; test sense of smell on each side

★★Loss of smell
sinus conditions, head trauma, smoking, aging　
the use of cocaine ,Parkinson disease

2)　Optic; assess visual acuity, check visual fields and inspect optic disc

★Abnormalities★
visual acuity→blindness
visual fields→hemianopia
optic disc→papilledema, optic atrophy

２,３）optic and oculomoter; check reactions to light

３,４,６）oculomotor, trochlear, and abducens; assess extraocular movements

★Abnormalities　＝＝＞　Strabismus, nystagmus …etc

5) trigeminal
check touch sensations, contractions of temporal and masseter muscles corneal refluxes.

7) facial; assess raising eyebrows, showing teeth and puffing out cheeks

8) acoustic; assess hearing→Weber test and Rinne test (if necessary)

9,10) glossopharyngeal and vagus

assess swallowing, voice, soft palate rise and gag refluxes  

11) accessory; assess the strength of Trapezius muscles and Sternomastoid muscles

★Trapezius muscle paralysis★
the shoulder droops, and the scapula is displaced downward and laterally

12) hypoglossal

listen pt’s articulation and inspect the resting and protruded toungue

motor system

body position, involuntary movements, muscle tone and muscle strength

Involuntary movements’ abnormalities;
　 tremors, fasciculations …
muscle tone abnormalities
　 spasticity, rigidity and flaccidity
muscle strength

 biceps/triceps/wrist extension/grip/finger abduction/thumb opposition/trunk
 hip flexion/hip abduction/knee extension/knee flexion/ankle dorsiflexion/ankle 　　plantar flexion

coordination
rapid alternative movements/point to point movements/gait/stance
★★Pronator drift
Flexion and pronation at elbow and downward drift of arm from contralateral　corticospinal　tract lesion

sensory system

sharp and dull sensation/vibration/position etc.
compare symmetric areas on the two sides of the body and proximal to distal areas of the extremities for pain, temperature and touch sensation.

★Sensory loss
hemisensory deficits, glove and stocking loss, dermatomal loss…
★Loss of vibration and position sense★　　peripheral neuropathy

• diabetes, alcoholism
• posterior column disease from syphilis or B12 deficiency

refluxes

●deep tendon refluxes; biceps(C5,6)/triceps(C6,7)/brachioradialis(C5,6)/knee(L2,3,4)/ankle(S1)

●cutaneous stimulation reflexes： abdominal reflux/anal reflux

★★Upper motor neuron lesions
＝＞　hyperactive deep tendon reflexes
＝＞　absent abdominal reflexes
＝＞　 Babinski response
Cutaneous stimulaton refluxes

may be absent with upper or lower neuron lesions

<< Special techniques>

meningeal signs Kernig’s sign/Brudzinski’s sign
lumbosacral radiculopath(straight leg raise)pain and muscle weakness if herniated disc
Asterixis liver disease or uremia hypercapnia

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