Neurological Examination

Authors

Paul D. Larsen, M.D. University of Nebraska School of Medicine

Suzanne S. Stensaas, Ph.D. University of Utah School of Medicine

 

About

The "Neurological Examination Videos" uses over 250 video demonstrations and narrative descriptions in an online tutorial. It presents the anatomical foundations of the neurologic exam and provides examples of both normal and abnormal conditions as exhibited by patients.

 

This library combines the use of anatomical diagrams, live patient exams, video patient cases and self-evaluation tools to accomplish its educational goals. It utilizes clinical video patient cases as digital movie files that can be viewed online.

 

Anatomy and pathology of the nervous system is understood by directly visualizing it. This is best accomplished by handling the brain (or model of the brain as the case may be) and dissecting or taking it apart for direct examination. The purpose (for the clinician) of understanding neuroanatomy and neurophysiology is to be able to use that knowledge to solve clinical problems.

 

The first step in solving a clinical problem is anatomical localization. So, if one cannot directly inspect the patient's brain, how is this localization accomplished? The "WINDOW TO THE PATIENT'S BRAIN" is the neurological examination. A neuro exam is a series of tests and observations that reflects the function of various parts of the brain. If the exam is approached in a systematic and logical fashion that is organized in terms of anatomical levels and systems, then the clinician is lead to the anatomical location of the patient's problem.

 

Introduction

• "Window" to the Brain

• "x", "y" Graph

• "y" Values

• "x" Values

• Longitudinal Systems

• Corticospinal Tracts

• Somatosensory Tracts

• Mental Status

• Cranial Nerve

• Coordination

• Sensory

• Motor

• Gait

• Overview

Mental Status > Anatomy

• Introduction

• Frontal Lobes

• Temporal Lobes

• Language - Temporal & Frontal Lobes

• Parietal Lobes

• Occipital Lobes

• Traps

• Pearls

Mental Status > Normal

• Orientation, Memory

• Attention-working memory

• Judgement-abstract reasoning

• Set generation

• Receptive language

• Expressive language

• Praxis

• Gnosis

• Dominant parietal lobe function

• Non-dominant parietal lobe function

• Visual recognition

Mental Status > Abnormal

• Orientation, Memory

• Attention-working memory

• Judgement-abstract reasoning

• Set generation

• Receptive language

• Expressive language

• Praxis

• Gnosis

• Dominant parietal lobe function

• Non-dominant parietal lobe function

• Visual recognition

Mental Status > Media Resources

• Spastic Dysarthria

• Flaccid (LMN) Dysarthria

• Dystonic Dysarthria

• Spasmodic Dysphonia

• Confabulation

Cranial Nerve > Anatomy

• Introduction

• Cranial Nerve 1

• Cranial Nerve 2

• Cranial Nerve 3 and 4

• Pontine Level

• Cranial Nerve 6

• Major Oculomotor Gaze Systems

• Cranial Nerve 5

• Cranial Nerve 7

• Cranial Nerve 8

• Medullary Level

• Cranial nerves 9 and 10

• Cranial Nerve 11

• Cranial Nerve 12

• Traps

• Pearls  

Cranial Nerve > Normal

• Cranial Nerve 1- Olfaction 

• Cranial Nerve 2- Visual acuity 

• Cranial Nerve II- Visual fields 

• Cranial Nerve II- Fundoscopy 

• Cranial Nerves 2 & 3- Pupillary Light Reflex 

• Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignment 

• Cranial Nerves 3, 4 & 6- Versions 

• Cranial Nerves 3, 4 & 6- Ductions 

• Supranuclear gaze systems- Introduction 

• Saccades 

• Smooth Pursuit 

• Optokinetic Nystagmus 

• Vestibulo-ocular reflex 

• Vergence 

• Cranial Nerve 5- Sensory 

• Cranial Nerves 5 & 7 - Corneal reflex 

• Cranial Nerve 5- Motor 

• Cranial Nerve 7- Motor 

• Cranial Nerve 7- Sensory, Taste 

• Cranial Nerve 8- Auditory Acuity, Weber & Rinne Tests 

• Cranial Nerve 8- Vestibular 

• Cranial Nerves 9 & 10- Motor 

• Cranial Nerves 9 & 10- Sensory and Motor: Gag Reflex 

• Cranial Nerve 11- Motor 

• Cranial Nerve 12- Motor

Cranial Nerve > Abnormal

• Cranial Nerve 1- Olfaction 

• Cranial Nerve 2- Visual acuity 

• Cranial Nerve II- Visual fields 

• Cranial Nerve II- Fundoscopy 

• Cranial Nerves 2 & 3- Pupillary Light Reflex 

• Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignment 

• Cranial Nerves 3, 4 & 6- Versions 

• Cranial Nerves 3, 4 & 6- Ductions 

• Saccades 

• Smooth Pursuit 

• Optokinetic Nystagmus 

• Vestibulo-ocular reflex 

• Vergence 

• Cranial Nerve 5- Sensory 

• Cranial Nerves 5 & 7 - Corneal reflex 

• Cranial Nerve 5- Motor 

• Cranial Nerve 7- Motor 

• Cranial Nerve 7- Sensory, Taste 

• Cranial Nerve 8- Auditory Acuity, Weber & Rinne Tests 

• Cranial Nerve 8- Vestibular 

• Cranial Nerves 9 & 10- Motor 

• Cranial Nerves 9 & 10- Sensory and Motor: Gag Reflex 

• Cranial Nerve 11- Motor 

• Cranial Nerve 12- Motor

Cranial Nerve > Media Resources

• Pseudobulbar Palsy

Coordination > Anatomy

• Introduction

• Subdivisions

• Vestibulocerebellum

• Spinocerebellum

• Midline Ataxia

• Cerebrocerebellum

• Exam Tests

• Traps

• Pearls

Coordination > Normal

• Speech Rapid Alternating Movement

• Tremor

• Rebound

• Check Reflex

• Hand Rapid Alternating Movement

• Finger-to-nose

• Foot Rapid Alternating Movement

• Toe-to-finger

• Heel-to-shin

• Station

• Natural Gait

• Tandem Gait

Coordination > Abnormal

• Speech Rapid Alternating Movement

• Tremor

• Rebound

• Check Reflex

• Hand Rapid Alternating Movement

• Finger-to-nose

• Foot Rapid Alternating Movement

• Toe-to-finger

• Heel-to-shin

• Station

• Natural Gait

• Tandem Gait

Sensory > Anatomy

• Introduction

• Spinothalamic

• Dorsal Column-Medial Lemniscus

• Trigeminal System

• Level of Crossing

• Location of Tracts

• Trigeminal Crossing

• Sensory Dissociation

• Crossed Findings

• Exam Tests

• Traps

• Pearls

Sensory > Normal

• Light Touch

• Pain – Upper Extremities

• Pain – Lower Extremities

• Temperature

• Vibratory

• Position Sense

• Tactile Movement

• Two-Point Discrimination

• Graphesthesia

• Stereognosis

• Double Simultaneous Stimulation

• Romberg Test

Sensory > Abnormal

• Light Touch

• Pain – Upper Extremities

• Pain – Lower Extremities

• Temperature

• Vibratory

• Position Sense

• Tactile Movement

• Two-Point Discrimination

• Graphesthesia

• Stereognosis

• Double Simultaneous Stimulation

• Romberg Test

Motor > Anatomy

• Introduction

• Control Circuits

• Brainstem Motor Control Centers

• Upper Motor Neuron Lesion

• UMN Lesion Clinical Findings

• LMN Lesion Clinical Findings

• UMN Syndrome

• Decorticate vs. Decerebrate

• Localizing a UMN Lesion

• Spinal Cord Lesions

• Exam Tests

• Traps

• Pearls

Motor > Normal

• Upper extremities – Inspection & Palpation

• Tone - Upper extremity

• Strength testing

• Stretch or Deep Tendon Reflexes

• Testing for pronator drift

• Lower extremities – Inspection & Palpation

• Tone - Lower extremity

• Strength testing

• Stretch or Deep Tendon Reflexes

• Plantar Reflex

• Pathological reflexes

• Strength testing using squat & rise, heel & toe

Motor > Abnormal

• Upper extremities – Inspection & Palpation

• Tone - Upper extremity

• Strength testing

• Stretch or Deep Tendon Reflexes

• Testing for pronator drift

• Lower extremities – Inspection & Palpation

• Tone - Lower extremity

• Strength testing

• Stretch or Deep Tendon Reflexes

• Plantar Reflex

• Pathological reflexes

• Strength testing using squat & rise, heel & toe

Gait > Anatomy

• Introduction

• Localizing Value

Gait > Normal

• Station

• Natural Gait

• Heel and Toe Walking

• Tandem Gait

Gait > Abnormal

• Hemiplegic Gait Demonstration

• Diplegic Gait Demonstration

• Neuropathic Gait Demonstration

• Myopathic Gait Demonstration

• Parkinsonian Gait Demonstration

• Choreiform Gait Demonstration

• Ataxic Gait Demonstration

• Hemiplegic Gait

• Diplegic Gait

• Neuropathic Gait

• Myopathic Gait

• Parkinsonian Gait

• Choreiform Gait

• Ataxic Gait

Another companion to the ADULT NEUROLOGIC EXAM is the PEDIATRIC NEUROLOGIC EXAMINATION, where the neurological examination of the pediatric patient is couched within the context of neurodevelopmental milestones for Newborns, 3 month-olds, 6 month-olds, 12 month-olds, 18 month-olds, and 2-and-a-half year-olds.