Transcript Slide 1
Focused Neuro Exam Loren Bellows Norwalk Hospital – Surgery Rotation Comprehensive Neuro Exam Components • General Appearance – Posture, motor activity, speech • Mental Status exam • Cranial Nerves • Motor Function – Atrophy, tone, strength • Sensory – Vibratory, Position, sharp/dull, temperature • Reflexes • Cerebellar – Coordination, gait, Romberg’s Focused Neuro Exam • Three Exam Classifications – The Comatose Patient • Unresponsive, Profound state of unconsciousness • Example: Trauma, Neurogenic Shock – The Patient with Central Neurologic Disorder • Dysarthria, Aphasia, Partial Paralysis • Example: Stroke, Intracranial Bleed – The Patient with Spinal Cord Disorder • Dysaesthesia, Incontinence, Pain, Weakness • Example: Disk Herniation, Spinal Cord Compression, BrownSequard Syndrome Focused Exam: The Comatose Patient • Glasgow Coma Scale 6 5 4 3 2 1 Eyes N/A N/A Opens eyes spontaneously Opens eyes in response to voice Opens eyes to painful stimuli Does not open eyes Verbal N/A Oriented, converse s normally Confused, disoriented Utters inappropriate words Incomprehensible sounds Makes no sounds Motor Obeys commands Localizes painful stimuli Withdraws from painful stimuli Decorticate posturing upon painful stimuli Decerebrate posturing upon painful stimuli Makes no movements Interpretation: GCS < 8 = Severe, GCS 9-12 = Moderate, GCS > 13 = Minor Focused Exam: The Comatose Patient (con’t) • Brain Reflexes – – – – – • • • • Oculocephalic Reflex (Doll’s eyes) Babinski Gag Reflex (CN 9, 10) Corneal Reflex (CN 5) Cold Calorics Pupillary Response Response to Pain DTRs Gaze (Ping-Pong Gaze) Focused Exam: Central Neuro Disorder • • • • • • • • • CNs Speech Coordination Pronator Drift Motor Sensation Proprioception Graphesthesia Stereognosis Focused Exam: Spinal Cord Disorder • • • • • • • • • Sensation Motor Hot/Cold Vibratory Sense Proprioception Gait DTRs Rectal Tone Hoffman’s Sign Motor Function Testing • Lack of Consistency: – Patient: 90 y/o female vs. 20 y/o male – Examiner • Motor Weakness helps to pinpoint spinal cord lesion Keys to the Motor Exam • • • • Have patient perform movement First! One side at a time; Compare R vs L Examiner: Use the same hand throughout exam Examiner: Don’t be a wimp! Use full and consistent strength (unless there is known injury). – Use single muscle group, i.e. don’t use your body weight to oppose. • Important to assign a specific response to a set grade • Test Certain Muscle Groups Grading Strength • 5/5: Examiner is unable to overcome patient • 4/5: Examiner is able to overcome patient; patient demonstrates moderate resistance • 3/5: Patient able to overcome gravity only • 2/5: Patient unable to overcome gravity, but can move joint • 1/5: Muscle “fires”, but no joint movement • 0/5: No muscle response • May use +/- to differentiate further Strength Testing: The Muscle Groups • Upper extremities: Action Nerve Root / Spinal Level Shoulder Abduction C5 Elbow Flexion C5/C6 Elbow Extension C6/C7/C8 Wrist Extension C6 Wrist Flexion C7 Grip Strength (Finger Flexion) C8 Interosseous (Finger Ab/Adduction) T1 Strength Testing: The Muscle Groups • Lower Extremities: Action Hip Flexion Nerve Root / Spinal Level L1 Knee Extension L3 Ankle Dorsiflexion L4 Great Toe Extension L5 Ankle Plantarflexion S1 Nerve Root Landmarks • • • • • • C3 – Front of Neck T 4 – Nipples T 10 – Umbilicus L3 – Knee L4 – Medial LE L5 – Lateral LE & Great Toe Questions??