The Full Neurological Examination

Summary

This video script offers a comprehensive guide to performing a full neurological examination. It covers patient introduction, gait observation, coordination tests, mental state assessment, and a detailed cranial nerve examination. The script also instructs on motor and sensory system evaluation, reflex testing, and sensory function assessment. It concludes with an examination of related structures and emphasizes the importance of hygiene and patient care.

Takeaways

• 🧼 Start with hygiene: Begin the neurological examination by washing your hands and introducing yourself to the patient.
• 🤝 Obtain consent: Always ask for the patient's permission before starting the examination and check for any pain they might have.
• 🚶‍♂️ Observe gait: Pay attention to the patient's walking pattern, looking for signs of weakness or abnormal movements.
• 🔍 Test coordination: Assess the patient's coordination by asking them to walk heel-to-toe and perform a Romberg's test for balance.
• 👁️ Visual assessment: Examine the patient's visual acuity, pupil reactions, and perform a funduscopic examination using an ophthalmoscope.
• 👃 Smell test: Evaluate the olfactory nerve by asking the patient to identify common smells with their eyes closed.
• 🗣️ Speech and memory: Test the patient's mental state with general knowledge and memory questions, like naming the prime minister or counting backward.
• 👂 Hearing check: Assess auditory function by whispering and using a tuning fork to differentiate between types of deafness.
• 💪 Motor function: Test the strength and tone of muscles in the arms and legs, comparing them with what is considered normal for the patient.
• 🔨 Reflexes: Test reflexes in the upper and lower limbs, looking for absent, brisk, or clonus responses, and check the plantar reflex for the Babinski sign.
• 🤲 Sensory testing: Evaluate sensation in the limbs using light touch, pinprick, vibration, and proprioception, noting any abnormalities in distribution or perception.

Q & A

What is the significance of starting a neurological examination with a full one rather than a focused one?

A full neurological examination is important to ensure that no important physical signs are missed, providing a comprehensive assessment of the patient's neurological status.

Why is it necessary to observe the patient's gait during the examination?

Observing the patient's gait helps identify any evident weakness of their limbs, abnormal arm swinging, and assesses coordination, which can indicate neurological issues.

What is the purpose of the Romberg's test in a neurological examination?

The Romberg's test assesses balance by observing if the patient can stand still with their feet together and eyes closed, which can indicate issues with proprioception or the vestibular system.

How does hand dominance impact a neurological examination?

Hand dominance is clinically significant as it can affect the interpretation of certain test results, such as those related to motor function and coordination.

What is the purpose of testing the patient's mental state with general knowledge and memory tests?

These tests help assess the patient's cognitive function, which can be affected by various neurological conditions, providing insight into their mental health.

How is the olfactory nerve (cranial nerve I) tested during a neurological examination?

The olfactory nerve is tested by asking the patient to recognize the smell of common objects with their eyes closed, which assesses their sense of smell.

What is the significance of testing the optic nerve (cranial nerve II) and how is it done?

The optic nerve is tested by assessing visual acuity through reading small and large print, and using a bright light to test pupil reactions, which helps evaluate vision and the function of the optic nerve.

Why is it important to test the patient's visual fields during the examination?

Testing visual fields helps identify any blind spots or areas of reduced vision, which can be indicative of neurological disorders affecting the visual pathways.

How are the motor and sensory functions of the trigeminal nerve (cranial nerve V) assessed?

The sensory function is tested by assessing touch sensation over the three divisions of the nerve, while the motor function is evaluated by feeling the masseter muscles while the patient clenches their jaw.

What does testing the facial nerve (cranial nerve VII) involve and why is it important?

The facial nerve is tested by observing the patient's ability to close their eyes tightly, frown, and blow out their cheeks against resistance, which assesses facial muscle strength and control.

How is the auditory nerve (cranial nerve VIII) tested, and what does it reveal about the patient's hearing?

The auditory nerve is tested by whispering to each ear and using a tuning fork to compare the noise heard by the patient, which helps differentiate between conductive and perceptive deafness.

What is the purpose of testing the patient's reflexes during a neurological examination?

Testing reflexes assesses the reflex arc and the influence of the super spinal system, providing information about the patient's motor neuron function and potential neurological disorders.

How can coordination and sensation in the limbs be tested during a neurological examination?

Coordination is tested by asking the patient to perform tasks like touching their nose and finger rapidly, while sensation is assessed using light touch, pinprick, and vibration sense tests.

Why is it important to examine related structures such as the skull, spine, and skin during a neurological examination?

Examining these structures helps identify any abnormalities or signs of neurological disorders, such as bony defects, spinal curvature issues, or skin changes associated with certain diseases.