Date post: | 03-Jun-2015 |
Category: |
Health & Medicine |
Upload: | randy-rosenberg |
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Or Why Can’t Neurologists KISS? (Keep It Simple
Stupid)?
Common Sense Aspects of the Neurological Exam
Visual Loss From Brain Injury
• Patients may see movement even if they can count static fingers
• Don’t forget that you can get field cuts with disease of the optic chiasm or optic tract (especially in MS)
• Superior cuts suggest involvement of the contralateral temporal occipital region
• Inferior cuts suggest involvement of the contralateral parietal occipital region.
Pupillary Reflexes
Afferent Pupillary Defect (Marcus Gunn Pupil)
Eye Simulator.html.lnk
What Six Little Eye Muscles Can Do
CN VI (ABDUCENS) AND III (OCULOMOTOR) PALSIES
Directions in Nystagmus
Horizontal
Upbeating vertical
Downbeating vertical
Direction in Nystagmus
Unidirectional
Bidirectional
Horizontal Nystagmus
First Degree
Second Degree
Third Degree
Horizontal Third Degree Nystagmus
Bidirectional Nystagmus in a Patient
Eye Movement Problems With Brain Injury
Doll’s Eye Reflex
CN VII (Facial)Peripheral v Central
Do-It-Yourself Cranial Nerve Exam
CN VIII (Auditory)Weber and Rinne Tests
• Weber test = Tuning fork over middle of head to lateralize hearing loss
• Rinne=bone conduction v air conduction
CN IX and X Palsy
• Absent gag on stimulated side
• Weakness of levator of palate
• Dysphonia secondary to vocal cord paralysis
CN XI (Spinal Accessory Nerve) Palsy
• Affects SCM and trapezius
• Shoulder shrugging tests trapezius
• Forward flexion of the next tests both SCM
• Most often injured with pathology of the anterior cervical triangle
CN XII (Hypoglassal) Palsy
• Atrophy and often fasculations on the side of the palsy
• Tongue deviates towards the side of the lesion
• Beware bilateral tongue atrophy and fasciculationsALS
Thinking About Biceps Jerk
Thinking About The Triceps Jerk
Thinking About the Brachioradialis Jerk
Thinking About the Knee Jerk
…Remember even
Presidents don’t know everything