EXAMINATION OF Aroosha Abrar

NERVOUS SYSTEM
INTRODUCTION
Examination of the nervous system consists of
Conscious level
Higher mental function
Motor system
Sensory system
Cranial nerves
CONSCIOUS LEVEL
Glasgow coma scale
HIGHER MENTAL FUNCTION
Cognitive skills
 Fluent language
 Understanding spoken commands
 Naming objects, reading, writing
 Finding way and copying a pattern

Memory
 Ask about present illness
 Ask about something from years ago

Reasoning and problem solving

 Ask patient to explain a proverb or reverse days of week

Emotional state
 Depression
 Excitement
MOTOR SYSTEM
Appearance
 Asymmetry or deformity
 Muscle wasting or hypertrophy
 Fasciculations

Tone
 Tone assessed through alternate flexion and extension at large joints. Feel hypertonia or hypotonia
 Hypertonia ( clasp knife, lead pipe, cog wheel)
 Hypotonia
 Clonus ( series of involuntary muscle contraction initiated by stretch)

Power ( muscle grading 0-5)

Reflexes + grading (0 - ++++)
 (Biceps, triceps, brachioradialis, ankle, knee) ( planter, abdominal, cremasteric)

Co ordination
 Finger to nose test ( past pointing, intention tremor)
 Rapidly alternating movements
 Heel shin test
 Rebound
SENSORY SYSTEM
Pain
 Use a new needle for exam

Touch
 Response verbally with closed eyes to touch with cotton

Temperature
 Use tubes filled with hot and cold water

Vibration
 Tunning fork

Proprioception
 Dip pip of upper limb

Two point discrimination

 On fingers
 On back
RAPID CRANIAL NERVE
EXAMINATION
OLFACTORY NERVE
Each nostril is separately examined using different non pungent substances in bottle.
OPTIC NERVE
Visual acuity
 Near vision checked through book reading and far vision through Snellen Chart

Color vision
 Ishihara Chart

Field of vision
 Confrontation method

Fundoscopy
 Fundoscopic examination is a visualization of the retina using an ophthalmoscope to diagnose high
blood pressure, diabetes, endocarditis etc.
OCULOMOTOR TROCHLEAR
AND ABDUCENT(3 4 6)
Eyelids
 Ptosis

Pupil
 Shape, size, reaction to light, and reflex

Eye movement in all direction with respect to muscle action

TRIGEMINAL NERVE
Sensory
 Corneal reflex conjunctival reflex

Motor
 Masseter ( clenching teeth)
 Pterygoids ( opening jaw and moving jaw laterally against resistance )

Jaw Jerk
 Increased in case of UMNL
FACIAL NERVE
Examine wrinkles of forehead
Tightly close the eyes
Blow in cheeks
Show teeth
Whistle
VESTIBULOCOCHLEAR NERVE
Whisper in each ear to check deafness
Rinne’s and Weber’s Test
GLOSSOPHARYNGEAL AND
VAGUS NERVE
Reflexes
 Gag
 Palatal
 Ah test

Conversation to check hoarseness

HYPOGLOSSAL NERVE
Ask patient to take the tongue out ( weak side deviation)
Inspect for any tongue wasting
ACCESSORY NERVE (11)
Trapezius ( shrugging)
SCM bulk check by turning head against resistance