04.15 Neuro

Written By Joan

Neuro exam

Cranial nerve exam – brief documentation

Neuro exam
GCS 15
PEARL 3mm, no visual field defects, no diplopia on H test
No dysdiadochokinesia, no intention tremor, no nystagmus, normal gait
No sensation defects in CN V distribution, no facial droop/motor weakness
Upper limb – full power, normal tone, normal sensation
Lower limb – full power, normal tone, normal sensation

Cranial nerve exam [detailed]

  • CN I Olfactory nerve – ask about smell

  • CN II Optic nerve – think AFRO

    • Acuity – Snellen chart + colour vision

    • Fields – check all 4 visual fields, inattention, blind spot

    • Reflexes – direct, indirect, RAPD

    • Ophthalmology/fundoscopy – papilloedema

  • CN III Oculomotor + CN IV Trochlear + CN VI Abducens nerves

    • H-test to see if any paralysis / diplopia

  • CN V Trigeminal nerve

    • Sensation – test both sides forehead, cheek, chin – equal & normal sensation?

    • Motor – temporalis, masseter (ask pt to clench jaw)

    • Reflexes – jaw jerk, corneal [not usually done]

  • CN VII Facial nerve

    • Change in taste? Change in hearing?

    • Asymmetry

    • Able to raise eyebrows, shut eyes tightly, puff out cheeks, and smile normally

  • CN VIII Vestibulocochlear nerve [use 512Hz tuning fork]

    • Change in hearing?

    • Rinne’s test – tuning fork to compare sensorineural hearing vs bone conduction

    • Weber’s test – tuning fork in the middle of forehead to see if it localises to either ear

  • CN IX Glossopharyngeal & CN X Vagus nerve

    • Open mouth – any deviation of the uvula?

    • Normal swallow?

    • Gag reflex [not usually done]

  • CN XI Accessory nerve

    • Shrug & turning head against resistance

  • CN XII Hypoglossal nerve

    • Stick tongue out – any deviation?

Cerebellar exam – DANISH

  • Dysdiadochokinesia – flip hands

  • Ataxia – gait

  • Nystagmus – H test

  • Intention tremor – finger-to-nose test

  • Slurred speech

  • Hypotonia

Upper/limb limb exam [brief]

  • Inspection

  • ± Gait (observe when walking in)

  • Tone

    • Arm shake – “relax like a rag doll” and twist arm/hand around

    • Leg roll – “relax” and roll leg side to side

  • Power – depends on how detailed

  • Reflexes

    • UL: biceps, triceps and supinator

    • LL: patellar, ankle jerk, plantar

  • Sensation [see table below]

Dermatome Where to test
C5 Regimental badge region
C6 Thumb pad
C7 Middle finger pad
C8 Little finger pad
T1 Medial epicondyle
L1 Top of medial thigh
L2 Lateral aspect of mid-thigh
L3 Medial knee
L4 Medial ankle
L5 Medial big toe
S1 Lateral little toe

GCS – see Neuro 04.05

Geeky medic links for neurological exams

Joan
Previous

01.11 Chest pain
Next

17.10 Gynae